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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
Q

The normal respiration rate for a 6 year old is what?

A

16-22 RPM

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26
Q

The normal respiration rate for a 10 year old is what?

A

16-20 RPM

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27
Q

Which types of retractions are considered mild?

A
  • Sub costal
  • Sub sternal
  • Intercostal
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28
Q

What types of retractions are considered severe?

A
  • Supra-clavicular
  • Supra-sternal
  • Sternal
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29
Q

You listen to breath sounds on a kid on their front and back, what are you listening for?

A
  • 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
Q

What are the scary signs that a kid is in respiratory distress?

A
  • Tripod position
  • Sniffing
  • Drooling
  • Use of accessory muscles
  • Grunting respirations
31
Q

You walk in the room and the kid is sitting in the tripod position, do you reposition them?

A

No, leave them in the tripod position and put them on O2

32
Q

What are the signs of respiratory failure in kids?

A
  • Seesaw breathing
    • Chest retracts and abdomen expands during inspiration
  • Head bobbing use of neck muscles
    • Child lifts chin and extends neck during inspiration
33
Q

When using pulse ox on a kid, what must it be done in conjunction with?

A
  • Clinical assesment
    • Respiratory rate
    • Effort
    • Level of consciousness
  • Must have a good wave form
34
Q

What states does a pulse ox not recognize?

A
  • Carboxyhemoglobin
  • Methemoglobin
35
Q

Where on a kid should you palpate a pulse?

A

Brachial or femoral arteries

36
Q

How do you test for capillary refill and how long should refill take?

A

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
Q

What is the most common arrhythmia found in kids?

A

SVT

38
Q

What is the normal heart rate range for newborns (0-1 month)?

A

100-170 BPM

39
Q

What is the normal heart rate range for Infants-2 years?

A

80-130

40
Q

What is the normal heart rate range for kids 2-6 years old?

A

70-120

41
Q

What is the normal heart rate range for kids 6-10 years old?

A

70-110

42
Q

What is the normal heart rate range for kids 10-16 years old?

A

60-100

43
Q

A heart rate below __ is ALWAYS a bad sign in kids?

A

<60 BPM

44
Q

For kiddos 1 year and older what is a quick way to calculate normal systolic BP?

A

70+ (2 * age in years)

45
Q

In the event of asystole or bradycardia in kids what meds are given?

A

Epinephrine and atropine (Adults in asystole do not get atropine)

46
Q

When are high doses of epi ( 0.1 mg/kg of 1:1000) indicated?

A
  • Anaphylaxis (the main one)
  • Sepsis
  • Certain overdoses
47
Q

Peripheral cyanosis is?

A

Cyanosis of the hands and feet

48
Q

Central cyanosis is?

A

Cyanosis of the lips and mucus membranes

49
Q

Acrocyanosis (blueness of only the hands and feet) is a normal finding in which patient group?

A

Newborns

50
Q

Kids compensate to shock better or worse than adults?

A

Initially better, but fail more quickly.

51
Q

Kids are more prone to hypovolemic shock due to blood loss then adults, why?

A

They bleed the same as adults but proportionally they have less blood

52
Q

Tachycardia may be the only initial sign of circulatory compromise in kids, why is this?

A

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
Q

Two most common causes of cariac arrest in kids are?

A

Respiratory failure and shock

54
Q

Leading causes of death in kids < 1 year of age

A
  • Congenital
  • SIDS
55
Q

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?)

A
  • Unintentional injury
    • 1-4 years of age drowning
    • > 4 years of age MVA (motor vehicle accident)
  • Malignancy
  • Suicide
56
Q

Using the pediatric assessment triangle you note that your patient is showing signs of distress, your first step is what?

A

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
Q

What is the number one food kids choke on?

A

Cut hot-dog pieces

58
Q

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)

A
  • 5 back blows
  • 5 chest thrusts
59
Q

You have an infant/toddler patient who was choking but is now unresponsive what do you do?

A
  • 1 chest thrust
  • Begin CPR
60
Q

For adult BLS we follow the CBA rules (compressions, breathing, airway) for kids it is different, how so?

A

Use ABC

  • Airway
  • Breathing
  • Compressions
61
Q

What is th emost likely cause for unwithnessed cardiac arrest in a child?

A

Hypoxia

62
Q

What is a Broselow tape?

A

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
Q

Youve tried to get peripheral IV access on an unresponsive child twice but failed, what is the next step?

A

Use and intraosesous line (IO)

64
Q

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?

A
  • 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
Q

What are the 8 ductal dependent cardiac lesions that Dr. Ross mentioned?

A
  • Truncus arteriousis
  • Transposition
  • Tricuspid atresia
  • Tetrology of fallout
  • Total anomalous transposition
  • Coarcation of the aorta
  • Hypoplastic left ventricle
  • Aortic stenosis
66
Q

What is the glucose rule of 50 for pediatrics

A

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
Q

What is the leading cause of SIDS?

A

Leaving an infant in the prone position unattended

68
Q

Common allergies?

A

Fish, nuts and bees

69
Q

What is the normal epi dosage for kids in anaphylaxis?

  • Who weigh <10 Kg?
  • Who weigh 10-20 Kg?
  • Who weight >20 Kg?
A
  • <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
Q

What is commotio cordis?

A

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
Q

What is the ominus last step before impending ardiac arrest in a child?

A

A slow heart rate (<60 BPM) in a child with respiratory distress

72
Q

What is a CBC?

A

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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