Pediatric Emergencies

Question 1

Blood Pressure lower limit

Answer 1

age x2 +70

Question 2

Blood Pressure Normal

Answer 2

age x2 +90

Question 3

Newborn Vitals

Answer 3

Resp- 30-60
Pulse 120-160
SBP 75-100

Question 4

Infant/Toddler/Preschool VItals

Answer 4

Resps 20-30
Pulse 80-140 80-130 80-120
SBP 85-105 95-105 100-115

Question 5

Peds Assessment Triangle Apperance

Answer 5

TICLS tone, interactiveness, consolability, look, speech/cry

Question 6

Peds Triangle Breathing/Circulation

Answer 6

B- position, audible sounds ?
C- colour of skin, cap refill, pulses (brachial vs apical)

Question 7

PALS Assessment

Answer 7

a/b/c/d/e

Question 8

Cardiac Arrest for 30days-8yo Joules delivered

Answer 8

First shock 2j/kg, second shock 4j/kg

Question 9

What is PEA for peds pts

Answer 9

Hr 60> or no palpable pulse

Question 10

CPR For Peds

Answer 10

15:2 for 2 rescuer

Question 11

6 H’s

Answer 11

Hypoxia, hypovolemia, hypothermia, hydrogen ions (acidosis) hypo/hyperkalemia, hypoglycemia

Question 12

6 T’s

Answer 12

trauma, tamponade (cardiac), thrombosis (MI), thrombosis (PE), tension pneumothorax, tablets (OD)

Question 13

What is stridor

Answer 13

Upper a/w narrowing, high pitched sound. Caused by fbao, inflammation (croup/epiglottits), allergix rx, trauma etc

Question 14

Signs of Respiratory DIstress

Answer 14

Retractions, nasal flaring, head bobbing, grunting

Question 15

What causes Asthma

Answer 15

Body’s auto immune response leads to bronchospasms, edema, and release of histamine which plugs the terminal a/w and traps air inside lungs

Question 16

Why asthma leads to PEA

Answer 16

Late asthma is the result of air being trapped and increasing intrathoracic pressure which can collapse the inferior and superior vena cava = hypotension and PEA

Question 17

Dexamethasone Directive

Answer 17

Hx asthma, COPD, 20 pack year hx smoking
Contra- allergy/sens or on PO or parental steroids “one”
0.5mg/kg max 8mg 1x

Question 18

What is croup

Answer 18

Viral infection causing inflammation and swelling leading to narrowing of upper a/w just below vocal cords

Question 19

S/S of croup

Answer 19

Seal like barking cough, low grade fever, sats 88%, dloa, cyanosis, stridor

Question 20

Croup Directive Epi

Answer 20

Conditions- hx of URTI AND barking cough, 6mo <= - 8yo, hr 200>, stridor at rest
Contra- all/sens
10kg> neb 1:1000 2.5 mg 1x
10kg <= neb 1:1000 5mg 1x

Question 21

Croup Directive Dexamethasone

Answer 21

Conditions- hx of URTI AND barking cough, 6mo <= - 8yo, unaltered, for mild/mod/severe croup
Contra- all/sens, steroids rec w/i 48 hrs, unable to tolerate oral meds
0.5mg/kg max 8mg 1x

Question 22

What is Epiglottitis

Answer 22

Bacterial infection causing swelling of epiglottis and falls overtop of the a/w causing stridor

Question 23

Stridor S/S and age

Answer 23

3-7yo, high fever, difficulty swallowing, stridor, drooling, hoarse voice, head bobbing, tripoding

Question 24

Allergic Rx Patho (angioedema, histamine release)

Answer 24

May affect upper and lower a/w. Angioedema is result of shift of fluid from vascular to interstitial space. Histamine release causes vasospasm and mucous secretion

Question 25

Causes of Seizures

Answer 25

Hypoxia, hypoglycemia, electrolyte imbalance, brain trauma/bleeding, idiopathic

Question 26

Types of seizures

Answer 26

Generalized, partial, complex partial, absence, febrile

Question 27

Phases of generalized seizure

Answer 27

Aura, tonic (rigidity), tonic/clonic (relax,rigid etc), postictal

Question 28

Why are febrile seizures (generalized) common in peds

Answer 28

Less body sa to cool, immature hypothalamus, smaller resp reserve to correct hypoxia and hypercarbia

Question 29

Partial Seizures

Answer 29

Usually result of identifiable lesion to particular area of brain. May relate to area of body which is controlled by that part of brain ie tonic/clonic activity to specific part of body (hand, leg). Usually no loc

Question 30

Complex Partial Seizure

Answer 30

Changes in pts personality and behaviour (lip smacking, sit idle)

Question 31

Absence Seizures

Answer 31

Ages 4-12, brief lapses in consciousness, stare off into space

Question 32

Osmotic Diuresis Patho

Answer 32

Carbs are broken down releasing glucose but there is not insulin to transport it into the cells =hyperglycemia. Kidneys are overwhelmed by high concentration of glucose so it tries to flush it out leading to loss of fluid

Question 33

S/S of Osmotic DIuresis

Answer 33

Polyuria/polydipsia, muscle tetany, dysrhythmias, tachycardia, hypotension

Question 34

Gluconeogenesis in absence of insulin or carbs

Answer 34

Protien breakdown via gluconeogenesis is increased releasing large amounts of amino acids to circulation. Fatty acids are broken down and release ketones

Question 35

Glucagon Directive

Answer 35

Hypoglycemia 2<= 4mmol/l 2> 3mmol/l Contra- allergy, hx pheochromocytoma 25kg> 0.5mg 25 <= 1.0mg

Question 36

Dextrose Directive

Answer 36

2yo <= 0.2mg/kg (2ml/kg) max 25g (250ml) 2x 10 min prn

Question 37

Acronym for OD

Answer 37

ABCDGETMOM

Question 38

Opioid Toxicity Directive

Answer 38

24hr<=, aloa, resp depression, inability to vent or persistent need, sus opioid od Contra- all/sens SC 0.8mg IM/IV 0.4mg 3x 5 min

Question 39

Burns (3 types)

Answer 39

Superficial- epidermis Partial thickness- penetrate into dermal layer Full thickness- penetrate into subcutaneous fat and muscle

Question 40

Rule of 9's

Answer 40

Head front and back 18%, arms each 9%, legs 14% each

Question 41

Critical Burns for Each Type

Answer 41

Partial- tbsa >20% child, >30 %adult Full- tbsa any amount in child, >10 % adult Complex burns- face/hands/perineum/resp tract/ electrical/involving fx/elderly +immunosuppressed pts

Question 42

Treatment of burns

Answer 42

Superficial and partial thickness <15% tbsa = wet bulky sterile dressings 15%< or full thickness= dry bulky dressings

Question 43

Subdural Hematoma S/S

Answer 43

d-loa, widening pulse pressure, ipsilateral pupil dilation, bradycardia, ataxic resps