pediatric a/w +trauma Flashcards
physiological differences of peds anatomy….
- larger head, larger tongue, higher larynx, flat/flexible epiglottis thats funnel shaped, vocal cords are lower and more forward, less residual long capacity
resistance to air flow formula?
=inversly proportionate to the 4th power of the radius of the airway
size of infant airway?
4mm across while adults are 8mm a
how should you lay your pediatric pt down?
rolled towel/blanket under the patient shoulders to align a/w! do not over extend neck, sniff position, chin life to move tongue out tf the way
what are common ages to have mechanical airway obstructions?
12-24 months
how to treat airway obtructions?
basic maneuvers, Back-blows/chest thrust?abdo thrusts, suction at (80mmhg-100mmhg)
child vsa
1 analysis than transport (unless vf-3 analysis then transport), 2 breaths- 15 compressions ( solo), check a/w after 1 round *noadjuncts for FBAO
what is CROUP?
Laryngotacheobronchiolitis
- subglottic airway infection usually affecting pt ages 3months-3 years old,Hx of URTI/fever/runny nose etc. causes major airway swelling, baring cough at night time, slow onset (24-72 hours), impending respiratory failure
management for croup?
blow by O2 w/ simple face mask, NRB if tolerated, neb EPI, dexamethasone, PPV prn, cold air
indications for nebulize epi?
current history of URTI
conditions for neb epi?
> 6 months-8 yrs old, hr=<200bpm, stridor at rest
Contraindications for epi?
allergy/sensitivity
croup standard tx?
weight=<10kg, route: NEB, concentration: 1:1000, dose=25mg, ma single=25mg, max #=1
Weight>10kg, dose=5mg, max single=5mg, max#=1
what is epiglotitis?
supraglottic viral infection with a rapid onset of high fever, drooling, SOB/stridor w/ retractions
epiglotitis management?
keep kid calm ( w parent), DO NOT INSPECT A/W, sniff possition, O2, ppv w/ BVM prn, support under the pt shoulders for alignment!
pediatric respiratory triangle
1)appearance: muscle tone, speech, retractions etc
2) circulation: pallor, cyanosis, mottling
3) WOB: abnormal?head bobbing?nasal flare?
what is the pediatric Tidal volume?
5-6mls/kg, vent till you see chest rise & fall
why is a scared child crying concerning?
+secretions, +aw irritability, +risk of laryngospasms, +a/w edema+wheeze
normal breathing rates for peds:
3months-6months: 25-45bpm
0-3months:30-60bpm
*higher metabolic demand
presentation of aspiration in peds?
dyspnea/tachypnea, fever, crackles, pleural rib, decreased breath sounds
Asthma:
chronic a/w inflammation and bronchial hyperactiviry causing bronchospasms and air trapping when exacerbated (ex exercise). will have dyspnea/tachypnea, tachycardia, chest tightness, pulsus paradoxus
triad for asthma:
dyspnea, wheeze, cough
what is pulsus paradoxus?
when you SBP changes by 10 sd during inspiration
Status asthmaticus:
caused by an acute exacerbation. pt is unresponsive to initial bronchodilators and will be hypercapnic–> resp fialure & retarctions&wheeze& pneumo, lethargy
- give pt epi first, then bag so air can get in
CF?
cyctic fibrosis genetic disorder characterized by abnormal Cl- ion transport on the surface of the epithelial cells in the exocrine glands causing sticky thick secretions of mucous that obstructs small bronchioles.
- airtrapping, electrolyte imbalances, digestive issues, salty skin on babies, dyspnea, chronic cough, sputum, fracturs
Bronchiolitis (febrile disorder)
inflammation of the small airways in the lower resp tract—> necrosis caused by RSV. common in ages 1-12 months, <2 yrs)
presentation: recent fever/cold, dyspnea, wheeze, crackles, chest retarctions
pneumonia
can be bacterial, virus, or fungal, commonly strep. Inflammation of the lung parenchyma–> aveolar exudate.
presentation: fever, dyspnea, sputum or not, pleuritic cp, unilateral crackles
management for pneumonia?
posiiton of comfort, O2 therapy, PPV prn, salbutamol, bronchidlators, NEB.aero chamber…
Bronchconstriction ALS PCS indications….
EPI- NBM vent required, Hx of asthma
dex- Hx of asthma CR, COPD, or 20 pack-year hx
salbutamol- none
contraindications for bronchoconstriction management?
salbu: allergy
Dex: allergy/currently on PO/parental steroids (systemic)
EPI: allergy
Salbutamol Tx:
weight:<25kg, route: MDI, Dose up to 600 mcg (6puffs), max single=600mg, dose int:5-15mins prn, 3x
- route:NEB, dose 25mg, max single=25, 3x, int-5-15mins
weight>25kg
- routeMDI, dose:up to 800 mcg ( 8puffs), max single=800mcg, dose int:5-15min, 3x
route: NEB, dose=5mg, max single=5mg, 5-15mins, 3x
consider epi tx for broncho constriction?
route:IM, dose: 0.01mg/kg, 0.5mg, 1 dose
what drug should be deliver first if pt is apneic? which is second?
1) epi 2)salbutamol subsequently
how often to peds traumas occur?
