Chapter 34 Pediatric Emergencies Flashcards
Infancy
First year of life
Neonatal or newborn period
The first month after birth
The amount of time infants generally spend sleeping
16 hours
An infant not easily aroused from sleep is a sign of this
An emergency
The quality of an infants thermoregulation ability
Poor
Infants are able to recognize caregivers at
2 to 6 months
By the first year, infants can
Say their first word and walk
Toddler stage
Each one to age three
Toddler stage is characterized by
Increased mobility and vocabulary. Separation anxiety usually develops in this stage.
Preschool age
Ages 3 to 6
Preschool age is characterized by
Increased language ability and increased imagination
School-age
Ages 6 to 12
Direction assessments should be performed
Prior to school-age, begin at the feet and proceed upward. Following school age, begin at the head and proceed downward
Adolescence
Ages 12 to 18
The relative size of a pediatric airway compared to an adult airway
Pediatric airway is smaller in diameter and shorter in length
Relative size of a child’s lungs to an adult’s lungs
A child’s lungs are smaller
The relative location of the heart in a child compared to an adult
The heart is higher in a child’s chest
The relative position of the glottic opening in a child compared to an adult
Glottic opening is higher in position to more anteriorly
Relative length of the neck in a child compared to an adult
The neck is shorter
The difference between a child’s head and adult’s head
Children have larger, rounder occiputs compared tho the rest of their heads. Requiring more careful positioning of the airway
Difference between an adult’s and a child’s tongues
Children have a proportionately larger tongue relative to the size of the mouth and a more anterior location in the mouth. Child’s tongue is also larger relative to the small mandible and can easily block the airway
Difference between child’s epiglottis an adult’s epiglottis
In infants and toddlers, the epiglottis is long, floppy, and U-shaped.
The difference between a child’s trachea and an adult’s trachea
Child’s trachea has less developed rings of Cartlidge that may easily collapse if the neck is flexed or hyperextended
Infants are obligate ____
Nose breathers
The oxygen demand of a child
Is twice that of adult’s
Normal respiratory rate of an infant
30 to 60
Normal respiratory rate of a toddler
24 to 40
Normal respiratory rate of a preschool age child
22 to 34
Normal respiratory rate of a school age child
18 to 30
No respiratory rate of an adolescent
12 to 16
Children are belly breathers which means
They use the diaphragm the most
Normal pulse rates in a newborn to 3 months
85 to 205
Normal pulse rates at three months to 2 years
100 to 190
Normal pulse rate at two years to 10 years
60 to 140
Normal pulse rates at greater than 10 years
60 to 100
Larger head to body ratio of an infant and young child makes them more prone to what
Head injuries
Child’s brain has less cushioning due to
Smaller subarachnoid space
The internal organs are ____ in children
Proportionally larger, situated more anteriorly, and are closer together
The abdominal muscles are ____ in children
Less developed
The bones of children are ____ than adults
Softer
The skeletal system of children contain active ____
Growth plates
Immobilize extremities with suspected strains and sprains in children because
They may be stress fractures
Children are more susceptible to these types of fractures
Stress
The anterior fontanelle closes at ____
18 months
The posterior fontanelle closes at
6 months
Bulging at the fontanelles is normal in an infant who is ____
Crying, coughing, or lying on the back or stomach
In a non-crying, non-coughing infant who is not lying on his back, bulging fontanelles can be a sign of ____
Increases ICP
A sunken fontanelle is an indication of ____
Dehydration
The thoracic cage in children is largely composed of ____
Cartilage
The ribs and vital organs are less protected by _____ in children
Muscles and fat
Children’s skin is ____ and has less ____
Thinner, less subcutaneous fat
Infants and children typically suffer from more significant fluid and heat loss due to
A larger body-surface-area-to-body-mass-ratio
Pediatric assessment triangle (PAT)
Observational tool meant to assist assessment of pediatric patients at a glance
The three categories of the PAT
Appearance (muscle tone in mental status), work of breathing, and circulation to the skin
The number of signs of increased work of breathing
Seven
First sign of increased work of breathing
Abnormal airway noise such as grunting or wheezing
Second sign of increases work of breathing
Accessory muscle use such as contraction of the muscles above the clavicles (supraclavicular)
Third sign of increased work of breathing
Retractions: drawing in the muscles between the ribs (intercostal retractions) or of the sternum (substernal retractions) during inspiration
Fourth sign of increased work of breathing
Head bobbing: The head lifts and tilts back during inspiration, then moves forward during expiration
Fifth sign of increased work of breathing
Nasal flaring
Sixth sign of increased work of breathing
Tachypnea
The seventh sign of increased work of breathing
Tripod position
TICLS Mnemonic
Pediatric assessment tool. T: tone I: interactiveness C: consolability L: look or gaze S: speech or cry
Through vasoconstriction
Blood from areas of lesser need such as the skin is shunted to areas a greater need such as the brain, heart, and kidneys.
Mottling
Caused by constriction of peripheral blood vessels
Sniffing position
An upright position in which the patient’s head and chin are thrust slightly forward to keep the airway open; the optimal position for the uninsured child that requires airway management
Symmetric chest wall movement can be assessed by
Placing both hands on pediatric patients chest
When bradypnea sets in, this can be a sign of
Impending respiratory arrest
In infants pulse is assessed using
The brachial or femoral pulses
In children older than one year, pulse is assessed using
The carotid pulse
Central pulses in infants
Brachial or femoral
Bradycardia in children
Heart rate is less than 80 bpm
Bradycardia in newborns
Heart rate is less than 100 bpm
Crackles
Crackling or bubbling sound we heard on inspiration; indicates inflammation or infection (such as pneumonia)
Stridor
High-pitched inspiratory sound; indicates a partial upper airway obstruction (such as in croup or from a foreign body)
Wheezing
High or low pitch sound heard usually during expiration; indicates a partial lower airway obstruction (such as in asthma or bronchitis)
Grunting
An uh sound heard during exhalation; reflects the pediatric patient’s attempt to keep the Alveoli open by increasing pressure in the chest cavity
How to estimate capillary refill time
Squeeze the end of the finger toe for several seconds. Normal color should return within two seconds after you let go
Capillary refill is most reliable in children younger than
Six years old
Difference between infant GCS scale and normal GCS scale
Verbal: 5 - Coos, babbles 4 - irritable cry 3 - cries to pain 2 - moans to pain 1 - no response
Infants younger than six months
Lack the ability to shiver in response to a cold stimulus
Hypothermia in pediatric patients can lead to
Convulsive seizure activity
Pediatric patients younger than two years must be transported in this position due to lack of mature neck muscles
The rear facing position
When asking about pediatric medications, you should ask about these to types
Analgesics or antipyretics
