Module 4 - Pediatrics Flashcards
What is the first thing to assess in children?
PAT
(Pediatric Assessment Triangle)
What are the components of PAT?
- Appearance
- Breathing
- Circulation
What is assessed during “Appearance” of the PAT?
- Tone
- Interactiveness
- Consolability
- Look/gaze
- Speech/cry
What is assessed during “Breathing” of the PAT?
- abnormal airway sounds
- abnormal positioning
- retractions
- flaring
What is assess during “Circulation” of the PAT?
- pallor
- mottling
- cyanosis
What might you have to do to help position a child for an airway intervention?
- Place a pad/towel under their shoulders
True or False:
Infants < 6 months are obligate nose breathers
True
Why might nasal airways be difficult to place in children?
Large adenonoids and tonsils that can be traumatized during insertion
- could lead to bleeding and add to airway problem
How is an oral airway placed on a child? Why?
Straight in (no rotation like adults)
- prevent damaged to soft palate, tonsils, or teeth
Children have a (higher or lower) metabolic rate compared with adults
Higher
- twice the oxygen consumption
- rapidly deplete O2 stores
Why are retractions seen on children in respiratory distress?
Thoracic cage is more pliable and intercostal muscles are underdeveloped
- they collapse rather than expand during respiratory distress
What is the primary muscle of respirations in a child?
Diaphragm
- causes children to “belly-breathe”
What is a late sign of decreased cardiac output in children?
Hypotension
Why are children at greater risk for dehydration?
Greater percent of total body weight in water
How do children compensate for decrease in cardiac output?
Increase in HR
- limited ability to increase SV
What is the most accurate route of temperature in children?
Rectal
What is the 6th vital sign in children?
Weight
If a weight cannot be obtained for a child, what can be used instead?
Broselow tape
What are the components of the secondary assessment for children?
CIAMPEDS
C = chief complaint
I = immunizations / isolation
A = allergies
M = medications
P = past medical history / parent perception
E = events surrounding illness
D = diet / diapers
S = symptoms associated
What can a depressed fontanelle indicate?
Sign of moderate to severe dehydration
What can a tense or bulging fontanelle indicate?
- Increased ICP
- Hematoma
- Bacterial Meningitis
Under the BC Infants Act, when can a minor consent for their own medical care?
- Must demonstrate they have the capacity to make a sound decision
- HCP must demonstrate they made reasonable efforts to ensure the treatment is in the minor’s best interest
What is a common upper airway problem in children?
Croup
What are the signs and symptoms of croup?
- barky cough
- inspiratory stridor
- hoarseness
- respiratory distress
- usually worsens at night
What is the treatment for croup?
- Dexamethasone (0.15 - to 0.6 mg/kg PO = max 12mg)
- Nebulised Epinephrine for moderate to severe croup (1mg/mL injectable formulation)
What are some other differentials for Croup?
- Bacterial tracheitis
- Retropharyngeal, paraphyaryngeal, peritonsillar abscesses
- Epiglottitis
- Aspiration of FB
- Acute allergic reaction
What are two common lower airway problems in children?
- Bronchiolitis
- Asthma
What is Bronchiolitis?
Inflammation of the smaller bronchioles caused by a virus (RSV, adenovirus, parainfluenza
What are signs and symptoms of bronchiolitis?
- runny nose
- cough
- wheezing
- crackles
- increase respiratory effort
- fever
What is the treatment for Bronchiolitis?
SUPPORTIVE CARE
- no meds are given!
If a child presents with wheezes but no runny nose, what should the child be worked up for?
- Cardiac anomalies
- Congenital airway abnormalities
- FB aspiration
What is Asthma?
Common, chronic inflammatory disorder of the airways associated with airway hyper-responsiveness
- lower airway problem!
What are signs and symptoms of Asthma?
- nasal flaring
- instercostal, subcostal, suprasteral indrawing
- tachypnea
- decreased air entry
- scalene retractions
- decrease O2 sats
- diffuse abdominal pain
- cough
- irritability
What are some triggers of asthma?
- Viral respiratory tract infecton
- Exposure to allergens
- Lack of good control of asthma at baseline
What is the treatment for MILD asthma?
