Pediatric emergencies, Abuse/ACEs Flashcards
How do we assess peds pt in emergency situations?
order of operations: CABD (cardiovascular, airway, breathing and disability)
initial rapid assessment: safety, airway, breathing, circulation, and disability
Safety
PAT
ABCDE
AVPU
Broselow Tape
determines accurate dosing weight for media
Hx of the Child
Ongoing assessment
PCAS (post- cardiac arrest syndrome)- treatment of primary injury and prevention of secondary injury.
key elements: myocardial injury, brain injury, systemic/ischemic reperfusion injury, and the precipitating cause of cardiac arrest
-assess for fever (common), renal dysfunction
labs for emergency situation
Respiratory arrest
-period of apnea or resp dysfunction so sever that adequate ventilation and oxygenation can’t be maintained. Usually priced by resp distress
Causes: (many) upper airway (croup, aspiration, strangulation) or lower airway disorders (asthma, bronchitis, pertussis, pneumonia, pneumothorax). upper and lower simultaneous: burns, aspiration, reflux.
neuro (seizures, spinal cord trauma, CNS infection, SIDS), shock, CF, metabolic (DKA), cardiac, trauma
s/s: may appear tachypneic but shallow chest rise, bradypneic with low RR, or apneic. Often lethargic, unresponsive to stimuli, cyanosis
appropriate tx: open airway, breath assist (bag mask), intubation, ventilation
outcomes: airway and breathing adequately supported. CO2 and O2 levels in normal limits, emotional support provided to caregivers.
-can lead to cardiopulmonary arrest if untreated.
Submersion injuries
Trauma by near drowning or survival after suffocation and resp impairment by submersion in a liquid medium
-drowning is leading cause of death from unintentional injury
RF: males age 1-4, ethnic/racial minorities; underlying conditions (cardiac etiologies, epilepsy), alcohol and drug use
causes: airway submerged in water followed by breath holding, panic, swallowing of water, aspiration, and laryngospasm. Unconsciousness invokes hypoxia and hypercapnia–> metabolic and rep acidosis. Bradycardia and pulseless electrical activity (PEA), and cardiac arrest.
s/s: resp compromise for up to 8 hrs after the event. following return of breathing, tachypnea, labored breathing, SOB, wheezing, and hypoxemia are present. Hemodynamic instability likely if child sustain prolonged time w/o O2
Assess: resp, neuro, CV, CXR
Interventions: CPR, rescue breaths (clear vomit from mouth first), temp control (hypothermic or hyperthermic due to brain injury), fluid resusciation (esp. if submerged longer than 5 min)
ongoing: may need cpap or biped, O2 support. monitor for pulmonary edema, ARDS
outcomes: regain consciousness following CPR, signs of resp distress and mental changes are detected quickly and managed, oxygenation and ventilation are optimized, hemodynamic stability, educate parents on drowning prevention
shock
-Body can’t deliver adequate oxygen to meet metabolic demands of organs and tissues
-imbalance of O2 demand and supply
-if prolonged, it can lead to cell death, MODS
-hypovolemic, distributive (neurogenic, septic, and anaphylactic), obstructive and cardiogenic.
-compensated: homeostatic mechanisms (RAAS to retain sodium and fluid) and ADH release to hold fluids. Resp centers blowing off CO2 to maintain blood pH. liver releases glucagon for energy and vital function maintenance. peripheral vasoconstriction)) compensate for decreased perfusion to maintain BP- s/s: tachy, tachy, warm or cool skin.
-decompensated: metabolic demands not being met; hypotension leads to rapid deterioration, CV collapses. S/s: early- cool skin, decreased pulses, and UO. extreme tachy, hypotension, altered NEuro
-irreversible: death is imminent. s/s: hypotension unresponsive to inotropic agents, evidence of organ damage
general s/s: fever, malaise, hx of recent illness
assess: ABCs, hx, vitals
labs: BG, CBC, blood cultures, CRP, procalcitonin, lactate, UA and urine culture. LP may be taken for suspected neuro infection.
tx: IV fluids (caution with cardiogenic or DKA- could worsen)
hypovolemic shock (volume problem)
(most common form for children)
-loss of plasma/blood in intravascular space
-causes: diarrhea, vomiting, dehydration, and hemorrhage, DKA, burns, sepsis
Distributive shock (vessel problem)
abnormal distribution of blood volume- decreased systemic vascular resistance, vasodilation, or capillary permeability. Preload drops due to less blood return to heart and CO diminished. Afterload is decreased.
causes: neurogenic, sepsis, poisoning, anaphylaxis
-neurogenic- spinal cord injury leading to autonomic dysregulation (massive vasodilation and lack of vasomotor tone)
-sepsis- usually involved distributive, hypovolemic, and cardiogenic shock. Inflammatory reaction caused by bacteria in blood or tissues. Identified by a circulatory, metabolic or cellular dysfunction.
-anaphylaxis – hypersensitivity reaction causes vasodilation, resulting in loss of vasomotor tone and capillary leak, bronchoconstriction and inflammatory mediators released.
tx: pressors if unresponsive to fluids: inotropes (epi and norepinephrine) vasoconstrictors (phenylephrine, or vasopressin)
anaphylaxis: epinephrine, diphenhydramine, hydrocortisone
sepsis: abx
Obstructive shock (blockage problem)
Reduced or blocked blood flow from the heart to greater vessels. Examples include pulmonary embolism, pneumothorax plural, effusions, pericardial, tamponade, and congenital heart defects.
tx: fluid bolus buys time but need to identify cause. ex:(pneumothorax- chest tube placed), PE: thrombectomy required, pericardial effusion- pericardial drain
Cardiogenic shock (pump problem)
Hearts, in ability to pump blood to the rest of the body. Low, cardiac output results in decreased tissue perfusion. Ventricles are affected. Causes include congenital heart diseases, cardiomyopathy, myocarditis endocarditis.
tx: smaller fluid boluses to maintain preload, epi or dopamine to improve CO, vasodilators to decrease SVR (milrinone)
poisoning
Causes:
s/s:
appropriate tx:
outcomes:
Traumas
Causes: MVC, burns, drowning, poisoning, suffocation, falls, sports
s/s:
appropriate tx:
outcomes:
How can nurses help prevent these from occurring?
4 types of child maltreatment
Causes of ACEs
potential behaviors developed from ACEs
long term consequences of ACEs
RF for parents and children at higher risk for child abuse/maltreatment
Common areas for bruising based on age
uncommon areas for bruising based on age
Mongolian spots
s/s:
appropriate treatments (if needed):
nursing considerations:
coining
s/s:
appropriate treatments (if needed):
nursing considerations:
cupping
s/s:
appropriate treatments (if needed):
nursing considerations:
bite marks
s/s:
appropriate treatments (if needed):
nursing considerations:
burns
s/s:
appropriate treatments (if needed):
nursing considerations:
factitious disorder
s/s:
appropriate treatments (if needed):
nursing considerations:
sexual abuse
s/s:
appropriate treatments (if needed):
nursing considerations:
What disease processes can mimic child abuse
Cultural practices that don’t necessarily need to be reported unless a provider has them not to do them:
