Pediatric Emergencies and Resuscitation, part 1 (Nelson) Flashcards

1
Q

Some standard principles in pediatric vital signs

A
  1. A child’s respiratory rate should not be >60 breaths/min for a sustained period
  2. Normal heart rate is 2-3x normal respiratory rate for age
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2
Q

A simple guide for pediatric BP is that the lower limit of SBP should be

A

neonates: ≥60 mm Hg
1mo-1yr: ≥70 mm Hg
1-10 yr: ≥70 + (2 x age)
>10 yr: ≥90 mm Hg

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3
Q

The most common precipitating event for cardiac instability in infants and children is

A

Respiratory insufficiency
Therefore, rapid assessment of respiratory failure and immediate restoration of adequate ventilation and oxygenation remain the first priority in the resuscitation of a child.

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4
Q

Earliest and most reliable sign of shock

A

Tachycardia
but is itself fairly nonspecific and should be correlated with other components of the exam, such as weakness, threadiness, and absence of pulses.

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5
Q

Remarks on airway obstruction

A
  1. Children <5 yr old are particularly susceptible to foreign body aspiration
  2. Liquids are the most common cause of choking in infants, whereas small objects and food are the most common source of foreign bodies in the airways of toddlers and older children
  3. Any child in the proper setting with the sudden onset of choking, stridor, or wheezing has foreign body aspiration until proven otherwise
  4. Blind suctioning or finger sweeps of the mouth are NOT recommended
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6
Q

An appropriately sized bag-valve-mask is

A

one that fits over the child’s mouth and nose but does not extend below the chin or over the eyes

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7
Q

In infants and young children, optimal ventilation is often provided when the child’s head is in what position?

A

neutral sniffing position without hyperextension of the head

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8
Q

The most important phase of the intubation procedure is

A

the preprocedural preparation,
where the provider ensures all the equipment and staff needed for safe intubation are present and functioning

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9
Q

Mnemonic for preprocedural preparation for intubation

A

SOAP-MM
Suction
Oxygen
Airway
People
Monitor
Medications

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10
Q

Formula for selectding the appropriately sized ET tube

A

Uncuffed ETT size (in mm)
= (age in yrs/4) +4

Cuffed ETTs should generally be 0.5 m smaller

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11
Q

Cricoid cartilage pressure is also known as

A

The Sellic maneuver
- used to compress the esophagus against the vertebral column to prevent aspiration of gastric contents

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12
Q

Analgesic that may cause inffective ventilation

A

Fentanyl
Rapid administration risks “tight chest” response, with no effective ventilation

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13
Q

Analgesic that may lead to hypotension in hypovolemic patients

A

Morphine
(though might be nonspecific to morphine?)

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14
Q

Remarks on shock

A

The definition of shock does not include hypotension,
and it is important for care providers to understand that shock does not begin when blood pressure drops; it merely worsens and becomes more difficult (refractory) to treat once blood pressure is abnormal.

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15
Q

Most common type of shock in children worldwide

A

Hypovolemic shock

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16
Q

Most common prearrest rhythms in young children

A

Bradyarrhythmias

17
Q

A heart rate ________ with poor perfusion is an indication to begin chest compressions

A

<60 beats/min

18
Q

Features of probably SVT

A

P waves absent/abnormal
HR not variable
Infants: rate usually ≥220/min
Children: rate usually ≥180/min

19
Q

Adenosine dose

A

1st dose: 0.1 mg/kg (max 6 mg)
2nd dose: 0.2 mg/kg (max 12 mg)

20
Q

If SVT needs shock, administer

A

synchronized cardioversion 0.5 - 1.0 J/kg