Chapter 8 - Pediatric Emergencies Flashcards
Symptomatic pediatric bradycardia: cool mottled skin, diminished pulses, altered mental status, increased capillary refill time greater than or equal to 3 seconds.
True or false?
True
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Pediatric Bradycardia - 8010
TREATMENT: (6)
• Airway/breathing management
▪Monitor SpO2
▪ Administer 100% O2 via NRB
• If signs of severe cardiopulmonary compromise are present:
▪ Administer 100% O2 and ventilate the patient with BVM
▪ Provide advanced airway adjuncts if the patient deteriorates
▪ If patient eight years old or less and has signs of poor perfusion, the heart rate remains
< 60 despite 100% O2 and ventilation, initiate chest compressions
• Look for signs of Airway obstruction
▪Absent breath sounds
▪Tachypnea
▪Intercostal and suprasternal retractions
▪Stridor
▪Choking
▪Cyanosis
• Initiate cardiac monitoring
• Determine blood glucose level
• Assess temperature
▪ Hypothermia - Rewarm patient, ensure patient compartment is warm and administer warm IV fluids
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Symptomatic pediatric tachycardia: cool mottled skin, diminished pulses, altered mental status, increased capillary refill time greater than or equal to 3 seconds.
True or false?
True
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Pediatric Tachycardia - 8020
Sinus Tachycardia =
infant < ______ or Child < _____ with narrow QRS
220, 180
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Pediatric Tachycardia - 8020
Symptomatic Tachycardia =
infant > ______ or Child > _____ with signs of poor perfusion
220, 180
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Pediatric Tachycardia - 8020
TREATMENT: (6)
• If the patient is a symptomatic look for underlying causes (fever, dehydration, pain, etc)
• Airway/breathing management
▪Monitor SpO2
▪ Administer 100% O2 via NRB
• if signs of severe cardiopulmonary compromise are present:
▪ administer O2 and ventilate the patient with a BVM
Pediatric Tachycardia - 8020
TREATMENT: (6)
• If the patient is a symptomatic look for underlying causes (fever, dehydration, pain, etc)
• Airway/breathing management
▪Monitor SpO2
▪ Administer 100% O2 via NRB
• if signs of severe cardiopulmonary compromise are present:
▪ Administer 100% O2 and ventilate the patient with a BVM
▪ Provide advanced airway adjuncts if the patient deteriorate
• Initiate cardiac monitoring
• Assess temperature
• Consider specific treatment based on evaluation of patient and QRS
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* No - Determine blood glucose level *
Shock pts may deteriorate rapidly. Sx of poor perfusion incl: cool mottled skin, dimin. pulses, AMS, increased cap refill time (> 3 secs) and tachycardia AND BP < 70 systolic. True or false?
True
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Pediatric Shock - 8030
TREATMENT: (7)
• Place patient in SUPINE position • Maintain body warmth • Airway/breathing management ▪Monitor SpO2 ▪Administer O2 via NRB • Assess temperature • Determine blood glucose level • Initiate cardiac monitoring • If unable to intubate after 2 attempts ▪Insert supra- glottic airway if child is equal to or greater than 4' tall. Otherwise, ventilate via BVM and airway adjunct(s)
Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Conscious infant
▪Mild Obstruction with good air exchange (3)
- Do not interfere with patient’s owns attempts to expel the obstruction.
- Monitorr closely for signs of worsening
- Attempt to keep patient com
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Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Conscious infant
▪Severe Obstruction (5)
- If possible, bare the infant’s chest
- support the infant in prone position, deliver up to five back blows in the middle of the upper back
- Continuing to support the infant, rotate to a Supine position with the head lower than the trunk
- Deliver up to 5 quick downward chest thrusts in the same location as chest compressions
- Repeat sequence into obstruction is cleared or the infant becomes unresponsive
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Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Unconscious infant (3)
- Reposition Airway and remove object by direct laryngoscopy with Magill forceps
- Begin CPR as indicated
- Suction as indicated
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Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Conscious child
▪Mild Obstruction with good air exchange (2)
- Encourage patients own spontaneous coughing and breathing efforts
- Attempt to keep patient calm
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Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Conscious child
▪Severe Obstruction: (1)
• Abdominal thrusts (Heimlich maneuver)
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Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Unconscious child (3)
- Reposition Airway and remove object by direct laryngoscopy with Magill forceps
- Begin CPR is indicated
- Suction as indicated
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Ped. Foreign Body Airway Obstruction - 8040
GENERAL TREATMENT: (2)
• Airway/breathing management
▪Monitor SpO2
▪ Once obstruction is removed, maintain oxygen saturation of 95% or greater
▪ Assist ventilations with BVM if necessary
▪ Premature Neonate in Neonate: 40 to 60 per minute
▪ Infants and children: 12 to 20 per minute (once every 3 to 5 seconds)
• Initiate cardiac monitoring
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The following signs/symptoms will be treated as respiratory distress: increased RR, increased work of breathing, retractions, nasal flaring, SpO2 < 95%. True or false?
