CLIPP 23 Flashcards
determining severity of illness should take into account these two things
if pt is perfusing major organs and if pt has underlying issues that place them at risk
irritable, lethargic
two words we commonly use in daily language that don’t seem so bad but have bad connotations in medical jargon
4 conditions–>AMS that must be quickly reversed to prevent cellular damage
shock (septic, hypovol, or cardiac), hypoxemia, hypoglycemia, poisoning
conditions leading to shock/acidossis can lead to AMS and include
DKA, renal failure, intussception, sepsis. also consider CNS pathology
always start w the ___ in an exam
CAB and VS
poor test of circulatory well being
checking if extremities are warm (BP also a poorish indicator bc body’s protective mech maintain it, not bodys circulation)
key measure of vol statsu
heart rate - listen to heart, take a periph or central pulse
how to assess breathign
listen to lungs, identify WOB and rate, pulse oxy
if no air movement, you should
open the airway - jaw thrust or by positioning the neck (higher age = more hyperextension)
lethargy + pinpoint pupils
opioid ingestion
to determine if someone is in shock, look for
signs of decreased perfusion? like incr cap refill, tachycarida, poor pulses
definition of shock
physiologically as inadequate delivery of substrates and oxygen to meet the metabolic needs of tissues:
As cells are starved of oxygen and substrate, they can no longer sustain aerobic oxygen production.
Eventually, cellular metabolism is no longer able to generate enough energy to power the components of cellular homeostasis, leading to disruption of cell-membrane ionic pumps.
The cell swells, the cell membrane breaks down, and cell death occurs.
shock in pediatrics
hypotension is a LATE sign of shock in kids due to their excellent compensatory mechanisms such as tachycardia, vasoconstriction, increased contractility, tachypnea and increased venous tone
hypotension in pediatrics in terms of shock
LATE sign of shock!
most common causes of shock in kids
hypovol (hemorrhagic , dehyd, diarrhea) or septic
4 key categories of shock and their definitions
distributive (neurogenic, anaphylactic) -intravascular hypovolemia
hypovolemic - most common, occurs due to not enough fluid intake to compensate for fluid output
cardiogenic-rare in kids
septic-toxins affect fluid distrib and CO and often can present as warm/compensated shock
shock characterized by Warm extremities Bounding pulses Tachycardia Tachypnea Adequate urination Mild metabolic acidosis
septic
shock characterized by Cool extremities Delayed capillary refill (> 2 seconds) Hypotension Tachypnea Increasing obtundation Decreased urine output
cardiogenic
shock characterized by Mental status changes Tachypnea Tachycardia Hypotension Cool extremities Oliguria
hypovolemic
shock characterized by third space losses, increased cap. permeability, and vasodil
distributive (neurogenic, anaphylactic)
priority tx in shock
intravascular volume replacement (even in situations in which increased volume could be contraindicated such as meningitis which can –> ICP increase. first you stabilize then w/ more volume replacent and then you can fluid restrict when pt no longer n shock
what type of fluid to give in shock
isotonic solutions ie NS, @ a rate as fast as possible, often sepsis pts will need repeated boluses and then give inotropes+vasoconstrictors
if PIV cannot be placed in 90s/3 attempts, use ___
intraosseous line often in prix tin or dotal femur in kids(Central venous line has more risks)
presentation with fever and petchiae - must always consider
meningococcal sepsis
sequelae in meningococcal surviviros
Hearing loss
Neurologic disability
Loss of digit/s or limb/s
Scarring
TSS sx
fever and sandpapery rash
Kawasaki muccocutaneous findings
strawberry tongue, crackled lips, erythema, hand/foot erythema/edema, truncal polymorphic rash
RMSF vs meningitis
both cause fever and petchiciae tho RMSF rash is on palsms/soles
scarlet fever
sandpaper rash appearing on upper trunk then to extremities, fades–>desquam–>linear petchiae in creases( Pastia) along w/ beefy red pharynx and white tongue that becomes red
pastia lines
linear petchiae in scarlet fever in creaes of skin
most appropriate tx for meningoccemia
Penicillin G:
Pediatric dose: 250,000-300,000 units/kg/day divided every 4-6 hours
Adult dose: 12-24 million units daily divided every 4-6 hours
initial ED tx of pts presenting w/ fever and rash
vanc, ceftriaxone, doxy(for rmsf)
close contacts of a meningitis patient including workers who care for him/her, should be prophylaxes w/…
cipro for adults , also zpack, ceftri and rifamp are options
rifampin for kids <18, or can do IM ceftri
these two prophylactic meningitis drugs are not recommended in pregnancy
rif and cip
in sepsis context, do not necessariy misinterrept a high BUN and Cr as renal failure - could be ___
pre renal causing elevations, perfusion takes priority
who is at risk for meningococcal dz
those traveling to endemic areas, those who have complement def or are asplenic/functionally a splenic, those that live in areas w/ community outbreaks
unless kid is high risk, give mcv4 vaccine at __ age
11-18 (IM at pre-adol visit and then booster at 16, or if get first dose at 13-15, give next at 16-18. if after age 16 for first dose, don’t need second)
