pediatric emergencies

Question 1

what are pediatric emergencies

Answer 1

• Early recognition and acute management of shock
• Respiratoryfailure
• Meningitis
• Seizures
• Burn

Question 2

shock definition

Answer 2

Shock:
an acute complex dyfunction of the circulatory system irrespective of the cause,which results in impaired tissue perfusion,
thus,in the failure of meeting the oxygen and metabolic demand of the tissues

Question 3

causes of shock

Answer 3

• decrease in the intravascular volume
  *dysfunction of the cardiovascular system
• Imbalance of the different fluid spaces

Question 4

in case of compensated shock
how is the perfusion?

Answer 4

there’s no hypoperfusion

Question 5

Compensated shock

Answer 5

Centralization of the circulation and tachycardia in order to maintain the circulation of the vital organs

Question 6

decompensated shock

Answer 6

Disease progression can lead to the impairment of the vital organs with cardiovascular dysfunction ,
acute lung injury OR
dysfunction of two or more organs (coagulopathy, thrombocytopenia, hypotension or hypoperfusion
increased creatinine
bilirubin >34.2

Question 7

what is cardiovascular dysfunction ?
is it in compensated or decompensated??

Answer 7

if the patient is hypotensive or blood pressure can only be maintained with vasopressors,
OR if two is true from the followings:
metabolic acidosis,
increased arterial lactate, oliguria, prolonged capillary refill time.

Question 8

irreversible shock

Answer 8

without intervention a decompensated shock can lead to irreversible injury, MOF, death

Question 9

cardiogenic shock

Question 10

obstructive shock

Question 11

hypovolemic

Question 12

distributive shock

Question 13

how to recognize shock

Question 14

what is the earliest and most characteristic symptom of shock?

Answer 14

Tachycardia

Question 15

does absence of tachycardia exclude shock?

Answer 15

NO
Incase of spinal injury, certain drugs (BB) heart rate can be normal

Question 16

hypoxia effect on heart rate

Answer 16

bradycardia

Question 17

symptoms of shock

Answer 17

• tachycardia
• tachypnoe : with respiratory distress
• Impaired peripheral circulation ( due to centralization of circulation, the skin perfusion is impaired.; cold)
• impaired end organ perfusion : most common is decreased consciousness and oliguria

Question 18

levels of decreased consciousness

Answer 18

irritability
agitation
apathy
somnolence

Question 19

what is BBB approach?

Answer 19

breathing
body color
behavior

Question 20

what should you think of when u see early petechia

Answer 20

meningococcal meningitis

Question 21

what increases CRT

Answer 21

fever
cold
can be low BP
etc..

Question 22

What isa LATE SIGN of shock in infants and children

Answer 22

Hypotension

Question 23

if hypoperfusion is present does it confirm shock?

Answer 23

YES

Question 24

What should you take into count when evaluating hypotension?

Answer 24

always take age into count

Question 25

value of hypotension in newborn

Answer 25

<60 mmHg systolic BP

Question 26

value of hypotension in infants

Answer 26

<70 mmhg systolic BP

Question 27

VALUE FOR HYPOTENSION for 1-9 years old

Answer 27

systolic BP <70 mmhg + (2 x age)

Question 28

value of hypotension for 10 years old or older

Answer 28

systolic BP <90mmhg

Question 29

Heart rates for different ages

Answer 29

Question 30

Does shock require laboratory tests?

Answer 30

No, they are not necessary because shock is a clinical diagnosis!

Question 31

when to correct hypoglycemia

Answer 31

<3 mmol/l

Question 32

what is used to correct hypoglycemia? what is the target value?

Answer 32

Rapid dextrose infusion
Target = 3.9- 8.3 mmol/l

Question 33

if you notice patient might be in anaphylaxis shock would u administer Epinephrin before confirming?

Answer 33

YES because if we dont give it patient might die
but if we do it’s no problem

Question 34

if septic shock is resistant to catecholamines what to give?
what dysfunction might be the cause?

Answer 34

steroids (hydrocortisone 2mg/kg)

think of adrenal dysfunction

Question 35

most common cause of cardiac arrest in childhood is
(from breathing disorders)

Answer 35

apnea

Question 36

how to treat croup

Answer 36

• steroid (rectal, oral)
• epinephrin ( acts on upper airways, decreases edema )