Salbutamol with spacer
What is the treatment for MODERATE asthma?
- Salbutamol Q20 mins x3 doses
- Corticosteriod (dex, prednisone, prednisolone)
- Ipratropium
What is the treatment for SEVERE asthma?
- Salbutamol nebulized over 60 - 180 minutes
- Magnesium sulfate
What happens if an infant’s HR is < 60 bpm?
Call a CODE!
Why are pediatric patients at increased risk for dehydration and hypovolemia?
- High metabolic needs
- larger body surface area
- higher proportion of water
- increased insensible / evaporative losses
- cannot communicate thirst
What is the most common cause of dehydration in children?
Gastroenteritis
What are signs and symptoms of gastroenteritis?
- acute diarrhea
- nausea
- vomiting
- fever
- abdominal pain
How do you calculate hourly maintenance fluids for a child < 10 kg?
4 mL/kg/hour
How do you calculate hourly maintenance fluids for a child 10-20 kg?
40 mL + 2 mL/kg for every kg > 10 kg
How do you calculate hourly maintenance fluids for a child > 20 kg?
60 mL + 1 mL/kg for every kg > 20 kg
What is the hourly maintenence fluid for a child weighing 8 kg?
32 mL/hour
What is the hourly maintenance fluid for a child weighing 17 kg?
54 mL/hour
What is the hourly maintenance fluid for a child weighing 24 kg?
64 mL/hour
What is a sign of shock in children?
HR > 160
True or False:
Children often present with cold shock vs warm shock
True
What are red flags for fever in children?
- Fever in a child < 1 month
- Lethargy, listlessness, toxic appearance
- Respiratory distress
- Inconsolability
When do febrile seizures commonly appear?
Ages 6 months to 5 years
What needs to happen if a child has a febrile seizure?
Tylenol - if < 15 minutes, no neurologic problems, occurs once in 24 hours
- NO EEG
- NO labs
- NO antiepileptics
What can be a sign of abuse in a child < 6 months?
Bruises!
No cruise … no bruise
If you suspect that a child is maltreated, what do you need to do?
Call MCFD
- do NOT need to engage RCMP
What age range in children are possessive, have separation anxiety, and are concrete thinkers?
Toddlers
(13 months to 2 years)
What age range in children are magical thinkers, have big imaginations, are curious, and have little grasp of cause and effect?
Preschool
(ages 3-5 years)
What age range in children are easily embarrassed, very physically active, understand the concepts of pain, and need to be asked questions directly (not to the parents)?
School-aged children
(5-12 years old)
What age range in children are taking risks, value independence, value honesty, need to consider mental health and sexual health presentations?
Adolescents
(12 - 17 less a day)
What is one of the first signs of respiratory distress in children?
Tachypnea
- limited ability to increase tidal volume
- increase RR instead
What increases oxygen demand in children?
- fever
- dehydration
- illness
- infection
- physical activity
- trauma
What happens to preload, cardiac perfusion, and oxygen demand during sinus tachycardia?
- Decreased preload, decreased ventricular filling time = decreased cardiac output
- Decreased coronary artery filling time, decreased coronary artery perfusion = decreased cardiac output
- Increased myocardial oxygen demand
What is the Rule of 50 for dextrose in children?
D10 x 5 mL = 50
D25 x 2 mL = 50
What is a very important consideration regarding weight based medications in pediatrics?
Do NOT pass adult maximums!
What is the standard amount of fluid bolus in pediatrics?
20 mL/kg
What is the formula for daily fluid replacement in children?
- < 10 kg = 100mL/kg/day
- 10-20 kg = 1000 + 50 mL/kg/day for every kg > 10
- > 20 kg = 1500 + 20mL/kg/day for every kg > 20
What is the daily total of fluid for a child weighing 9 kg?
900 mL
What is the daily total of fluid for a child weighing 13 kg?
1150 mL
(1000 + 150)
What is the daily total of fluid for a child weighing 28 kg?
1660
(1500 + 160)
What is the fluid bolus amount for a child weighing 14 kg?
280 mL
