Pediatric emergencies Flashcards
What is the normal respiratory rate for infants, young children and older children in that order?
30-40 Infants
25-35 Young children
20-25 Older children
What is normal heart rate of Infants, young children and older children in that order?
Infants 110-160
young children 95-150
Older chidren 80-120
What is the normal systolic BP for infants, young children and older children in that order?
Infants 80-90
young children 85-100
older children 90-110
What does AVPU stand for and what does it asses?
Alert, Respond to voice, Responds to pain, Unresponsive
it asses level of consciousness but less detailed than glascow coma scale.
If child present with shock, what can be the cause and give examples of diseases?
- Hypovolemia (sepsis, dehydration-gastroenteritis, diabetic ketoacidosis, blood loss).
- Maldistribution of fluid ( sepsis and anaphylaxis)
- Cardiogenic (arrhythmias and heart failure)
- Neurogenic (spinal cord injury)
If child present with respiratory distress, what can be the cause and give examples of disease?
- Upper airway obstruction- stridor (croup/epiglottitis, foreign body, congenital malformations, trauma)
- Lower airway obstruction (asthma, bronchiolitis, pneumonia, pneumothorax)
If child present drowsy or unconscious or seizing, what can be the cause and give examples of disease?
- Post-ictal, status epilepticus or infection (Meningitis/enchephalitis)
- Metabolic (diabetic ketoacidosis, hypoglycemia, electrolyte imbalances, congenital error of metabolism
- Head injury (trauma/non-accidenta injury)
- Drug/poison ingestion
- Inctracranial hemorrhage
Give examples of surgical emergencies?
- Acute abdomen (appendicitis, peritonitis)
- Intestinal obstruction (Intussusception, Malrotation, Bowel atresia/stenosis)
What is the pathophysiology of respiratory failure?
Alveolar hypoventilation, diffusion impairment, intrapulmonary shunting or ventilation-perfusion mismatch.
Complication of respiratory failure?
hypoxemia leading to tissue hypoxia or hypercabia which can cause carbon dioxide narcosis, or both.
Also respiratory arrest
What is the maximum fractional concentration of oxygen delivered via facemask?
0.60 unless a reservoir bad is added.
What is inlcuded in noninvasive ventilation?
continous positive airway pressure (CPAP) or biphasic positive airways pressure via face mask or nasal mask.
Also high-flow humidified gas.
When should you use endotracheal intubation or mechanical ventilation?
- severe respiratory distress
- tiring due to excessive work of breathing
- progerssive hypoxemia
- reduced conscious level
- progressive neuromuscular weakness (Guillain-Barre syndrome)
why are children so susceptible to fluid loss?
- Higher surface area-to-volume ratio and higher basal metabolic rate.
What are the features of early compensated shock?
- Maintained blood pressure by increased HR and RR.
- Redistribution from periphery to vital organs–> pale skin and cold.
- 10% loss of bodyweight and acidosis, if its due to dehydration.
- delayed capilarry refil >2s
- sunken eyes and fontanelle
What are the features of late compensated shock?
- Low blood pressure (compensatory is failing)
- Lactic acidosis increases
- Bradycardia
- Confusion
- Kussmaul breathing
- blue peripheries
- Absent urine output
What is the main management of shock following fluid loss?
0.9% saline, or blood if following trauma
If fluid and blood fails to get the child out of shock, what to do?
- Intubation
- Invasive monitoring of Bp
- Inotropic support
- Correction of hematologic, biochemical and metabolic derangements
- Support for renal failure
Whats the most common cause of anaphylaxis in children?
85% is food allergy; IgE mediated
What the emergency treatment of anaphylaxis?
adrenaline IV
What is status epilepticus?
continues seizure lasting more than 30 minutes or seizure intermittently lasting more than 30 minutes without recovery of consciousness between seizures.
What is the priority in status epilepticus?
to stop the seizure by treating any reversible causes such as hypoglycemia or electrolte disturbance.
Management protocol for status epilepticus
0 min: airway (high-flow oxygen, dont forgen glucose).
5 min: vascular acces? Yes–> lorazepam (IV/IO), no–> midazolam (buccal) or diazepam (rectal).
15 min: lorazepam (IV/IO) call for senior help. Prepare phenytoin. Reconfirm it is an epileptic seizure.
25 min: seek aneasthetic/ICU advice, consider rectal paraldehyde, Phenytoin IV/IO over 20 min. Or if already on phenytoin give phenobarbitone IV/IO over 5 min.
45 min: rapid sequence induction of anesthesia with thiopental
initial assesment and managemetn of coma?
ABCDE
Examination: raised intracranial pressure? abnormal breathing, posture, pupils, fundi (papilloedema or retinal hemorrhage). Bradycardia and hypertension suggest impending brain stem herniation.
Treat the treatable: hypoglycemia, poisoning, DM, septicemia/meningitis, herpes simplex encephalitis.
Intubate and ventilate if neceessary
Whats the most common cause of death in children under the age of 1?
sudden infant death syndrome
