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Peds > Critical Care > Flashcards

Critical Care Flashcards

1
Q

When does increased intracranial pressure become a neurologic emergency?

A

When it leads to herniation of cerebral contents

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2
Q

What is an important signs associated with increased intracranial pressure and coma?

A

Hyperventilation (Have to differentiate from compensatory tachypnea- underlying heart failure, toxic ingestion, ect.)

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3
Q

What is the best way to distinguish tachypnea from central hyperventilation?

A

Presence of nonreactive pupils in central hyperventilation

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4
Q

What is treatment for increased ICP?

A

Osmotic agents: Mannitol, hypertonic solutions

NEUROSURGERY

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5
Q

What is characterized by unilateral pupil dilation?

A

Uncal herniation

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6
Q

What causes unilateral pupil dilation seen in uncal herniation?

A

Compression of the oculomotor nerve

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7
Q

What is malignant hyperthermia?

A

A hypermetabolic state that follows the administration of general anesthesia

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8
Q

Name 9 things that result from malignant hyperthermia

A
  1. Metabolic acidosis
  2. Hyperthermia
  3. Cardiac arrhythmia
  4. Elevated CK (markedly)
  5. Myoglobinuria
  6. Tachypnea
  7. Muscle rigidity
  8. Increased CO2 production
  9. Fever
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9
Q

Name 3 things to treat malignant hyperthermia

A
  1. Hyperventilation
  2. Oxygen
  3. Dantrolene
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10
Q

Name 7 things (insults) that ARDS can occur with

A
  1. Sepsis
  2. Pneumonia
  3. Aspiration
  4. Lung contusion (secondary to trauma)
  5. Smoke inhalation
  6. Blood transfusion reaction
  7. Near-drowning
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11
Q

The prognosis of ARDS is better if it occurs in what context?

A

Trauma

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12
Q

What are 3 features in the initial presentation of ARDS?

A
  1. Hypoxemia
  2. Atelectasis
  3. Pulmonary edema
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13
Q

What causes pulmonary edema seen in ARDS?

A

Increased permeability of the alveolar capillary membranes

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14
Q

What are 2 things ARDS can progress to?

A
  1. Decreased lung compliance (development of pneumothorax)

2. Multiorgan failure

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15
Q

True or False: It can take several days for the symptoms of ARDS to present

A

True

*Don’t be fooled by patient who is asymptomatic following initial triggering insult

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16
Q

What are the initial XR findings in ARDS?

A

Fine reticular infiltrate- Then things get worse

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17
Q

True or False: Steroids are indicated for acute near-drowning episodes

A

False

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18
Q

If you are presented with a patient with ARDS who isn’t improving on supportive measures, what is indicated?

A

Steroids

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19
Q

What is the key element of ventilatory support in ARDS?

A

Peep (because of pulmonary edema

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20
Q

What causes death in ARDS?

A

Multi-organ involvement - not respiratory failure

liver, kidney, brain, bone marrow, and lungs

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21
Q

When can a near drowning patient be observed at home?

A

If they were submerged for <1 minute with no LOC and required no resuscitation in the field

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22
Q

True or False: Kids rescued from near-drowning episodes can be stable upon arrival to ED and go downhill quickly requiring advanced life support

A

True

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23
Q

What is the key to prognosis in near-drowning?

A

Duration of asphyxia

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24
Q

What determines the extent of the damage in near drowning?

A

Duration from time of submersion to restoration of adequate respiration

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25
Q

Name 3 things which predict risk for future deterioration (warranting continued medical supervision) in near drowning

A
  1. History of apnea and CPR in the field
  2. Neurological signs (seizure/disorientation) or respiratory failure (from aspiration)
  3. Arterial desaturation and/or tachypnea
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26
Q

What can tachypnea in a near drowning victim be a warning sign of?

A

Aspiration pneumonia or ARDS

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27
Q

Name 3 things which are unfavorable signs that may worsen prognosis in near drowning

A
  1. Submersion >25 minutes
  2. Apnea or coma at admission
  3. Initial arterial pH of < 7.0
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28
Q

In a near drowning victim, under how many minutes of CPR has a good change they will survive with no neurologic impariment?

A

<10 minutes CPR

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29
Q

What is the most important procedure to perform initially to determine management of a child who has respiratory symptoms following blunt trauma to the chest?

A

Physical exam of the chest

*Once stable airway and breathing have been confirmed)

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30
Q

What is important to do in a child who has had blunt trauma to the chest?

A

Physical exam of the chest

*Even if there are no signs of respiratory distress and tachycardia

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31
Q

Why is a PE of the chest so important in blunt trauma to the chest?

A

Evaluate for flail chest

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32
Q

What is flail chest?

A

2 or more rib fractures in 2 or more locations

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33
Q

What results form flail chest?

A

Paradoxic chest wall movement- Underlying lung is pulled into the chest cavity during chest expansion and pushed out during chest wall relaxation

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34
Q

Patient with history of flail chest with respiratory distress and tachypnea- what is the most appropriate next step?

A

Placement of a chest tube (decompress hemothorax and/or pneumothorax

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35
Q

What should you consider with blunt abdominal trauma?

A

Splenic rupture

36
Q

In splenic rupture, what is the most important first step?

A

ABCs

37
Q

What is a safe and effective diagnostic tool for splenic rupture?

A

Abdominal CT with contrast (v. peritoneal lavage)

38
Q

True or False: CBC is a reliable diagnostic measure for splenic rupture

A

False- baseline is useful, but no diagnostic

39
Q

When is surgery indicated for splenic rupture?

