CLIPP 23

Question 1

determining severity of illness should take into account these two things

Answer 1

if pt is perfusing major organs and if pt has underlying issues that place them at risk

Question 2

irritable, lethargic

Answer 2

two words we commonly use in daily language that don’t seem so bad but have bad connotations in medical jargon

Question 3

4 conditions–>AMS that must be quickly reversed to prevent cellular damage

Answer 3

shock (septic, hypovol, or cardiac), hypoxemia, hypoglycemia, poisoning

Question 4

conditions leading to shock/acidossis can lead to AMS and include

Answer 4

DKA, renal failure, intussception, sepsis. also consider CNS pathology

Question 5

always start w the ___ in an exam

Answer 5

CAB and VS

Question 6

poor test of circulatory well being

Answer 6

checking if extremities are warm (BP also a poorish indicator bc body’s protective mech maintain it, not bodys circulation)

Question 7

key measure of vol statsu

Answer 7

heart rate - listen to heart, take a periph or central pulse

Question 8

how to assess breathign

Answer 8

listen to lungs, identify WOB and rate, pulse oxy

Question 9

if no air movement, you should

Answer 9

open the airway - jaw thrust or by positioning the neck (higher age = more hyperextension)

Question 10

lethargy + pinpoint pupils

Answer 10

opioid ingestion

Question 11

to determine if someone is in shock, look for

Answer 11

signs of decreased perfusion? like incr cap refill, tachycarida, poor pulses

Question 12

definition of shock

Answer 12

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.

Question 13

shock in pediatrics

Answer 13

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

Question 14

hypotension in pediatrics in terms of shock

Answer 14

LATE sign of shock!

Question 15

most common causes of shock in kids

Answer 15

hypovol (hemorrhagic , dehyd, diarrhea) or septic

Question 16

4 key categories of shock and their definitions

Answer 16

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

Question 17

shock characterized by Warm extremities
Bounding pulses
Tachycardia
Tachypnea
Adequate urination
Mild metabolic acidosis

Answer 17

septic

Question 18

shock characterized by Cool extremities
Delayed capillary refill (> 2 seconds)
Hypotension
Tachypnea
Increasing obtundation
Decreased urine output

Answer 18

cardiogenic

Question 19

shock characterized by Mental status changes
Tachypnea
Tachycardia
Hypotension
Cool extremities
Oliguria

Answer 19

hypovolemic

Question 20

shock characterized by third space losses, increased cap. permeability, and vasodil

Answer 20

distributive (neurogenic, anaphylactic)

Question 21

priority tx in shock

Answer 21

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

Question 22

what type of fluid to give in shock

Answer 22

isotonic solutions ie NS, @ a rate as fast as possible, often sepsis pts will need repeated boluses and then give inotropes+vasoconstrictors

Question 23

if PIV cannot be placed in 90s/3 attempts, use ___

Answer 23

intraosseous line often in prix tin or dotal femur in kids(Central venous line has more risks)

Question 24

presentation with fever and petchiae - must always consider

Answer 24

meningococcal sepsis

Question 25

sequelae in meningococcal surviviros

Answer 25

Hearing loss
Neurologic disability
Loss of digit/s or limb/s
Scarring

Question 26

TSS sx

Answer 26

fever and sandpapery rash

Question 27

Kawasaki muccocutaneous findings

Answer 27

strawberry tongue, crackled lips, erythema, hand/foot erythema/edema, truncal polymorphic rash

Question 28

RMSF vs meningitis

Answer 28

both cause fever and petchiciae tho RMSF rash is on palsms/soles

Question 29

scarlet fever

Answer 29

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

Question 30

pastia lines

Answer 30

linear petchiae in scarlet fever in creaes of skin

Question 31

most appropriate tx for meningoccemia

Answer 31

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

Question 32

initial ED tx of pts presenting w/ fever and rash

Answer 32

vanc, ceftriaxone, doxy(for rmsf)

Question 33

close contacts of a meningitis patient including workers who care for him/her, should be prophylaxes w/…

Answer 33

cipro for adults , also zpack, ceftri and rifamp are options

rifampin for kids <18, or can do IM ceftri

Question 34

these two prophylactic meningitis drugs are not recommended in pregnancy

Answer 34

rif and cip

Question 35

in sepsis context, do not necessariy misinterrept a high BUN and Cr as renal failure - could be ___

Answer 35

pre renal causing elevations, perfusion takes priority

Question 36

who is at risk for meningococcal dz

Answer 36

those traveling to endemic areas, those who have complement def or are asplenic/functionally a splenic, those that live in areas w/ community outbreaks

Question 37

unless kid is high risk, give mcv4 vaccine at __ age

Answer 37

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)