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Pediatric Protocols > Pediatric > Flashcards

Pediatric Flashcards

1
Q

Most children requiring urgent EMS intervention have?

A

Primary respiratory problem

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2
Q

What percentage of pediatric cardiac emergencies originate from respiratory arrest?

A

80 - 90%

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3
Q

Assessment of pediatric respiratory status should focus on?

A

General appearance

Work of breathing

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4
Q

General appearance in pediatric emergency assessment should be judged by?

A 
Alertness
Distractability
Consolability
Eye contact
Speech/cry
Spontaneous
Color
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5
Q

Work of breathing for pediatrics is judged by?

A 
Use of accessory muscles
Respiratory rate
Tidal volume
Nasal flaring
Grunting
Cyanosis
Pulse oximeter
Lung sounds
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6
Q

Causes of pediatric airway obstructions?

A 
Tongue
Foreign bodies
Swelling of upper airway due to angio neurotic edema
Trauma
Infections
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7
Q

What is essential to determine proper treatment in upper airway obstructions?

A

Cause

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8
Q

How do you try and relief FBAO in unresponsive infants?

A

Chest thrusts and back blows

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9
Q

High pitched “crowning” sound caused by restriction of the upper airway(usually herd on inspiration)?

A

Stridor

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10
Q

What airway sound can be caused by FBAO and Croup or Epiglottitis?

A

Stridor

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11
Q

What is laryngotraceobronchitis?

A

Croup

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12
Q

A viral infection of the upper airway, which causes edema/inflammation below the larynx and glottis with resulting narrowing of the lumen of the airway is called?

A

Croup

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13
Q

Croup most often occurs in what age children?

A

6 months to 4 years

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14
Q

A child with croup will typically have?

A

Stridor
Distinctive barking cough
Cold symptoms(low grade fever)
Gradual onset of respiratory distress

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15
Q

An acute infection and inflammation of the epiglottis that is life threatening is called?

A

Epiglottitis

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16
Q

Epiglottitis occurs in children ages?

A

4 years and older

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17
Q

Signs and symptoms of epigottitis?

A 
Stridor
Acute respiratory infection
Sore throat
Pain upon swallowing
Distinctive drooling
High grade fever(102-104)
May be in the tripod position
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18
Q

When should you avoid IV’s in the respiratory distressed pediatric?

A

In patients with upper airway emergencies

You must avoid any procedure that will agitate the patient

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19
Q

In the patient with epiglottitis you should?

A

Avoid agitating
Keep in position of comfort
Have them held by parent
Never inspect the epiglottis

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20
Q

If no humidified oxygen is available for the Croup/Epiglottitis patient you should adminsiter?

A

Nebulized saline

Do not force mask, use blow by if necessary

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21
Q

What patient do you administer 3-5 mL of aerosolized Epi 1:1000 to?

A

Croup patient only

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22
Q

Aerosolized Epi is contraindicated in ?

A

Epiglottitis patients

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23
Q

What sound is associated with narrowing of spasm of the smaller airway which is usually herd on expiration?

A

Wheezing

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24
Q

Wheezing in children younger than 1 year of age usually is associated with?

A

Bronchiolitis

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25
Q

What is bronchiolitis?

A

A viral infection of the bronchioles that cause prominent expiratory wheezing

Clinically resembles asthma

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26
Q

What different factors can cause asthma?

A 
Environmental
Cold air
Exercise
Foods
Irritants
Certain medications
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27
Q

Asthma is?

A

Chronic inflammatory disease

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28
Q

The first phase of asthma is associated with?

A

Histamine release which causes Bronchoconstriction and bronchial edema

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29
Q

Early treatment with what medication may reverse bronchospasm?

A

Bronchodilators

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30
Q

The second phase of asthma consists of?

A

Inflammation of the bronchioles and additional edema

This phase does not usually respond to bronchodilators

Anti inflammatory is typically required

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31
Q

Why may the asthma patient not have wheezing?

A

In severe asthma attacks patients may not wheeze at all due to lack of air flow

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32
Q

Asthma patients will typically be?

A

Tachypneic with unproductive cough

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33
Q

Albuterol in the pediatric patient less than 1 years old or 10 kg?

