CPS acute care Flashcards
GCS eyes
Eyes:
- no response
- to pain
- to verbal stimuli
- spontanous
GCS verbal
- no response
- nonspecific sounds
- inappropriate
- confused
- oriented
GCS motor
- no response
- decerebrate extension
- decorticate flexion
- withdraws to pain
- localizes pain
- follows commands
Indication skull x-rays in head injury (3)
- children < 2 yrs: with large, boggy hematoma
- obvious penetrating lesion or dpsressed skull fracture
- suspicion child abuse
Indication for CT scan in head injury
- Relative Indications (8)
Relative:
- GCS <14 at any point or GCS <15 at 2hr after injury
- clinical deterioration e.g. worsening HA or vomiting
- signs of basal skull
- large boggy hematoma >2yrs
- high risk mechanism
- persistent irritability in child<2 yrs
- seizures at time of event or later
- known coag disorder
Indication for CT scan in head injury
- absolute indications
Absolute indications:
- focal neuro deficit
- suspected open or depressed skull fracture or a widened or diastatic skill fracture on X-ray
RFs for post-traumatic seizures (5)
- younger age
- severe head trauma
- cerebral edema
- subdural hematoma
- open or depressed skull #
Risk factors for ICU admission in asthma (4)
- previous life-threatening events
- admissions to ICU
- intubation
- deterioration while on systemic steroids
Oxygen goal sats in Asthma
- target 94% as per CPS
Acute management of anaphylaxis
- ABCs - oxygen if needed
- immediate admin of IM epi
- IV access with large-bore
- if hypotensive then 20mL/kg of NS
- if sever resp distress prep for definitive airway management
Epinephrine dose in anaphylaxis
- 0.01mg/kg to max of 0.5mg
= epineprhine 1:1000 IM to anterolateral thigh
Epinephrine dosing IV infusion
epi 0.1-1 ug/kg/min (max 10ug/min)
Diagnosis of asthma in preschoolers requires
- objective documentation of signs of airflow obstruction
- reversiility of airflow obstruction
- absence of alternative diagnosis
- diagnosis apply to children with 2+ exacerbations
When to refer a preschooler to a specialist for asthma (6)
Severity:
- life-threatening exacerbation,
- 2+ exacerbation requiring steroids/hospitalizations
- or frequent sx (>8 days per month) despite moderate daily doses of ICS
Associated sx:
- diagnostic uncertainty,
- need for allergy testing
Other: parental anxiety or need for more education
guidelines for admission in bronchiolitis (6)
- resp distress e.g. RR>70/min
- supplemental O2 required to keep sats >90%
- dehydration or hx of poor fluid intake
- cyanosis or hx of apnea
- infant at high risk for severe disease
- family unable to cope
groups at high risk for severe disease bronchiolitis
- infants born <35 weeks
- <3 months at presentation
- hemodynamically significant cardiopulmonary disease
- immunodeficiency
Recommended tx for bronchiolitis
Equivocal tx
Not recommended tx
- Recommended: oxygen, hydration
- Evidence equivocal: epi neb, nasal suctioning, combined epi+dex
Not recommended: salbutamol, steroids, abx, antivirals, cool mist therapy/saline aerosol, hypertonic saline nebs, chest PT
Covid-19 acute clinical severity
- mild
- moderate
- severe
- critical
Mild: asymptomatic or URTI < 7 days, no oxygen, normal X-rays, no evidence of sepsis
Moderate: more sx than a URTI, increased WOB,PNA on CXR no hypoxemia, no sepsis,
Severe: features of resp distress or organ dysfunction, tachypnea, hypoxemia, CNS effects, GI effects, coag dysfunction
Critical: rapid disease PLUS resp failure, septic shock, organ failure
Blood work for unwell pts with covid who require hospitalization
Blood: CBC, blood culture, electorlytes (+ extended lytes), glucose, renal function, liver enzymes, bili, LDH, troponin, coag screen, blood gas, lactate, inflamm markers e.g. cRP, procalcitonin, ferritin
Other: 12-lead ECG, CXR
Treatment for covid
- supportive care: oxygen, Iv hydration, anti-pyritics
severe disease: aditional pressure and ventilatory support - abx only if suspect bacterial co-infection
Not supported by evidence: antivirals, corticosteroid IVIG, ACEi and ARBs, IL-6 receptor antagonists
Pediatric populations high risk for covid
- infants
- children with heart or lung disease
- neuro or neuromuscular condition
- other chronic conditions: diabetes, sickle cell, malignancies, immunosuppressive conditions, home ventilation
Croup epidemiology
- 6 mo to 3 years of age
- sx last 3-7 days, peaks in fall and winter
Croup DDX
- bacterial tracheitis
- retropharyngeal, parapharyngeal, peritonsillar abscess
- epiglottis
- foreign body aspiration
- anaphylaxis
Ondansetron in gastro
consider for:
- infants 6+ months
- vomiting due to suspected acute gastro
- mild/mod dehydration
- OR who have failed ORT
Most common side effect of ondansetron in gastro
- diarrhea (self-limited and lasts <48hrs)
- risk of arrhythmia
ITP red flags on history (4)
- constitutional sx
- bone pain
- recurrent thrombocytopenia
- poor treatment response
ITP red flags on physical exam
- lymphadenopathy
- hepatomegaly
- splenomegaly
- signs of chronic disease
ITP red flags on investigations
- low hemoglobin (unless mildly low due to bleeding
- high MCV
- abN WBC and/or neutrophil count
- abN cell morphology on smear
ITP relapse rate
- 1/3
Advanced airway in place
- compression-ventilation ratio
- compressions: 100-120 pm
- resps 8-10/min
3 Ps to minimize pain
- physical
- psychological
- pharmacological
which is more painful heel lances or venicpuncture
heel lances
Sepsis vs. septic shock
Sepsis = life-threatening organ dysfunction caused by a dysregulated host response to infection
Septic shock = severe infection leading to CV dysfunction (e.g. hypotension, need for treatment with a vasoactive medication or impaired perfusion)
Sepsis shock and lab findings of adrenal insufficiency and management
- relative hyponatremia, hyperkalemia and hypoglycemia
- give hydrocortisone 50-100mg/m2 early in course, before septic shock develops
in status treat blood sugar is <=
- 6
- tx with 2-4mL/kg of 25% dextrose of 5mL/kg of 10% dextrose water
side effects of
- phenytoin/fosphenytoin
- phenobarb
Pheny: cardiac arrhythmias, bradycardia, hypotension
Phenobarb: sedation, resp depression, hypotension
Indications for pyridioxine in seizures
- children < 18 months with seizures caused by undiagnosed metabolic disorder
indications for CT in status epilepticus (5)
- hx of trauma
- increased ICP
- focal neuro signs
- unexplained LOC
- suspicion of herniation
How does HHHFNC work?
- supplemental gas flow rates wash out anatomic dead space
- humidification and heating allows gas at flow rates that are better tolerated
- provides some degree of positive pressure
Starting HHHFNC
- start flow at 1-2L/kg/min
- escalate for WOB
max = 2L/kg/min with UL being 50-60 for adult-size pts
O2 concentration start at 50% and go up and down to achieve target - if flow too high may breath stack or auto-PEEP
Contraindications to HHFNC
- nasal obstruction
- epistaxis
- severe upper airway obstruction
rare, serious SE: air-leak syndrome, abdominal distention
