ER Flashcards
cardiac arrest
1 cause = hypoxia 2/2 pulmonary prob. CPR. assess brachial artery in infants and carotid in kids. compressions for systole or bradycardia
shock classification
compensated- normal BP, adequate perfusion but maldistribution. compensate by tachycardia, vasoconstriction, incr heart contractility, incr venous tone, tachypnea.
decompensated: hypotension, low CO, inadequate perfusion
irreversible shock- cell death, refractory to med
hypovolemic shock
most common shock in kids. >25% volume loss –> decompensated shock
MSA, tachypnea, tachycardia, hypotension, cool extremities, oliguria
septic shock
hyper dynamic stage- normal or high CO, bounding pulses, warm extremities, wide pulse pressure
decompensated state- impatited mental status, cool extremities, diminished pulses
tx: boluses of fluid until good perfusion. may need interpose like epi or do to incr contractility and vasopressors to incr BP
distributive shock
pooling of fluid distally. due to anaphylactic or neurogenic shock (2/2 spinal transection, loss of distal sons CV tone + hypotension), meds, toxins. vasodialtion, incr capillary permeability, third space loss
sx of shock
severe N/V, trauma with hemorrhage, febrile illness in IC pt, CHF sx, allergic allergen exposure, SC injury
coagulation factors
evaluate for disseminated intravascular coagulation that may accompany shock. give FFP
trauma
1 cause of death in
pulseless electrical activity on ecg
cardiac tamponade. T PTX, profound hypovolemia
head trauma
- self limiting seizure
- open fontanelle/suture= susptive to subgaleal/ epidural/subdural hemorrhage = more tolerant of expansion. don’t need fracture or loc. subdural common in infancy & 75% b/l, worse prog than epidural
3) intracerebral hemorahge - frontal and temporal lobe. contrecoup injury= opp side of impact.
4) incr ICP: HA= 1st sx then pupillary and AMS is 1st signs.
bradycardia
1st sign of herniation in
signs of herniation
bradycardia. fixed and dilated pupils. cushion’s triad= late sign= bradycardia, HTN, irreg breathing. CL hemiparesis
treat incr ICP
mild hypervent, elevation of head, diuretic, neurosurgery
T PTX
distended neck vein, decr breath sounds, hyper resonance to percussion, displaced trachea, pulseless electrical activity shock
abdominal trauma
common bc unnerved abd muscle.
duodenal hematoma- 2.2 bicycle handle bar in RUQ
lap belt injury- chance fracture
spleen liver kidney in blent trauma
burns
2nd most common injury.
secondary burn
superficial partial thickness brun- epi + outer portion of dermis. moist, painful, red, blister +no scar
deep PTB: epi + lower part of dermis. pale whit, blister + scar
tx: opiates, debridement of dead skin, don’t remove bulla unless ruptured
first degree burn
red, blanching painful. epi
tx: moisturizer, analgesics
3rd degree burn
epi, dermis, part of subQ. dry, white, leathery. need skin graft bc nerve ending burn so insensitive to pain.
BSA
adolescent and adult- arm/head+neck=9 each, leg/anterior trunk/posterior trunk= 18 each
child- palm= 1%
burn management
1) resuscitation, endotracheal intubation of hot gas, pulse ox, IV through non burned skin
2) fluid resusitation
3) skin care
4) hospitalize if partial burn >10% or full burn >2%, overly J, hands, feet , circumferential, inhalation injury
near drowning
older infant/ toddler, + adolescent
drawing cause denaturing of surfactant, alveolar instability and collapse –> pul edema–> decr compliance - incr pul P, restricting gas exchange
penumonia in 24hr from aspirating mouth flora
slow deterioration of pul func in 12-24hr
neuro damage dep on time hypoxia
CV-dysrhythmia, MI
hemolysis and DIC
Renal failure may occur
drowning management
1) resuscitate ABC, remove wet cloth to prevent heat loss
2) intubate and mechnical vent PEEP if respiratory failure
3) rewarming with warm saline gastric lavage, bladder washing or peritoneal lavage if needed. conti resuscitation until 89.6- 32
4) attention- fluid and electrolyte imbalance
drowning prog
better in children bc dive reflex shunt blood to heart, brain, liver. but poor in 5min, resusitate delay >10min, CV resusitation needed, abn near, ph