A

When there is hemodynamic instability

40
Q

What are 2 things that are often indicated for splenic rupture?

A
  1. IVFs

2. Blood products

41
Q

Infant with poor weight gain, tachycardia, tachypnea, CXR has cardiomegaly…?

A

Acute heart failure

42
Q

What EF is consistent with acute heart failure?

A

<25%

43
Q

What valve abnormalities may be described with acute heart failure?

A

Tricuspid or mitral regurgitation

44
Q

What is a normal EF?

A

> 55%

45
Q

What is the best initial IV therapy for a child in heart failure?

A

Furosemide- Acts within minutes and may yield rapid clinical improvement

*Things like ACEi or Digoxin can be helpful, but have slower onset and are for long-term management

46
Q

What medication can be helpful for acute heart failure due to myocarditis?

A

Steroids

47
Q

When is epinephrine helpful for acute heart failure?

A

It isn’t- it increases cardiac afterload by increasing peripheral vascular resistance

48
Q

How does chronic heart failure present in infants?

A
  1. Tire easily with feedings

2. FTT

49
Q

How does chronic heart failure present in older children?

A
  1. Fatigue

2. Other nonspecific symptoms

50
Q

How do infants and children in cardiogenic shock present?

A
  1. Poor perfusion
  2. Tachycardia
  3. Diminished pulses
  4. Gallop rhythm
  5. Enlarged liver (if there is right-sided heart failure)
51
Q

True or False: BP is a very poor indicator of circulatory status in children

A

True- May not even be adversely affected by shock

52
Q

What are good indicators for shock in children?

A
  1. Cap refill
  2. Urine output
  3. Mental status
53
Q

What is prolonged capillary refill a good early sign for?

A

Shock (this is not a good predictor of dehydration)

54
Q

What is important to consider when evaluating delayed capillary refill?

A

Environmental factors- Must be done at room temperature, with no external factors influencing the reading

55
Q

How is diagnosis of cardiogenic shock made?

A

EKG and ECHO

56
Q

What is initial treatment for cardiogenic shock?

A

Dobutamine (problem is the pump)

57
Q

What happens if you give fluid boluses to a child in cardiogenic shock?

A

Makes the shock worse (not better)

58
Q

What is brain death?

A

Irreversible end of brain activity (including absence of cardiorespiratory function)

59
Q

What is required in order for someone to be declared brain dead?

A

No other disorders which could obscure neurological functioning (ie- hypothermia)

60
Q

What are two studies which can be used to document brain death?

A
  1. Radionucleotide scan

2. Angiography

61
Q

True or False: The absence of vertebral and carotid artery blood flow is consistent with brain death

A

True

62
Q

What is the order for CPR?

A

C-A-B

63
Q

How long do you take to check for a pulse?

A

5-10 seconds

64
Q

What do you do if you cannot find a pulse after 5-10 seconds of checking?

A

Start compressions

65
Q

How deep should chest compressions be?

A

At least 1/3-1/2 of the AP depth of the chest or approximately 2in (5cm)

66
Q

What is the rate for chest compressions?

A

At least 100/minute (allow for complete chest recoil between compressions)

67
Q

What is the ratio for one-rescuer CPR?

A

30:2 (start with compressions)

68
Q

How many cycles of CPR should be done in single-rescuer CPR prior to activating EMS and getting an AED?

A

5

69
Q

What is the ratio for 2-rescuer CPR?

A

15:2

70
Q

How many cycles of CPR should pass before switching roles in 2-rescuer CPR?

A

5

71
Q

What is the depth of chest compressions for an infant?

A

1 1/2in (4cm)

72
Q

What technique is preferred for chest compressions in 2-rescuer CPR on an infant?

A

Two-thumb encircling hands (over 2 fingers on sternum)

73
Q

Where do you check for a pulse in an infant?

A

Brachial

74
Q

Where do you check for a pulse in a child?

A

Carotid or femoral

75
Q

What is the ratio for CPR in adults and adolescents?

A

30:2 (regardless of # of rescuers)

76
Q

What is the compression depth for CPR in adults and adolescents?

A

At least 2 inches (5cm)

77
Q

What is the ventilation rate if an airway has been established during CPR?

A

1 breath every 6-8 seconds (or 8-10 breaths per minute)

78
Q

How are breaths given if there is an established airway during CPR?

A

Independent of compressions

*Compressions are given at 100/min without pausing

79
Q

If a child needs rescue breaths without compressions, what is the rate?

A

Breath every 3-5 seconds (about 12-20 breaths per minute)

80
Q

When can chest compressions generally be discontinued during CPR?

A

Once spontaneous HR reaches 60

*Not absolute- if evidence of poor perfusion (delayed capillary refill, weak pulses, cool extremities) continue chest compressions

81
Q

In what age group can AEDs be used?

A

Kids older than 1

82
Q

When is AED use indicated?

A

After 5 cycles of CPR or as soon as available for sudden witnessed collapse

83
Q

What should be done during a resuscitation after each shock?

A

Immediately resume CPR, beginning with compressions

84
Q

When is an IO indicated?

A

To obtain emergency access in children during life-threatening situations (cardiac arrest, shock, burns, status epilepticus)

85
Q

What can IOs be used to infuse?

A

Medications, blood products, fluids

86
Q

When should an IO be removed?

A

When another method of vascular access if achieved

87
Q

What is the preferred site for an IO in children?

A

Anteriomedial surface of the proximal tibia

Peds (35 decks)

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