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RRPA Clinical Med II > ER Pediatric Evaluation (Exam 1) > Flashcards

ER Pediatric Evaluation (Exam 1) Flashcards

1
Q

There are 4 levels to the emergency severity index, what are they?

A

Level 1: Dying

Level 2: Emergent

Level 3: Urgent

Level 4: Non urgent

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2
Q

In the event of a mass casualty event, patients of which ESI level are seen first?

A

Level 2 Emergent patients.

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3
Q

According to Dr. Ross’ slides what are the age ranges for:

Neonates:

Infants:

Toddlers:

School age kids:

Adolecents:

A

Neonates: 0-30 days

Infants: 1 month-1 year

Toddlers: 1-3 years

School age kids: 4-10 years

Adolecents: 10+ years

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4
Q

Instead of a set medication dosage, what are medication doses based on for kids?

A

Weight

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5
Q

Name the 6 growth and development stages:

A

Newborn, infancy, toddler, preschool, school-age, and adolescence.

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6
Q

How do kids improve their cardiac output?

A

Increase heart rate instead of increasing stroke volume

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7
Q

Cardiac arrest in kids is different than in adults. What is the process that usually leads to cardiac arrest in kids?

A

Hypoxemia leads to hypercapnia and acidosis which leads to bradycardia, this leads to hypotension and secondary cardiac arrest.

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8
Q

How is the skin, muscles and bones different in kids when compared to adults?

A
  • Skin surface are is greater and thinner
  • Less muscle and more body fat
  • Bones, ligaments and joints are more flexible
    • Leads to higher rate in internal injury
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9
Q

Kids have giant heads (dart heads) this leads to?

A

HEad will tend to be hit first in traumas, such as falling off a bike.

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10
Q

The pediatric assessment triangle consists of what?

A
  • Appearance
  • Work of breathing
  • Circulation to skin
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11
Q

When using the pediatric assessment triangle to asses apperance what are you looking at?

A
  • Tone
  • Interactiveness
  • Consolability
  • Look/Gaze
  • Speech/Cry
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12
Q

When using the pediatric assessment triangle to asses work of breathing what are you looking for?

A
  • Abnormal breath sounds
  • Abnormal positioning
  • Retractions
  • Nasal Flaring
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13
Q

When using the pediatric assessment triangle to asses circulation to the skin what are you looking for?

A
  • Pallor
  • Mottling
  • Cyanosis
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14
Q

The TICLS “tickles” acronym is used for which part of the pediatric assessment triangle?

A

Appearance

  • Tone
  • Interactive
  • Consolable
  • Look/gaze
  • Speech/cry
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15
Q

When assesing tone you are looking for what?

A

Are they floopy? Are they moving all 4 extremities? Is their body stiffening?

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16
Q

When assesing interactiveness you are looking for what?

A
  • Irritability?
  • Feeding poorly?
  • Listless?
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17
Q

When assesing look/gaze you are looking for what?

A

Do they have a blank stare?

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18
Q

When assesing speech/cry you are looking for what?

A
  • What is the pitch of the cry and is it different from their normal cry? Is the care giver concerned?
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19
Q

The caregiver states that their babies cry sounds different than normal, what should you do?

A

Assume the worst and do a full workup

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20
Q

Newborns are obligate _____ breathers

A

Nose

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21
Q

Infants/small children breath using their _____?

A

Diaphragm

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22
Q

The normal respiration rate for a newborn ( 0-1 month) is what?

A

30-80 RPM

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23
Q

The normal respiration rate for a 1 year old is what?

A

20-40 RPM

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24
Q

The normal respiration rate for a 3 year old is what?

