Infants & Children

Question 1

common causes of most deaths

Answer 1

• Motor vehicle injuries
• falls
• poisoning
• assaults
• drowning

Question 2

signs of shock in children

Answer 2

SBP lower than 70 with tahcycardia and cool skin is an indicator of shock in children

Question 3

hypovolemic shock causes (2)

Answer 3

1. acute dehydration
2. acute blood/fluid loss

less common causes of shock:
vasodilation seen with sepsis, anaphylaxis and spinal cord shock
-tension pneumothorax
-cardiac tamponade

Question 4

possible causes of cardiogenic shock (3)

Answer 4

† Previous congenital heart disease
† Acute infection of myocardium
† Severe contusion to heart

Question 5

peds ABC primary assessment

Answer 5

appearance
breathing
circulation

Question 6

secondary assessment

Answer 6

pt’s history

• chief complaint
• SAMPLE
• assess breath sound 1st then circulation
• trunk to head approach
• check BP and cap refill children over 3

Question 7

stiff neck indication of

Answer 7

• ndicates infection in brain or its coverings
  (meningitis)
  † Child may have meningitis without stiff
  neck or bulging fontanel

Question 8

Respiratory disorders

Answer 8

Respiratory disorders
Ø Upper airway
• Major upper airway diseases requiring
emergency attention:
† Croup
† Epiglottitis
† Choking
• Distinction must be made between infectious
causes and foreign body presence because
management will differ

Question 9

Croup affect what body parts and produce what sound

Answer 9

Croup
• Viral infection affecting:
o Larynx
o Trachea
o Bronchi
• Causes airway narrowing:
• Produces stridor

Question 10

S&S of croup

Answer 10

Signs & symptoms
† Hoarseness
† Low-grade fever
† Cough that sounds like a barking seal
† Varying degrees of inspiratory stridor
† Retractions with inspiratory effort
† Often worse at night or on awakening

Question 11

Croup common among what age group?

-management

Answer 11

• Most common from age 6 mos to 3 yrs
• Effective management
† Humidification
† Hydration
† Oxygenation

Question 12

Epiglottitis is?
caused by?
age group?
S& S (8)?

Answer 12

Epiglottitis
• Infectious swelling of epiglottis
† Caused by bacterial infection
• Rapid onset of 10 to 12 hrs
• Usually affects children ages 2 to 7 yrs
Major signs & symptoms
† High fever
† Sore throat
† Dysphagia (difficulty swallowing)
† Occasional inspiratory stridor
† Drooling
† Restlessness
† Flushed face
† Signs of dehydration
Potentially life threatening
• Stimulation of the pharynx with tongue blade
can cause reflex spasm
† Results in total airway obstruction

Question 13

management of epiglottitis

Answer 13

Approach to management
o Use gentle and calm handling, staying away
from child’s airway
o Let child stay in parent’s arms
o Offer humidified O2; if child resists, do not
persist
o Hold mask near airway
o If cyanosis & lethargy evident – attempt PPV

Question 14

lower airway diseases and management

Answer 14

Ø Lower airway
• Primary diseases
† Bronchiolitis
† Asthma
† Pneumonia
† Other infectious processes
† Small foreign objects
Management
† Reduce stress & exertion
† Administer humidified O2

Question 15

Bronchiolitis

Answer 15

Lower airway
• Bronchiolitis
o Viral illness affecting infants – causing swelling
and mucus production in the lower and smaller
airways
o Follows upper respiratory tract infection
o Often occurs in winter

Question 16

asthma

Answer 16

Lower airway
• Asthma
† Affects children and adults
† Causes bronchospasm with mucus &
edema production
† Patient can die when obstruction is severe
† Asthma can be triggered by different
conditions in different patients
† Be wary of child with AMS, becomes
lethargic and wants to lie down
† In some cases, ventilation cannot be
adequately accomplished without drugs to
relax that airway constriction

Question 17

Pneumonia

Answer 17

Lower airway
• Pneumonia
† Often follows simple upper respiratory tract
infection
† Patient usually has complaint/history of
fever & cough
† Dehydration & signs of recent upper
respiratory infection may be present
† May cause abdominal pain because
irritation of the diaphragm may be
interpreted as abdominal
† Rales may be heard with/without wheezing
† Possible pleuritic pain

Question 18

lower airway management for all

Answer 18

Ø For all pediatric patients with lower airway
disease, treatment is based on:
• Administration of humidified O2
• Reduction of exertion & emotional stress
• Keep in upright position or in a position of
comfort

Question 19

evidence of inadequate oxygenation

Answer 19

† AMS
† Extreme weakness or sleepiness
† Dilated pupils
† Assess HR & pulse strength

Question 20

febrile seizure

Answer 20

Febrile seizure
• Common during childhood
• Most are Brief (less than 5 min)
• Associated with fever and tonic-clonic
generalized convulsion

Question 21

Complex febrile seizure

Answer 21

Complex febrile seizure
• More than 15 min duration
• Localized to part of the body
• Multiple episodes in 24 hrs
• 5% will present in status epilepticus
˜ Must evaluate every child with seizure to find
the underlying cause

Question 22

Causes of seizures

Answer 22

Causes
• Infections
† Encephalitis
† Meningitis
† Roseola
† Shigellosis
Metabolic disorders
† Hypoglycemia
† Hypoxia
† Fever
† Hyponatremia
† Hypocalcemia
Toxic substances
† Lead
† Aminophylline
† Lidocaine
† Cocaine
† Nicotine
† Phenothiazine
† Drug withdrawal
• Structural problems
† Trauma
† Bleeding
† Mass lesion
† Scar in brain
• Idiopathic

Question 23

Complications of seizures

Answer 23

Respiratory problems
† Lower respiratory drive
† Airway obstruction by the tongue
† Risk of aspiration during unconscious period
† Ineffective respiratory muscles during
seizure activity
† Contribute to low oxygenation and
retention of CO2
Metabolic problems
† Rise of body temperature from persistent
muscular activity
† Depletion of glycogen stores and blood
glucose
† Cell damage
• CNS affected from:
† Prolonged electrical activity of the brain
† Respiratory and metabolic problems