True
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Pediatric Respiratory Distress - 8050
Normal Respiratory Rates
Infant (<1yr) =
30 - 60
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Pediatric Respiratory Distress - 8050
Normal Respiratory Rates
Toddler (1-3yr) =
24 - 40
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Pediatric Respiratory Distress - 8050
Normal Respiratory Rates
Preschooler (4-5yr) =
22 - 34
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Pediatric Respiratory Distress - 8050
Normal Respiratory Rates
School-age (6-12yr) =
18 - 30
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Pediatric Respiratory Distress - 8050
Normal Respiratory Rates
Adolescent (13-18yr) =
12 - 20
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Pediatric Respiratory Distress - 8050
TREATMENT (5)
• Airway/breathing management
▪Monitor Spo2
▪Administer O2 via NRB
▪ If unable to maintain oxygen saturation with NRB, provide 100% O2 via BVM and positive pressure ventilations
▪Assess breath sounds
• Initiate cardiac monitoring
• Assess temperature
▪If patient is febrile apply cooling measures
• Determine Blood Glucose Level
• MILD croup (barking cough)
• MODERATE to SEVERE croup (Inspiaratory or expiratory stridor at rest)
• If unable to intubate after 2 attempts
▪Insert supra-glottic airway (Appendix D) of child is equal or greater than 4’ tall. Otherwise, ventilate via BVM and airway adjunct(s)
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Pediatric Asthma - 8060
TREATMENT: (6)
• Airway/breathing management
▪Monitor SpO2
▪Administer O2 via NRB
▪Assess breath sounds
• Initiate cardiac monitoring
• Assess temperature
▪If patient is febrile apply cooling measures
• Treatment should be based on lung sounds and level of distress
▪MILD distress - Wheezes only
▪MODERATE distress - Wheezes/decreased breath sounds/accessory muscle use
▪SEVERE distress - Wheezes/stridor/decreased breath sounds with little to no air movement/accessory muscle use/tripoding
• If unable to intubate after 2 attempts
▪Insert supra-glottic airway (Appendix D) if child is equal or greater than 4’ tall. Otherwise, ventilate via BVM and airway adjunct(s)
• Determine Blood Glucose Level
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Pediatric Non-Fatal Drowning - 8090
TREATMENT (9)
• ALL near drowning patients should be transported
• Maintain body warmth
• If trauma suspected, immobilize using proper techniques
• Airway/breathing management
▪Monitor SpO2
▪ Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater
▪Apply CPAP (Appendix H) to patients with pulmonary edema
• If unable to intubate after 2 attempts
▪Insert supra-glottic airway (Appendix D) if child is equal or greater than 4’ tall. Otherwise, ventilate via BVM and airway adjunct(s)
• Assess temperature
• Determine Blood Glucose Level
• ANTICIPATE RAPID DETERIORATION AND THE NEED TO INTUBATE
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Pediatric Allergic Reaction/Anaphylaxis - 8100
TREATMENT: (10)
• Airway/breathing management
▪Monitor SpO2
▪Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater
▪ANTICIPATE RAPID DETERIORATION AND THE NEED TO INTUBATE
• Initiate cardiac monitoring
• ASSIST WITH THE ADMINISTRATION OF PATIENT’S AUTO-INJECTOR EPINEPHRINE IF PRESENT
• Determine blood glucose level
• ANTICIPATE RAPID TRANSPORT IN THE SETTING OF ANAPHYLAXIS
• Assess temperature
• MILD reaction - Without respiratory compromise
• MODERATE reaction - Involves respiratory compromise
• SEVERE reaction/ANAPHYLAXIS - severe respiratory distress
• If unable to intubate after 2 attempts
▪Insert supra-glottic airway (Appendix D) if child is equal or greater than 4’ tall. Otherwise, ventilate via BVM and airway adjunct(s)
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Pediatric Altered Consciousness - 8110
Treatment: (11)
• Maintain aspiration prophylaxis by placing the patient in the RECOVERY POSITION
• If trauma suspected, immobilize using proper techniques
• Airway/breathing management
▪Monitor SpO2
▪ Administer O2 via proper adjunct maintain oxygen saturation 95% or greater
• Determine blood glucose level
• Initiate cardiac monitoring
• Assess temperature
• Look for underlying causes
▪ look for signs of abuse, toxins etc.
• Hypoglycemia - BGL < 50 mg/dl
• Hyperglycemia - BGL > 300 mg/dl
• Narcotic use
• unknown etiology
▪ Consider other treatable neurological or metabolic disorders and if identified follow the appropriate protocol
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Pediatric Diabetic - 8120
TREATMENT: (5)
• Airway/breathing management ▪Monitor SpO2 ▪Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater • Determine blood glucose level • Initiate cardiac monitoring • Look for underlying causes
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Pediatric Overdose/Poisoning - 8130
TREATMENT: (8)
• If substance is known, contact Poison Control at 1-800-222-1222. Provide all information requested by poison control representative
• do not delay treatment or transport but if possible bring medication or substance ingested
• Maintain aspiration prophylaxis by placing the patient in the RECOVERY POSITION
• Airway/breathing management
▪Monitor SpO2
▪Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater
• Determine blood glucose level
• Initiate cardiac monitoring
• Assess temperature
▪If patient is febrile apply cooling measures
• Consider specific treatment situations
▪Seizures may develop in many overdoses/poison/ingestion situations
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Pediatric Seizures - 8140
TREATMENT: (6)
• Maintain aspiration precautions by placing a patient in the RECOVERY POSITION
• If trauma suspected, mobilize patient using proper technique
• If the patient is actively seizing, protect the patient from further injury
• Airway/breathing management
▪Monitor SpO2
▪ Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater
• DETERMINE BLOOD GLUCOSE LEVEL IN EVERY PEDIATRIC SEIZURE PATIENT
• Assess temperature
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Pediatric Fever - 8150
TREATMENT: (5)
• Airway/breathing management
▪Monitor SpO2
▪ Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater
• Assess temperature
▪ If patient is febrile (rectal >105.0° or tympanic > 104.0°) apply cooling measures
• Determine blood glucose level
• Initiate cardiac monitoring
• If the pediatric patient has a temperature > 102.0° and the patient has Ibuprofen or Acetaminophen:
▪ administer Ibuprofen 10 mg/kg (not for children under 6 months) PO or Acetaminophen 15 mg/kg PO
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Pediatric Fever - 8150
Apply cooling measures if patient’s temperature is:
rectal > 105.0° or tympanic 104.0°
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