A

20-30 RPM

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25
The normal respiration rate for a 6 year old is what?
16-22 RPM
26
The normal respiration rate for a 10 year old is what?
16-20 RPM
27
Which types of retractions are considered mild?
* Sub costal * Sub sternal * Intercostal
28
What types of retractions are considered severe?
* Supra-clavicular * Supra-sternal * Sternal
29
You listen to breath sounds on a kid on their front and back, what are you listening for?
* Intensity of breath sounds * Stridor * High pitched inspiratory phase * grunting-short low pitched expiration * Gurgling weezing on expiration * Crackles-rales heard when there is alveolar fluid
30
What are the scary signs that a kid is in respiratory distress?
* Tripod position * Sniffing * Drooling * Use of accessory muscles * Grunting respirations
31
You walk in the room and the kid is sitting in the tripod position, do you reposition them?
No, leave them in the tripod position and put them on O2
32
What are the signs of respiratory failure in kids?
* Seesaw breathing * Chest retracts and abdomen expands during inspiration * Head bobbing use of neck muscles * Child lifts chin and extends neck during inspiration
33
When using pulse ox on a kid, what must it be done in conjunction with?
* Clinical assesment * Respiratory rate * Effort * Level of consciousness * Must have a good wave form
34
What states does a pulse ox not recognize?
* Carboxyhemoglobin * Methemoglobin
35
Where on a kid should you palpate a pulse?
Brachial or femoral arteries
36
How do you test for capillary refill and how long should refill take?
Kids needs to be in a warm room. Lift the extremity above the heart and press on the skin and time how long it takes for color to return. Color shouls return in less than 2 seconds.
37
What is the most common arrhythmia found in kids?
SVT
38
What is the normal heart rate range for newborns (0-1 month)?
100-170 BPM
39
What is the normal heart rate range for Infants-2 years?
80-130
40
What is the normal heart rate range for kids 2-6 years old?
70-120
41
What is the normal heart rate range for kids 6-10 years old?
70-110
42
What is the normal heart rate range for kids 10-16 years old?
60-100
43
A heart rate below __ is ALWAYS a bad sign in kids?
\<60 BPM
44
For kiddos 1 year and older what is a quick way to calculate normal systolic BP?
70+ (2 \* age in years)
45
In the event of asystole or bradycardia in kids what meds are given?
Epinephrine and atropine (Adults in asystole do not get atropine)
46
When are high doses of epi ( 0.1 mg/kg of 1:1000) indicated?
* Anaphylaxis (the main one) * Sepsis * Certain overdoses
47
Peripheral cyanosis is?
Cyanosis of the hands and feet
48
Central cyanosis is?
Cyanosis of the lips and mucus membranes
49
Acrocyanosis (blueness of only the hands and feet) is a normal finding in which patient group?
Newborns
50
Kids compensate to shock better or worse than adults?
Initially better, but fail more quickly.
51
Kids are more prone to hypovolemic shock due to blood loss then adults, why?
They bleed the same as adults but proportionally they have less blood
52
Tachycardia may be the only initial sign of circulatory compromise in kids, why is this?
Kids increase heart rate to increase or maintain cardiac output. Blood prerssure and cardiac output do not significantly change until a kid has lost 30% of their blood.
53
Two most common causes of cariac arrest in kids are?
Respiratory failure and shock
54
Leading causes of death in kids \< 1 year of age
* Congenital * SIDS
55
Leading causes of death in kids 1-14 years of age (I think she mentioned that this wouldn't be on the test but who knows?)
* Unintentional injury * 1-4 years of age drowning * \> 4 years of age MVA (motor vehicle accident) * Malignancy * Suicide
56
Using the pediatric assessment triangle you note that your patient is showing signs of distress, your first step is what?
Management of their air way!! * Proper airway positioning * Sniffing position * Suction early and often if vomit * NP/OPS * BVM * Make sure you use the right size for the kid * LM * Intubate * Use right size tube * Size of kids little finger
57
What is the number one food kids choke on?
Cut hot-dog pieces
58
You're walking down the street and happen upon an infant/toddler who is choking but responsive. What do you do (while wondering where the childs parents are)
* 5 back blows * 5 chest thrusts
59
You have an infant/toddler patient who was choking but is now unresponsive what do you do?
* 1 chest thrust * Begin CPR
60
For adult BLS we follow the CBA rules (compressions, breathing, airway) for kids it is different, how so?
Use ABC * Airway * Breathing * Compressions
61
What is th emost likely cause for unwithnessed cardiac arrest in a child?
Hypoxia
62
What is a Broselow tape?
Copied from wiki: The Broselow Tape relates a child's height as measured by the tape to his/her weight to provide medical instructions including medication dosages, the size of the equipment that should be used, and the level of shock voltage when using a defibrillator.
63
Youve tried to get peripheral IV access on an unresponsive child twice but failed, what is the next step?
Use and intraosesous line (IO)
64
You have a kid who is seriously ill, or as Dr. Ross put it in her power point (an ill appearing kid). What do you do and in what order?
* Start O2 using a high flow nasal cannula * Initiate rapid fluid resucitation * 20cc/Kg NS * If a neonate and no response thinkthey may have a ductal dependent cardiac lesion and give prostaglandin to keep the patent ductus arteriosus open * Give another bolus of 20cc/Kg NS * Give glucose using the rule of 50 for pediatric pateints * Keep them warm * Give pressors * Epi * Dopamine
65
What are the 8 ductal dependent cardiac lesions that Dr. Ross mentioned?
* Truncus arteriousis * Transposition * Tricuspid atresia * Tetrology of fallout * Total anomalous transposition * Coarcation of the aorta * Hypoplastic left ventricle * Aortic stenosis
66
What is the glucose rule of 50 for pediatrics
a\*b=50, where a= the type of fluid (D50, D10, D5), b = cc/kg of fluid to give. You will need to solve for b. Using this method you can deliver 0.5g/kg of glucose to the patient So if the fluid you are using is D5 you would use the folowing: a=5 5\*b=50 ---\> solve for b; b=50/5 ---\> b= 10cc/kg of D5
67
What is the leading cause of SIDS?
Leaving an infant in the prone position unattended
68
Common allergies?
Fish, nuts and bees
69
What is the normal epi dosage for kids in anaphylaxis? * Who weigh \<10 Kg? * Who weigh 10-20 Kg? * Who weight \>20 Kg?
* \<10 Kg * 0.1mL of 1:1000 epi solution * 10-20 Kg * 0.15 mL auto injector * or * 0.15 mL of 1:1000 epi solution * \>20 Kg * 0.3 mL auto injector * or * 0.3 mL of 1:1000 epi solution
70
What is commotio cordis?
Commotio cordis is an often lethal disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart (the precordial region) at a critical time during the cycle of a heart beat, producing what is termed an R-on-T phenomenon that leads to the condition. Basically a blow to the heart right at the beginning of the T wave.
71
What is the ominus last step before impending ardiac arrest in a child?
A slow heart rate (\<60 BPM) in a child with respiratory distress
72
What is a CBC?
It is the last bastion of the intellectually destitute (I don't really know what that means)

RRPA Clinical Med II (45 decks)

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