25% of traumatic injuries occur in peds, common: fire, homicide, TBI, MVC, suicide
Hypovolemia?
extreme blood loss from the body—> shock due to poor perfusion and loss of blood vol
management: stop bleeds, keep warm, CPR:low hr <60bpm/pulseless/signs of hypoperfusion, decreased LOA, IV access 20cc/KG fluid bolus (patch)
tx for different types of shock?
Hypovolemic: most common in kids due to hemorrhage, diarrhea, vomit, DKA, poisoning, 20ml/kg over 5 mins lost
cariogenic: 5-0ml/Kg over 60-120mins
septic: 20 ml/kg start(may need up to 60 ml/kg
DKA: patch required for 10-20ml/kg over 1-2 hrs
common causes of TBI
infancy: (non-accidental traumas), falls,
childhood: MVA, pedestrian struck, bicycle
adolescence: MVA, pedestrians, bike, boards, violence
*men=5x more likely to get tbi
S/s for tbi?
LOC changes, pupil size/reactivity changes, postur(decebrate/laccid), decreased motor, vomit, changes in speech, vs changes(cushings triad:+sbp, -pulse, alt breathing), seizure activity, headache
infants: bulging fronttanels, cranial suture separation, +heard circumference, high pitched cry
TBI management?
head at 30 degree angle, bvm rates
chest traumas?
2nd most common( MVA,bike,falls), increased mediastinal mobility(+tension pneumo).
abdo trauma?
3rd leading cause of traumatic death
seatbelt–> small bowel injury/fractures
Handle bar: duodenal hematoma/pancreatic injury
sport related: spleen/kidneybowel
Burns:
70%–>hot liquids, 20%–> abuse/neglagence
- lots of fluid loss ( to interstitial fluid shift),
management: ppe, analgesics, fluid resus(IV/20cc/lg)
submersions
drowning: respiratory impairment
near drownings: survial=within 24 hours of submersion
- >50% of drown victims=<5 y/o (peak 1-2 yrs/o)(deaths= higher in men)
most common cause of cardiac arrest in children:<1yr-bathtubs55%, 1-4yrs=pools 56%, >4yrs freshwater(63%)
submersion patho?
loss of normal breath pattern and possible laryngospasm causing aspiration, apnea, & hypoxia ( hypercarbia–> organ damage)
submersion management?
take off wet clothes, tx hypothermia,
bradycardic rhythms in peds?
hr<100 in NB & <80 in a small child= very slow
*tier acp, O2, transport
Tachycardic rhythms in peds/
hr<180bpm
- causes: hyperthermina, toxicity, hypoxemia, metabolic stress
peds SVT?
often occurs in PSVT 60% ar >200-300bpm.* hr >180 in peds=SVT until proven otherwise
presentation: depends on age, lightheadedness, dizzy, chest tightness, delayed cap refill
*can lead to chf
Ventricular tachycardia
*uncommon usually caused from underlying structural heart disease like myocarditis
causes: acute hypoxemia, acidosis, electrolyte imbalance, toxins
CPR in children until showing signs of puberty?
Hr<60, signs of hypo-perfusion
how to estimate peds weight?
age x2+10=weight in kg
causes of dehydration in peds?
vomit, diarrhea, DKA
–>electrolyte imbalance, potential arrhythmias
management: supportive, minimal scenentime, warm pt
meningitis:
inflammation/infection of the meninges can be bacterial or viral
s/s: fever, alt loa, bulging frontanelle, rash non-blanching, shock
seizures s/s:
lateralized tongue bitting, flickering eyelids, dilated pupils, lip smacking, +hr/BP+, post ictal phase
generalized seizures
loss of awarness & both hemispheres of the brain,ex:grand mal, tonic clonic
focal seizures:
involve loss of awareness & only 1 side of brain, jerking motion but still conscious,
simple febrile seizures:
age: 6months-5yrs
frequency: single seizure in 24hrs
Nature: generalized
duration: lasting<15mins
recovery: post ictal w return to base line & normal neuro exam (early onset of illness)
complex febrile seizure
multiple in 24hrs
focal or generalized, prolonged duration, recovery; Post ictal may not fully return to normal if multiple seizures
if a pt is post ictal for >10 mins you can assume…
status epilepticus
SIDS
- unknown etiology, suspected suffocation in bed , 10-200
how often do we see toxicology in peds?
50% in kids <6yrs, consider <5=accidental or intentional
poisonings
ca channel blockers/beta blockers ingested—>hypotension/weak heart contractility
ex: 2 glyburides (5mg each)—>fatal in toddler
physical child abuse?
pt harmed by his/her caregiver/when caregiver fails to protect child.
emotional abuse
neglecting/damage to peds self esteem from caregiver
ex: headaches w no med cause
sexual abuse
sexula explotation of a child by a caregiver
consider human trafficking when…
many EMS calls, Substance abuse, incongruent behavior
neglect
pattern when a care giver fails to provide basic needs.
failure to report to the CAS…
$1000 fine, duty overrides PHIPA
pediatric GCS?
spontaneous eyes=4
opents to verbal commona=3
opens to pain=2
npne=1
speech
oriented/infant babbles:5
infant irritable &cries/confused=4
infant cries to pain/inappropriate response=3
infant moans to pain/incomprehensible speech=2
none=1
motor;
INFANT MOVES SPONTANEOUSLY=6
WITHDRAWS from touch=5
withdraws to pain=4
abnorm flexion to pain=3extends to pain=2
none=1
