Board Review Flashcards
uncuffed/cuffed pediatric ett size
age/4+4
age/4+3.5
foreign body aspiration in <1 year old tx
back blows and chest thrusts
premature infants ett size
2.5-3.0 mm
newborns ett size
3-3.5 mm
needle cricothyrotomy time till crash
30-45 minutes
age when you can do surgical cric
greater than 8
medication associated with pill esophagitis
doxycyline
neonate hr
100-160
1-12 month hr
100-180
1-2 yo hr
90-150
2-4 year old hr
75-130
4-8 yo hr
60-120
> 8 year old hr
60-100
normal sbp >1 yo
70+2*age
1 month to 1 yo BP min normal
70
<1 month old bp min normal
60
what children get compressions
hr <60 and signs of poor perfusipn despite 100% O2
what neonates get compressions
hr <100 despite 100% o2 for 30 secs
pediatric compression depth
1/3 chest depth
newborns rate of compressiond and breaths
90 compressions, 30 breaths per minute
compression ventation ratio for 2 person cpr for children beyond newborns through 8
15:2, 100 per minute
ratio for compressions to breaths for one person cpr
30:2
defibrillation in peds for arrest dose
initial 2-4 joules/kg, then 4 joules/kg, then increase up to 10 joules/kg
first thing if unrepsonsive with shockable rhythm
initiate cpr, then shock, resume cpr immediately 2 minutes before checking pulse. administer epinephrine before subsequent attempts
cardioversion dose in peds
0.5-1 joule/kg, can go up to 24 joules/kg
medications that can be given intratracheally
LEAN
lidocaine, epinephrine, atropine, naloxone
intratracheal epinephrine dose
0.1 mg/kg (10x normal dose)
dose for non epi intratracheal meds
2-3x IV dose
how to give meds intratracheally
folled by 5 cc saline and several positive pressure ventilations
window for access to umbilical vein
up to 7 days post delivery
severe acidosis treatment in peds arrest
sodium bicarb 1 meq/kg (use 1 meq/ml 8.4 percent in kids, dilute to half in neonates) only after epi nt effective and good oxygenation and ventilation
peds calcium chloride dose in severe hyperkalemia arrest
calciun chloride 20 mg/kg ideally through central line or IO
hypoglycemia arrest treatment peds
1 g/kg of glucose
>2 year old 1-2 ml/kg d50
2 months to 2 yo 2-4 ml/kg of d25
<2 months 5-10 ml/kg of d10
naloxone arrest peds dose
0.1 mg/kg IV, up to 2 mg, use with caution since can cause life threatening withdrawal
arrest epinephrine peds dosing
0.01 mg/kg 1:10,000 IV, max 1 mg
0.1 mg/kg 1:1,000 via ET, max 2.5 mg
repeat every 3-5 minutes
epinephrine drip peds dosing, arrest, persisent bradycardia
0.1-1 mcg/kg/min IV
first line vs second line in peds brady arrythmias
epinepnrine first line
atropine if increased vagal tone or primary AV block suspected
atropine peds dose
0.02 mg/kg IV, max of 0.5 mg in childen, 1 mg in adolescents. may repeat once. can be given every 20-30 minutes in anticholinergic toxidrome
adenosine pediatric dose
0.1 mg/kg, max 6 mg, if fail 0.2 mg/kg max 12
vtach unstable treatment with pulse
synchronized cardioversion 0.5-1 joules/kg, if unsuccessful 2 joules/kg
amiodarone 5 mg/kg IV over 20-60 minutes or procainamide 15 mg/kg IV over 30-60 minutes
vtach/vfib treatment without pulses
defibrillatation 2-4 joules/kg, if fails 4 j/kg up to 10 j/kg up to max adult dose
epinephrine
consider amiodarone 5 mg/kg iv, lidocaine 1 mg/kg IV
how to use apgar
assign at 1 and 5 minutes, if 5 minute less then 7, attain additional scores
apgar categorie scoring
0, 1, 2
activity - limp, decreased flexion, good flexion
pulse - absent, <100, >100
grimace - none, some motion, cry
appearance - blue/pale, body pink/ext blue, pink
respirations - absent, slow/irregular, good/crying
initial antiepileptic treatment order in neonates
phenobarbital 15-20 mg/kg iv over 10 minutes, addtional 5 mg/kg every 5 min up to max 40 mg/kg
then phenytoin 20 mg/kg iv
then benzos
give pyridoxine if refractory
congential diaphragmatic hernia treatment
immediate intubation, place og tube, ivf, surgery
tracheoesophageal fistula treatmenr
reverse trendelenberg, place suction catheter in edophageal pouch, surgery
omphalmocele and gastroschisis treatment
keep child warm, place og tube, cover intestines with sterule saline soaked gauze and place in plastic bag, IVF, antibiotics, surgery
onset of NEC usually in
first 2 weeks of life
NEC risk factors
hypertonic feeding solutions, pda, apneia, infection, exchange transfusions
NEC on radiograohy
pneumatosid intestinalis, separation of bowel loops, air fluid levels, portal vein gas, pneumoperitoneum, fixed dilated loop that doesnt move on serial radiograohs
cyanosis in newborn patholigic if persists beyond how long
20 minutes
cyanosis in newborn test
if 100 percent oxygen fails to bring pa02 over 100, then methemoglobinemia or cyanotic heart condition. otherwise sepsis, cns, lung problem if it does bring it up.
o2 sat in newborns if only extremities blue
> 94%
how long for physiologic jaundoce to resolve
1-2 weeks
treatment for Tet slell from tetrology of Fallot
place child in prone knee to chest, give o2, morphine. if fails consider propanolol, pheylephrine and peds consult
inspiratory stridor in peds means
obstruction at or above larynx
biphasic stridor in peds means
obstructuon below larynx
expiratory stridor means
bronchial or lowert tracheal obstruction
lung appearance with inhaled foreign body
hyperinflated on side with shift away from side with foreign body
croup usually caused by
parainfluenza
treatment for croup
racemic epi if resting stridor or resp distress
steroids
heliox of racemic epi fails
how does tracheitis present in peds
several days of coup symptoms then more ill, fevers, toxic
tracheitis tx
ent consult for visualization, antibiotics
rpa age of typical onset
6 months to 6 years, peak 3-5
bronchiolitis usually caused by
rsv
<4 week old pneumonia treatment
ampicillin and gentamicin or ampicillin and cefotaxime
infants 1-3 month pneumonia treatment
ampicillin and third gen cephalosporin, add a macrolide if chlamydia trachomatis or bordetella pertussis is suspected
pneumonia treatment 3 months to 5 years
second or third gen cephlosporin, add macrolide if chlamdyia or mycoplasma suspected
At what age can you consider outpatient pneumonia treatment
older than 3 months
CXR and lab values consistent with pertsusis
WBC 20,000-50,000 and CXR with peribronchial thickening or a “shaggy” heart border
Who should be hospitalized for pertussis?
children <6 months, children with hypoxia, cyanosis during coughing spells or apnea
prophylaxis for whooping cougn
erythromycin 10-14 days
what pediatrix population should get US for UTI
all males, females under 5 years, all recurrent
kawasaki treatment
IV immunoglobulin
oral aspirim
febrile seizure age group
6 months to 5 years
ativan dose for pedatric seizure
lorazepam 0.1 mg/kg IV
midgut volvulus demo
usually under 1 year, most common in 1st month
midgut volvulus on xray
small bowel overlying liver, gaseous distention, air fluid levels
intussception demo
males 3 mo to 5 years, most common 6-12 months
intussception on xray
abdominal mass or filling defect in RUQ, bowel obstruction, free air