A

1.25mg/1.5 nebulized

May be repeated twice

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34
Q

Albuterol dose for pediatric greater than 1 years of age or 10 kg?

A

2.5 mg/3 mL

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35
Q

Atrovent dose for pediatric less than 8 years of age?

A

0.25/1.25mL

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36
Q

Atrovent dose for pediatric over 8?

A

0.5mg/2.5 mL

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37
Q

If respiratory distress is severe in the pediatric patient you should adminsiter?

A

Epi 0.1mg/kg 1:1000 IM

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38
Q

What is the max dose of Epi 1:1000 in the pediatric respiratory distress patient?

A

0.3 mg

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39
Q

ALS level 2 for pediatric lower airway severe dyspnea is?

A

Mag sulfate

Repeat Epi 1:1000

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40
Q

Dose of mag sulfate in ALS level 2 for pediatric respiratory distress?

A

40 mg/kg IV mixed in 50 ml of D5W given over 15-20 minutes

Max dose 2g

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41
Q

Cardiac arrest in the pediatric patient is usually end result of?

A

Hypoxemia and acidosis from Respirtory insufficiency from shock

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42
Q

Initial support for the pediatric patient with cardiac dysrhythmias should be to the?

A

Respiratory system

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43
Q

What three categories can pediatric dysrhythmias be classified into?

A

Slow
Fast
No rhythm

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44
Q

What is the most common pediatric dysrhythmia ?

A

Bradycardia

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45
Q

What is the most common cause of bradycardia in pediatrics?

A

Hypoxia or acidosis

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46
Q

Tachycardia in pediatrics will be?

A

Compensatory mechanism

Or reentry mechanism

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47
Q

V-fib in pediatric patients is?

A

rare, but usually result of hypoxia

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48
Q

Asystole in pediatric patients is usually caused by?

A

Prolonged untreated bradycardia

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49
Q

AED’s may be used on which pediatric patients?

A

Ages 1-8 who have no signs and symptoms of circulation

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50
Q

Asystole/PEA protocol is used for which other cardiac rhythms other than those?

A 
Electromechanical dissociation
Pseudo-EMD
Idioventricular rhythms
Bradyasystolic rhythms
Post defibrillation idioventricular rhythms
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51
Q

How much fluid should be given the the pediatric patient over 1 years old?

A

20 mL/kg

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52
Q

How much fluid should be given to the neonate patient?

A

10 mL/kg

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53
Q

Epi 1:10,000 in pediatric asystole/PEA dose?

A

0.01 mg/kg IV/IO

Max dose 1 mg

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54
Q

In asystole/PEA pediatric patient is taking calcium channel blockers or with high suspicion for hyperkalemia what medication should be administered?

A

Calcium chloride

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55
Q

Pediatric calcium chloride dose?

A

20 mg/kg

IV/IO slowly

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56
Q

How do you treat a patient who is less than 1 years old with a BGL of less than 60?

A

D10
5 mL/kg
IV/IO

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57
Q

How do you treat a patient who is between 1 and 8 years of age with a BGL of less than 60?

A

D25

2 mL/kg

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58
Q

How do you treat a patient over the age of 8 with BGL of less than 60?

A

D50

1 mL/kg

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59
Q

Glucagon dose for pediatrics?

A

Less than or equal to 20 kg - 0.5 mg IM

More than 20 kg - 1 mg IM

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60
Q

How many cycles of CPR should you perform in pediatrics prior to re checking a heart rhythm?

A

10 cycles

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61
Q

Narcan dose for pediatrics?

A

0.1 mg/kg

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62
Q

How many times may narcan be repeated in Asystole/PEA?

A

Once

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63
Q

How can epi be administered as a last resort in pediatric asystole/PEA?

A

ETT

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64
Q

What is the max dose of Epi 1:1000 for ETT administration in pediatric cardiac arrest?

A

2 mg

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65
Q

Dose of epi for ETT administration for pediatric cardiac arrest?

A

1: 1000

0. 1 mg/kg

66
Q

Causes of symptomatic bradycardia in pediatrics?

A 
Hypoxemia
Hypothermia
Head injury
Heart block
Heart transplant
Toxins
67
Q

A pediatric with a HR of less than ___ and ____________ is considered symptomatic bradycardia?

A

Less than 60 with poor systemic perfusion

68
Q

What should you do with a pediatric with a HR of less than 60 and poor systemic perfusion?

A

Begin chest compression

69
Q

In pediatric patients with symptomatic bradycardia what medication should be given with fluids?

A

Epi 1:10,000

0.01 mg/kg

70
Q

What medication should be given to pediatrics with symptomatic bradycardia after epi 1:10,000?

A

Atropine

0.02 mg/kg

71
Q

What is the minimum single dose of atropine in pediatric symptomatic bradycardia?

A

0.1 mg

72
Q

How many times may you repeated atropine in pediatric symptomatic bradycardia?

A

Once

73
Q

What is the preferred benzo when preparing to pace the pediatric symptomatic bradycardia patient?

A

Versed

74
Q

when would you consider external pacemaker in the symtomatic bradycardia pediatric patient?

A

Hypotensive and bradycardia after epi and atropine

75
Q

What is the pediatric dose of versed?

A

0.1 mg/kg
Max dose 4 mg
IV, IO, IM

76
Q

Can versed be given IN for the pediatric patient?

A

Yes
0.2 mg/kg
Max dose 5 mg

77
Q

If versed is unavailable for external pacemaker in pediatrics you can you?

A

Diazepam
0.2 mg/kg
IV/IO/IN
Max dose 10 mg

78
Q

If pediatric bradycardia is suspected to be caused by increased vagal tone or primary AV block you should?

A

Administer atropine before epi

79
Q

What can small doses of atropine cause?

A

Paradoxical bradycardia

Less than 0.1 mg

80
Q

What is the max single dose of atropine in pediatrics?

A

0.5 mg

81
Q

Narrow complex tachycardia is a QRS less than or equal to?

A

0.08

82
Q

What two types of tachycardia do you see in pediatrics?

A
  • Sinus tachcyardia

- Supraventricular tachycardia

83
Q

Sinus tachycardia for a child is a rate greater than?

A

180

84
Q

Sinus tachycardia in infant is rate greater than?

A

220

85
Q

Supraventricular tachycardia for infants is rate above?

A

220

86
Q

If a patient is greater than 2 years old, supraventricular Tachcyardia may be?

A

180-220

May be lower

87
Q

Because wide complex SVT’s are rare in children, they should be considered?

A

Ventricular unless proven otherwise

Documented QRS morphology consistent with preexisting BBB or WPW

88
Q

In pediatrics with stable SVT what can you do for ALS level 1 care?

A

Fluid challenge

89
Q

Level 2 orders for pediatric stable SVT?

A

Vagal maneuvers and adenosine

90
Q

What vagal maneuver should be attempted first in pediatrics with SVT’s?

A

Ice water

91
Q

What is the dose of adenosine for ALS level 2 stable pediatric SVT?

A
  1. 1 mg/kg, max dose 6 mg, followed by 6 mL flush

0. 2 mg/kg, max dose 12 mg, followed by 6 mL flush

92
Q

For unstable pediatrics with SVT when would you give adenosine?

A

If the patient is responsive

93
Q

If a pediatric patient is unstable with SVT and poorly responsive you should?

A

Synchronized cardiovert them

94
Q

What is the initial joules setting for unstable pediatric SVT?

A

0.5 joules/kg

95
Q

If a patient in pediatric SVT remains poorly responsive after 0.5 joules/kg cardioversions you should?

A

Cardiovert at 1 joule/kg

96
Q

If a patient with SVT remains poorly responsive after 1 joule/kg cardioversion you should?

A

Cardiovert at 2 joule/kg

97
Q

Prior to converting a pediatric patient you should consider sedation with?

A

Versed
0.1 mg/kg
Max single dose of 4mg IV, IO, IM
Max total dose

98
Q

Can versed be given IN in pediatrics?

A

Yes
0.2 mg/kg
Max dose 5 mg

99
Q

If versed in unavailable to give pediatrics in unstable SVT for sedation prior to cardioversion what can be given instead?

A

Valium
0.2 mg/kg
Max single dose 5 mg
IV, IO, IN

100
Q

Prior to cardioverting a unstable pediatric with SVT you should?

A

Record patients heart rhythm

101
Q

Should you delay cardioversion of the unstable pediatric for IV access for sedation?

A

No

102
Q

How do you treat stable V-Tach in the pediatric patient ALS level 1?

