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PEDIATRICS > PEDIATRIC CRITICAL CARE 1.1 > Flashcards

PEDIATRIC CRITICAL CARE 1.1 Flashcards

1
Q

What are the components of Pediatric Critical Care?

A

“Triage of the acutely ill child

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2
Q

When should a child be referred to intensive care?

A

“When critically ill or injured

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3
Q

What are the general danger signs to check for in a sick child?

A

“Ask if the child can drink or breastfeed

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4
Q

What is the most common reason for emergency room visits among children?

A

“Fever.”

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5
Q

What are the most common complaints leading to acute care visits for children?

A

“Fever

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6
Q

What is the most common reason for a sick child visit?

A

“Fever.”

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7
Q

What are age-dependent potential causes of serious bacterial infections?

A

“UTI

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8
Q

What pathogens are neonates (0-3 months) at risk of sepsis from?

A

○ Group B streptococcus
○ Escherichia coli
○ Listeria monocytogenes
○ Herpes simplex virus

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9
Q

What are common risk factors for neonatal sepsis?

A

○ Prematurity
○ Chorioamnionitis during the time of labor,
○ PROM (Premature Rupture of Membrane)
○ Maternal history of STI

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10
Q

What are signs of meningitis in an infant?

A

“Bulging fontanelles

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11
Q

What pathogens commonly cause bacteremia, sepsis, or meningitis in children over 3 months old?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae Type B
  • Neisseria meningitidis
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12
Q

What is altered mental status?

A

“A change in content of consciousness or level of arousal

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13
Q

What mnemonic is used to identify causes of altered mental status?

A

AEIOU TIPS (mnemonic)
○ Alcohol
○ Epilepsy
○ Insulin
○ Overdose of certain medication
○ Uremia
○ Trauma
○ Infection
○ Psychosis
○ Stroke

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14
Q

What are common non-GI causes of vomiting?

A

○ Hyperammonemia
○ Increased intracranial pressure (fever,
vomiting, intractable and projectile vomit,
decreased mental sensorium)
○ Poisoning

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15
Q

What are signs and symptoms associated with respiratory distress?

A

Tachypnea secondary to fever.

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16
Q

What are common causes of wheezing in children?

A

“Bronchial asthma
○ Cardiac disease
○ Congenital anomalies such as vascular
rings

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17
Q

What are common causes of abdominal pain in children?

A

“Constipation
○ Functional abdominal pain
○ Urinary tract infection
○ Gastroenteritis

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18
Q

What should be checked for in a child with abdominal pain?

A

○ Stooling patterns
○ Abdominal distention
○ Fever
○ Urinary symptoms
○ Vomiting

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19
Q

What is mottled skin, and what can it indicate?

A

“Mottled skin is a net-like discoloration pattern that can indicate respiratory distress or systemic illness.”

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20
Q

What are signs of systemic illness associated with vomiting?

A

“Bilious or bloody emesis

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21
Q

What is the definition of pediatric shock?

A

Pediatric shock is an acute life-threatening condition characterized by an inability to deliver adequate oxygen to meet the metabolic demands of vital organs and tissues.

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22
Q

Which system components are involved in the cardiovascular system?

A

The cardiovascular system consists of the heart, blood, and blood vessels, which transport blood, oxygen, and nutrients to tissues and remove waste products.

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23
Q

What are the main types of pediatric shock?

A

Hypovolemic, Cardiogenic, Distributive, Septic, and Obstructive.

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24
Q

What is the most common type of shock in children?

A

Hypovolemic shock is the most common type of shock in children.

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25
Q

What are common causes of hypovolemic shock?

A

Diarrhea, vomiting, hemorrhage, acute gastroenteritis, severe dehydration, and vehicular accidents.

26
Q

What are potential etiologies of cardiogenic shock?

A

Congenital heart diseases, cardiomyopathies (infectious or acquired), acute myocarditis, dilated cardiomyopathy, arrhythmias, and ischemia.

27
Q

What are the features of distributive shock?

A

Distributive shock is characterized by inadequate vasomotor tone, capillary leaks, maldistribution of fluid into the interstitium, and hypotension with cold, clammy extremities.

28
Q

What are examples of obstructive shock etiologies?

A

Tension pneumothorax, pericardial tamponade, pulmonary embolism, and critical coarctation of the aorta.

29
Q

What are the major features of septic shock?

A

Septic shock includes hypovolemic shock (fluid loss), distributive shock (decreased SVR), and cardiogenic shock (myocardial depression).

30
Q

What are compensatory mechanisms for shock?

A

The body increases cardiac output and systemic vascular resistance (SVR), leading to tachycardia, increased stroke volume, vasoconstriction, and redistribution of blood to vital organs.

31
Q

What happens during renal compensation in shock?

A

The kidneys maintain body pH by excreting hydrogen ions, retaining bicarbonate, and regulating sodium through the RAA pathway.

32
Q

Why does the gastrointestinal tract develop ileus during shock?

A

The gastrointestinal tract develops ileus as a compensatory mechanism to conserve oxygen for critical organs during shock.

33
Q

What are the effects of distributive shock on blood flow?

A

Distributive shock causes abnormal vasodilation and maldistribution of blood flow away from vital organs, initially leading to compensatory increased cardiac output.

34
Q

What is the primary cause of septic shock?

A

Septic shock is primarily caused by infection that activates the immune system, releasing toxic mediators such as TNF and interleukins.

35
Q

What is the clinical outcome if shock is not treated?

A

Untreated shock can lead to persistent inadequate tissue perfusion, multiorgan dysfunction syndrome (MODS), and death.

36
Q

How is blood pressure maintained during compensated shock?

A

Blood pressure is maintained by increasing cardiac output and systemic vascular resistance (SVR).

37
Q

What are the clinical signs of hypovolemic shock in children?

A

Clinical signs include hypotension, irregular pulses, and signs of dehydration such as dry mucous membranes and poor skin turgor.

38
Q

What is a common clinical manifestation of cardiogenic shock?

A

Signs include poor myocardial function, tachycardia, weak pulses, and cold extremities.

39
Q

What are signs of distributive shock?

A

Signs include hypotension, cold clammy skin, and maldistribution of fluids into the interstitium.

40
Q

What is the hallmark of septic shock?

A

The hallmark of septic shock is a combination of hypovolemic, distributive, and cardiogenic shock caused by an uncontrolled infection and inflammatory cascade.

41
Q

What are the causes of hypovolemic shock due to extracorporeal fluid loss?

A

Direct blood loss through hemorrhage, or abnormal loss of body fluids (diarrhea, vomiting, burns, diabetes mellitus or insipidus, nephrosis).

42
Q

What causes hypovolemic shock by lowering plasma oncotic forces?

A

Hypoproteinemia due to liver injury or increased capillary permeability.

43
Q

What is the pathophysiology of distributive shock?

A

Loss of vascular tone (venous, arterial, or both) caused by sympathetic blockade, local substances affecting permeability, acidosis, drug effects, or spinal cord transection.

44
Q

What leads to increased vascular permeability in shock?

A

Sepsis-induced capillary permeability changes due to endotoxins, or excess histamine release in anaphylaxis.

45
Q

What cardiac conditions can result in peripheral hypoperfusion?

A

Ischemia, acidosis, drug effects, constrictive pericarditis, pancreatitis, and sepsis.

46
Q

What are the general clinical manifestations of shock?

A

Tachycardia, decreased urine output, poor peripheral perfusion, altered mental state, respiratory distress, and hypotension.

47
Q

What is the normal urine output in patients?

A

1 mL - 1.5 mL/kg/hr.

48
Q

What are key signs of hypovolemic shock?

A

Orthostatic hypotension, dry mucous membranes, poor skin turgor, decreased urine output, and cool extremities.

49
Q

How can you assess dehydration in hypovolemic shock?

A

Look for dry lips, sunken eyeballs, poor skin turgor, thirst, mental status changes, and decreased urine output.

50
Q

What are signs of cardiogenic shock?

A

Tachypnea, delayed capillary refill time, poor peripheral or central pulses, cool extremities, declining mental status, and decreased urine output.

51
Q

What causes obstructive shock?

A

Physical restriction of forward blood flow, potentially presenting with cardiac arrest.

52
Q

What are common signs of distributive shock?

A

Peripheral vasodilation and increased but inadequate cardiac output.

53
Q

What cutaneous findings indicate uncompensated shock?

A

Petechiae, purpura, ecchymoses, diffuse erythema, ecthyma gangrenosum, peripheral gangrene, and jaundice.

54
Q

What is the International Consensus Definition for Pediatric Sepsis?

A

Infection can progress to SIRS, sepsis, severe sepsis, septic shock, and potentially MODS or death.

55
Q

What defines Systemic Inflammatory Response Syndrome (SIRS)?

A

An inflammatory cascade initiated by infectious or noninfectious triggers, with activation of inflammatory mediators like TNF, IL-1, IL-6, IL-12, and interferon-gamma.

56
Q

What is the clinical definition of sepsis?

A

SIRS plus a suspected or proven infection.

57
Q

What defines severe sepsis?

A

Sepsis plus cardiovascular organ dysfunction or 2 or more organ dysfunctions (respiratory, renal, neurologic, hematologic, or hepatic).

58
Q

What characterizes septic shock?

A

Sepsis plus cardiovascular organ dysfunction requiring medical intervention.

59
Q

What laboratory findings are associated with septic shock?

A

Thrombocytopenia, anemia, neutropenia, prolonged PT/aPTT, reduced fibrinogen, elevated fibrin split products, hypocalcemia, metabolic acidosis, and abnormal glucose levels.

60
Q

What is the first step in managing pediatric shock?

A

Follow Pediatric Advanced Life Support (PALS) or Neonatal Advanced Life Support (NALS): airway, breathing, circulation.

PEDIATRICS (19 decks)

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