Pediatric Emergencies Flashcards
Leading cause of preventable death in children?
Failure to control the airway
Second leading cause of preventable death in children?
Failure to correct fluid deficits
Pediatric arrests represent ___% of all arrests.
5
Neonate in shock - additional important DDx?
Congenital adrenal hyperplasia
Inborn errors of metabolism
Obstructive left-sided cardiac lesions, including aortic stenosis, hypoplastic left heart syndrome, and coarctation of the aorta
Rapid cardiopulmonary assessment?
- General appearance (color, mental status, tone/activity/movement, age-appropriate responsiveness)
- ABCs
- Classification of physiologic status
Assess Breathing in a child?
RR
Effort/mechanics
Breath sounds/air entry/TV - stridor, wheeze
Skin color and pulse ox
Define respiratory distress vs. failure.
Distress - increased WOB
Failure - inadequate O2 or ventilation (pO2 dropping or pCO2 rising, hallmark - AMS)
Important CV parameters in young children?
BP depends on HR and SVR
Stroke volume is fixed in this population
Assess Circulation in a child?
Observe mental status
Feel for HR, pulse quality, skin temperature, capillary refill, color (pink, pale, blue, mottled, grey)
Measure BP early
Measure urine output later (4-6 wet diapers in 24 hours)
GCS verbal score for infants?
5 - coos, babbles 4 - irritable cries 3 - cries to pain 2 - moans to pain 1 - none
Minimally acceptable systolic blood pressure (5th percentile) for 0-1 mo, >1 mo to 1 yr, 1-10 yr, >10 yr
60
70
70 + 2(age in years)
90
Normal urine output in pediatrics?
1-2 mL/kg/hr
initial measurement of urine in bladder is NOT helpful
Physiologic status classifications?
Stable Respiratory distress Respiratory failure Compensated shock Decompensated shock CP failure
Common pediatric problems in ED?
Fever Respiratory distress (bronchiolitis, asthma, pneumonia) Gastroenteritis Seizures Trauma (child abuse)
Etiologies of seizures in ED in pediatrics?
Fever Head trauma Hypoxia Infection Ingestion Hypoglycemia Metabolic disorder Bleeding into the brain Low level anti-seizure medication
Respiratory failure + shock in peds = ?
CP failure
Why are epinephrine and norepinephrine frequently given directly as an infusion in children?
They are generally catecholamine depleted when in shock
Pediatric epinephrine dose?
0.05-1.5 micrograms/kg/min
Pediatric norepinephrine dose?
0.05-1.0 micrograms/kg/min
Pediatric dopamine dose?
2-20 micrograms/kg/min
MOA epinephrine? End point?
Increase HR, SVR, contractility; adequate BP and acceptable tachycardia
MOA norepinephrine? End point?
Increase SVR
Adequate BP
MOA dopamine? End point?
At lower doses - increases renal and splanchnic blood flow and contractility
At higher doses - increases HR and SVR
Improved perfusion, BP, urine
Pediatric dobutamine dose?
1-20 micrograms/kg/min
MOA dobutamine? End point?
Increases contractility, may reduce SVR and PVR
Improved perfusion, may decrease BP
Pediatric milrinone dose?
0.375 mcg/kg/min
MOA milrinone? End point?
Increases contractility especially biventricular function leading to pulmonary vasodilation
Improved perfusion and oxygenation, may cause tachycardia
Pediatric prostaglandin E1 dose?
0.05-0.1 mcg/kg/min
MOA prostaglandin E1 dose?
Maintains patency of ductus, prepare fo intubation because it can cause respiratory depression
After you’ve given 3 fluid boluses, what should be given for the 4th?
W/colloid
