Pedia Emergencies and Resuscitation Flashcards
2nd leading cause of accidental death in children <5
Drowning
3rd major cause of death in adolescents
Drowning
Associated with survival rates as high as 70% with good neurologic outcome
Rapid, effective bystander CPR for children
Upon arrival at the scene of a compromised child, a caregiver’s first task is
A quick survey of the scene itself
Any child with these conditions requires immediate CPR
1) Without a pulse 2) HR <60
Normal HR is roughly ___x normal RR for age
2-3x
Lower limit of SBP in neonates should be
<60
Lower limit of SBP in infants should be
<70
Lower limit of SBP in 1-10 yr olds should be
< Age x 2 + 70
Lower limit of SBP in any child older than 10 y/o should be
<90
MC precipitating event for cardiac instability in infants and children
Respiratory insufficiency
First priority in resuscitation of a child
Rapid assessment of respiratory failure and immediate restoration of adequate ventilation
Earliest and most reliable sign of shock
Tachycardia
In the setting of a pediatric emergency, ___ refers to a child’s neurologic function in terms of the level of consciousness and cortical function
Disability
A GCS score of ___ requires aggressive management
≤8
Components of a secondary assessment in pediatric emergencies
Focused history and PE using SAMPLE
Children of this age group are particularly susceptible to foreign body aspiration and choking
<5
MCC of choking in infants
Liquids
MCC of choking in toddlers and older children
Small objects and food
Management of airway obstruction in an infant
5 back blows and 5 chest thrusts
Management of airway obstruction in a child >1 y/o
5 abdominal thrusts (Heimlich maneuver) with the child sitting or standing
Upper airway narrowing is most often caused by
Airway edema
Lower airway narrowing is most commonly caused by
Bronchiolitis and acute asthma exacerbations
As effective as ET intubation and safer when provider is inexperienced with intubation
Bag-valve-mask ventilation
A child requires intubation when at least 1 of these conditions exist
1) Unable to maintain airway patency or protect the airway against aspiration 2) Failing to maintain adequate oxygenation 3) Failing to control CO2 levels and maintain safe acid-base balance 4) Sedation and/or paralysis is required 5) Care providers anticipate a deteriorating course that will eventually lead to the first 4 conditions
Most important phase of intubation procedure
Preprocedure preparation
Goals of rapid sequence intubation (RSI)
1) Induce anesthesia and paralysis 2) Complete intubation quickly minimizing elevations of ICP and BP
T/F Chest radiography is necessary to confirm appropriate tube position
T
Shock occurs when
O2 and nutrient delivery to tissues is inadequate to meet metabolic demands
MC type of shock among children worldwide
Hypovolemic shock
MCC of distributive shock
Sepsis and burns
Type of shock associated with closure of ductus arteriosus in a child with ductus-dependent systemic blood flow
Obstructive shock
Type of shock associated with massive pulmonary embolism
Obstructive shock
Type of shock associated with tension pneumothorax
Obstructive shock
Type of shock associated with pericardial tamponade
Obstructive shock
MC pre-arrest rhythms in young children
Bradyarrhythmias
HR that is an indication to begin chest compression
<60bpm
Factors known to cause bradycardia
6 Hs and 4 Ts: Hypoxia, hypovolemia, hydrogen ions, hypo- or hyperkalemia, hypoglycemia, hypothermia, toxins, tamponade, tension pneumothorax, trauma
Narrow QRS complex is objectively how many sec
≤0.08 sec
Wide QRS complex is objectively how many sec
> 0.08 sec
Narrow complex tachycardia may either be
Sinus tachycardia and SVT
Sinus tachycardia vs SVT: History and onset are consistent with a known cause of tachycardia
Sinus tachycardia
Sinus tachycardia vs SVT: Onset is often abrupt without a prodrome
SVT
Sinus tachycardia vs SVT: P waves are consistently present, of normal morphology, and occur at a rate that varies somewhat
Sinus tachycardia
Sinus tachycardia vs SVT: P waves are absent or polymorphic, and when present is often fairly steady at or above 220/min
SVT
Management for SVT
Adenosine rapid push and flush; if without line or adenosine failed, do synchronized cardioversion using 0.5-1 J/kg
Management for wide complex tachycardia
Immediate cardioversion: 1J/kg then 2J/kg if 1J/kg is ineffective
Most important treatment of cardiac arrest
Anticipation and prevention
Unwitnessed pediatric cardiac arrest in an outpatient setting should be treated as ___ in nature
Asphyxial
Witnessed pediatric cardiac arrest in an outpatient setting should be treated as
Primary arrythmia
Management for asphyxial cardiac arrest
Initiate CPR immediately
Management for cardiac arrest from an arrythmia
Activate EMS immediately and obtain AED
When a LONE rescuer provides CPR, the universal ratio of ___ is used
30 compressions: 2 ventilations
When a second care provider arrives at the scene, ratio of ___ is used in children ≤8 years old
15:2
Emergency defibrillation is indicated for
Vfib or pulses Vtach
Meds to maintain cardiac output and for post-resuscitation stabilization: Inamrinone
Inodilator
Meds to maintain cardiac output and for post-resuscitation stabilization: Dobu
Inodilator
Meds to maintain cardiac output and for post-resuscitation stabilization: Dopa
Inotrope, chronotrope, renal and splanchnic vasodilator
Meds to maintain cardiac output and for post-resuscitation stabilization: Epi
Intrope, chronotrope, vasodilator at low doses, vasopressor at high doses
Meds to maintain cardiac output and for post-resuscitation stabilization: Mil
Inodilator
Meds to maintain cardiac output and for post-resuscitation stabilization: Norepi
Inotrope, vasopressor
Meds to maintain cardiac output and for post-resuscitation stabilization: Na nitrprusside
Vasodilator
Often the largest and easiest vein to access for cannulation in the upper extremities
Median antecubital vein
T/F IO is recommended for patients for whom IV access proves difficult or unattainable, even in older children
T
If venous access is not attainable within ___ with CP arrest, an IO needle should be placed in the anterior tibia
1 min
T/F Any and all medications and fluids may be administered via IO
T
Most common cannulated artery
Radial artery
