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Acutely ill child > acutely ill child > Flashcards

acutely ill child Flashcards

1
Q

upon arrival at the scene of a compromised child, a caregiver’s first task is a

A

quick survey of the scene itself

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2
Q

any child with a heart rate below 60 beats/min or without a pulse requires

A

immediate CPR

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3
Q

brief, hands on assessment of cardiopulmonary and neurologic function and stability

A

primary assessment

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4
Q

most common precipitating event for cardiac instability in infants and children

A

respiratory insufficiency

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5
Q

first priority in resuscitation of a child

A

rapid assessment of respiratory failure and immediate restoration of adequate ventilation and oxygenation

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6
Q

earliest and most reliable sign of shock

A

tachycardia

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7
Q

components of secondary assessment

A

SAMPLE

Signs and symptoms
Allergies
Medications
Past Medical History
Last meal
Events leading to situation
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8
Q

tertiary assessment

A

occurs in hospital setting where ancillary laboratory and radiographic assessments contribute to thorough understanding of child’s condition

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9
Q

sequential approach in airway obstruction

A

head tilt/chin lift maneuver
inspection of foreign body
finger sweep clearance or suctioning once visualized

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10
Q

most common cause of distributive shock

A

sepsis and burn injuries

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11
Q

most common pre-arrest rhythm

A

bradyarrhythmias

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12
Q

6 Hs that causes bradycardia

A 
hypoxia
hypovolemia
hydrogen ions
hypokalemia or hyperkalemia
hypoglycemia
hypothermia
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13
Q

4 T’s

A

toxins
tamponade
tension pneumothorax
trauma

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14
Q

for narrow complex tachycardia, we should distinguish between

A

sinus tachycardia and SVT

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15
Q

history and onset consistent with a known cause if tachycardia; P waves consistently present and of normal morphology

A

Sinus tachycardia

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16
Q

onset abrupt without prodrome; P waves absent or polymorphic; if present rate is often fairly steady at or above 220 beats/min

A

SVT

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17
Q

management for SVT with poor perfusion

A

convert child’s heart rhythm back to sinus rhythm

Adenosine can be given with rapid “push”
If no IV access or adenosine failed–> synchronized cardioversion using 0.5-1 joule/kg

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18
Q

management of wide complex tachycardia

A

Ventricular tachycardia

cardioversion and increase dose to 2 joules/kg if
1 joule/kg is not effective

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19
Q

most important treatment of cardiac arrest

A

anticipation and prevention

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20
Q

most important component of CPR

A

adequate chest compressions those that circulate blood around the body with a good pulse pressure

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21
Q

lone rescuer for unwitnessed pedia cardiac arrest should treat arrest as

A

asphyxial; immediately inititiate CPR

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22
Q

lone rescuer for witnessed pedia cardiac arrest should treat arrest as

A

primary arrhythmia; immediately activate EMS and obtain AED

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23
Q

pulseless VT or VF

A

emergency defibrillation

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24
Q

inotrope, vasodilator

A

Dobutamine

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25
Q

inortrope, chronotrope, renal and splanchnic vasodilator

A

Dopamine

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26
Q

inodilator

A

Milrinone

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27
Q

inotrope; vasopressor

A

Norepinephrine

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28
Q

most common cannulated artery

A

radial artery

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29
Q

intracranial dynamics in the setting of an expanding mass lesion

A

Munro-Kellie doctrine

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30
Q

hallmark of severe TBI

A

coma

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31
Q

3 key components of clinical brain death diagnosis

A

demonstration of irreversible coma/unresponsiveness

absence of brainstem reflexes

apnea

32
Q

extension of upper extremities followed by flexion of arms with the hands reaching to midsternal level

A

Lazarus sign

33
Q

to establish diagnosis of brain death, findings must remain consistent over a period of observation:

A

7 days to 2 months: 2 examinations separated by at least 48hr

2months to 1yr: 2 examinations separated by 24hr

older than 1yr: 12 hour observation

33
Q

to establish diagnosis of brain death, findings must remain consistent over a period of observation:

A

7 days to 2 months: 2 examinations separated by at least 48hr

2months to 1yr: 2 examinations separated by 24hr

older than 1yr: 12 hour observation

34
Q

confirmatory testing of brain death should be performed on

A

all children less than 1 yr old using EEG and studies to confirm absence of cerebral blood flow such as nuclear medicine cerebral flow scans

35
Q

supports diagnosis of brain death

A

electrocerebral silence for 30 min recording

36
Q

most common cause of shock in children worldwide

A

hypovolemic shock

37
Q

seen in patients with CHD, or with congenital or acquired cardiomyopathies including acute myocarditis

A

Cardiogenic shock

38
Q

stems from any lesion that creates mechanical barrier that impedes adequate cardiac output

A

obstructive shock

39
Q

inadequate vasomotor tone which leads to capillary leak and maldistribution of fluid into the interstitium

A

Distributive shock

40
Q

type of distributive shock but the septic process usually involves a more complex interaction of distributive, hypovolemic and cardiogenic shock