A

There are no ALS level 1 orders for this

103
Q

ALS level 2 orders for stable pediatric V-tach?

A

Amiodarone
5mg/kg IV over 20-60 minutes
ALS level 2 order

104
Q

How do you treat unstable V-tach in the pediatric patient?

A

Synchronized cardioversion

0.5, 1, 2 joules/kg

105
Q

If a pediatric patient converts from unstable v-tach with synchronized cardioversion and is normotensive you should?

A

Consult medical control for ALS level 2 orders on amiodarone

5 mg/kg over 20 minutes

106
Q

Compressions to ventilations ratio for pediatrics pulseless v-tach/v-fib?

A

15:2

107
Q

What joules do you initially defibrillate at for the Pulseless pediatric v-tach/v-fib?

A

2 to 4 joules/kg

108
Q

How many cycles of CPR should you administered after defibrillating v-tach/v-fib patient?

A

10

109
Q

What joules do you defibrillate at for your second shock of pediatric pulseless v-tach/v-fib?

A

4 joules

110
Q

What is the dose of epi in the pediatric pulseless v-tach/v-fib patient?

A

0.01 mg/kg IV/IO 1:10,000

May be repeated every 3-5 minutes

111
Q

Dose of Amiodarone in pulseless pediatric v-tach/v-fib?

A

5 mg/kg

IV/IO

112
Q

If a pediatric has torsades de pointes in pulseless wide complex tachcyardia you should?

A

Administer Mag sulfate

113
Q

Pediatric mag sulfate dose for tosades de pointes?

A

25-50 mg/kg IV/IO
Max dose 2 mg
Given over 2 minutes

114
Q

Infant and newborn cardiopulmonary arrest is usually result of?

A

Prolonged poor oxygenation and or severe circulatory collapse

115
Q

If a newborn has signs of meconium after suctioning with bulb syringe and not virorously crying you should?

A

Intubate the trachea using the meconium aspirator

116
Q

How quickly should you administer blow by oxygen to newborns that are breathing but have central cyanosis or no improvement in respiratory, circulatory, or neurological status?

A

Within 90 seconds

117
Q

What situations should you ventilate a newborn?

A

Apnea
HR less than 100/min
Persistent central cyanosis

118
Q

At what rate should you ventilate a newborn?

A

40-60 BPM

119
Q

What conditions should you place an advanced airway in the newborn patient?

A

BVM ineffective after 2 minutes
Tracheal suctioning is required
Prolonged positive pressure ventilation needed

120
Q

What rate should you perform chest compressions on the newborn patient?

A

120 min

121
Q

When should you perform compressions on newborn patients?

A

HR less than 100 and not rapidly increasing despite adequate ventilations with 100% oxygen for approximately 30 minutes

122
Q

When would you administer epi 1:10,000 0.01 mg/kg to the newborn patient?

A

Asystole

Hr less than 60 BPM despite adequate ventilation with 100% oxygenation and 30 seconds of chest compressions

123
Q

When should a fluid challenge of 10 mL/kg to a newborn?

A

Pallor that persists after oxygenation

Faint pulses with a good HR

Poor response to resuscitation with adequate ventilations

124
Q

What should you check in all newborn resuscitations who do not respond to initial therapy?

A

Blood glucose

125
Q

how should you check blood glucose in newborns?

A

Heel stick

126
Q

When would you administer D10 5 ml/kg IV/IO to newborns?

A

Blood glucose less than 40

127
Q

Whens should you perform the pediatric assessment triangle in newborn resuscitation?

A

Frequently

128
Q

When would you administer narcan to newborns during resuscitation?

A

When newborn is unresponsive with depressed respirations

This is a ALS level 2 order

129
Q

In which position should a newborn being resuscitated be placed in?

A

On there back or side with neck in neutral position

130
Q

How can you help maintain body position in newborn resuscitation?

A

Place a rolled towel under the back and shoulders of the supine newborn to elevate the torso 0.75 to 1 inches off the mattress to extend the neck slightly

131
Q

How should you position the newborn being resusicatated if there are copious amounts of secretions?

A

On side with neck slightly extended to allow for secretions to collect on side of mouth rather than posterior pharynx

132
Q

How should tracheal suctioning for think meconium be done?

A

Via ETT using meconium aspirator attached to the 15mm adaptor of ETT

Suction at low pressure
No more than 100

133
Q

How long should meconium suctioning be performed?

A

Until ETT is clear
Max 5 seconds
It may be necessary to repeat, max 3 times

134
Q

When should you avoid narcan in newborn resuscitation?

A

If there is a HX of drug use/abuse

135
Q

Why should you avoid the use of narcan in newborn resuscitation if mother has hx of drug abuse?

A

It may precipitate seizures

136
Q

When does SIDS almost always occur?

A

When the infant is asleep or thought to be asleep

137
Q

SIDS usually occurs in apparently healthy infants?

A

Less than 1 years old

138
Q

Some SIDS deaths are mistaken for?

A

Child abuse

139
Q

In most SIDS instances, resuscitation should be?

A

Attempted

140
Q

Causes of pediatric AMS?

A 
Hypoxia
Head trauma
Ingestion/poison
Infection
Hypoglycemia
141
Q

Seizures can be caused in pediatrics by?

A 
Underlying disease
Fever
Trauma
Hypoxia
Infection of brain or spinal cord
Hypoglycemia
Ingestion/poisoning
142
Q

Signs of altered mental status in pediatric patients include?

A 
Combative behavior
Decreased responsiveness
Lethargy
Weak
Cry
Moaning
Hyptonia
Ataxia
Changes in personality
143
Q

Initial approach to AMS in pediatrics should be towards?

A 
Infection
Hypoxia
Ischemia
Hypoglycemia
Dehydration
144
Q

Secondary approach to AMS in pediatrics should be towards?

A 
Mediations
Illicit drugs/alcohol
Plants
Trauma
Other factors
145
Q

How do you treat hypoglycemia in pediatrics less than 1?

A

D10
5 mL/kg
IV/IO

146
Q

How do you treat hypoglycemia in pediatrics less than 8 but older than 1?

A

D25
2 mL/kg
IV/IO

147
Q

How do you treat hypoglycemia in pediatrics over 8?

A

D50

1 mL/kg

148
Q

Glucagon dose for pediatrics less than or equal to 20 kg?

A

0.5 mg IM

149
Q

Glucagon dose for pediatrics over 20 kg?

A

1 mg IM

150
Q

How often should narcan be repeated in pediatrics with AMS and depressed respiratory effort?

A

Every 5 minutes

151
Q

What is the dose of narcan for AMS in pediatrics with respiratory depression?

A

0.1 mg/kg
Max dose 2 mg
May be repeated every 5 minutes as needed

152
Q

What medication can be given to restrain the pediatric patient?

A

Valium
Versed
Banadryl

153
Q

Dose of Benadryl for pediatric sedation?

A

1 mg/kg

Max dose 50 mg IM or IV

154
Q

What should you do prior to administering Benadryl IV to the pediatric patient?

A

Dilute in 9mL of NS

155
Q

If intubating a pediatric overdose patient what style tube should you use?

A

Cuffed tube to prevent aspiration

156
Q

At what rate should fluid be giving to sickle cell anemia pediatrics?

A

20 mL/kg

10 mL/kg for neonates

157
Q

Morphine sulfate may be given to pediatric sickle cell anemia patients how?

A

0.1 mg/kg
IV
Max dose 4mg
Do not exceed 1 mg/min

158
Q

Can a second dose of morphine be given to sickle cell anemia pediatric patients?

A 
Yes it is a level 2 order
May be given 3-5 minutes after 1st
Systolic BP must be adequate
Same dose as first
Max dose 10 mg for all children
Do not exceed rate of 1mg/min
159
Q

What is the max total fluid that can be given to pediatric trauma patients?

A

60 mL/kg

160
Q

What should you do to pediatric patients who present with signs and symptoms of brain stem hernation?

A

Consider advanced airway
Ventilate child a 20 BPM
Ventilate infant at 30 BPM

161
Q

For massive flail segments with respiratory compromise in pediatrics you should ventilate at?

A

20 BPM for child
30 BPM for infant
Consider advanced airway

162
Q

For infants with traumatic asphyxia when administering sodium bicarbonate you must?

A

Dilute from 8.4 to 4.1%

Pediatric Protocols (1 decks)

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