A

septic shock

41
Q

fluid loss and decrease preload

A

hypovolemic shock

42
Q

state of abnormal vasodilation

A

distributive shock

43
Q

hallmark of uncompensated shock

A

imbalance between oxygen delivery and oxygen consumption

44
Q

should be initiated in an attempt to reverse shock

A

20ml/kg Isotonic saline up to 60-80ml/kg

45
Q

associated with reduction in mortality in septic shock

A

early administration of broad spectrum antibiotics

46
Q

may improve systolic function and decrease SVR without causing significant increase in HR with added benefit of enhancing diastolic relaxation in cases of cardiogenic shock

A

Milrinone therapy

47
Q

may be beneficial in pediatric shock with up to 50% of critically ill patients having absolute or relative adrenal insufficiency

A

Hydrocortisone replacement

48
Q

simplified consensus definition of acute lung injury

A

acute onset (<7days)
severe hypoxemia (PaO2/FiO2 <300 for ALI or <200 for ARDS)
diffuse bilateral pulmonary infiltrates on frontal radiograph
absence of left atrial hypertension (pulmonary artery wedge pressure <18mmHg)

49
Q

both ventilation and perfusion are lower in nondependent areas of the lung and higher in dependent areas of lung

A
50
Q

estimation of FiO2 during use of nasal cannula

A

FiO2- 21% (nasal cannula flow (L/min) x 2)

51
Q

high flow nasal cannula delivers gas flow at

A

4-16 L/min providing significant CPAP

52
Q

formula for proper internal diameter for tracheal tube

A

Age (yr) /4 + 4

53
Q

volume of gas left in the alveoli at the end of expiration

A

Functional residual capacity

54
Q

In intrathoracic airway obstruction, airway narrowing is much more pronounced during

A

expiration therefore expiratory time is much more prolonged than inspiratory time

55
Q

most common type of shock in trauma

A

hypovolemic shock due to hemorrhage

56
Q

more common after bicycle handle impact or direct blow to abdomen

A

pancreatic and duodenal injuries

57
Q

most important step to reducing impact of drowning injury

A

Prevention followed by early initiation of CPR at the scene

58
Q

highest drowning rates seen in

A

1-4 yr and 15-19 yo

59
Q

most common cause of mortality and long-term morbidity in drowning

A

CNS injury

60
Q

pediatric drowning patients should be observed in ED for ___ hours even if aymptomatic

A

6-8 hours

61
Q

In drowning, death or severe neurologic sequalae are quite likely in patients with the ff:

A 
deep coma
apnea
absence of pupillary responses
hyperglycemia in ED
submersion duration >10min
failure of response to CPR given for 25 min
62
Q

most critical and and effective neurologic intensive care measures after drowning are

A

rapid restoration and maintenance of adequate oxygenation, ventilation and perfusion

63
Q

In drowning, what should be instituted asap after resuscitation and sustained for 12-24hr?

A

hypothermia (32-34C)

64
Q

burns in young children that should raise the suspicion of child abuse

A

“glove and stocking” burns of hands and feet
single-area deep burns on trunk, buttocks or back
small, full-thickness burns (cigarette burns)

65
Q

burns in patients that will warrant admission

A

BSA >10-15%
associated with smoke inhalation
burns from high-tension (voltage) electrical injuries
burns associated with child abuse or neglect

66
Q

children with burns __% require IV fluid resuscitation

A

> 15% BSA

67
Q

involve only epidermis characterized by erythema, swelling and pain; no blistering

A

1st degree burn

68
Q

injury to entire epidermis and variable portion of dermal layer; vesicle and blister formation

A

2nd degree burn

69
Q

destruction of entire epidermis and dermis leaving no residual epidermal cells

A

Full thickness

70
Q

Rule of nines must only be used in

A

children older than 14 years old

71
Q

In small burns, <10% what should be used to estimate BSA

A

rule of palm

area from wrist crease to finger crease(palm) in child equals 1% of child’s BSA

72
Q

appropriate starting guideline for fluid resuscitation in burns

A

Parkland formula

(4ml LR/kg/%BSA) half of fluid given over 1st 8 hours from onset of injury

remaining fluid to be given at an even rate over the next 16 hours

73
Q

chest compression depth

A

1.5in (4cm) in infants

2in (5cm) in children

74
Q

chest compression rate

A

100-120/min

75
Q

A case regarding a 5 year old boy who got reprimanded by his parents. Suddenly, he stops breathing and turns blue in color

A

*Nelson 21st: These are reflexive events in which the crying child becomes apneic, pale, or cyanotic, may lose consciousness, and occasionally will have a brief seizure.

Nelson 21st: Breath-Holding Spell (Chapter 612) …It is important also to educate parents on how to handle more severe spells with first-aid measures or even basic cardiopulmonary resuscitation when needed.

76
Q

2 types of breathholding spells

A

A cyanotic spell is caused by a change in the child’s usual breathing pattern, usually in response to feeling angry or frustrated. It’s the most common type.
A pallid spell is caused by a slowing of the child’s heart rate, usually in response to pain.
Some children may have both types of spells at one time or another.

Breath-holding spells can occur in children 6 months through 6 years of age. They are most common from 1 to 3 years of age. Some children have them every day, and some have them only once in a while.

Acutely ill child (1 decks)

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