Pediatric Emergencies and Resuscitation, part 1 (Nelson)

Question 1

Some standard principles in pediatric vital signs

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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.

Question 4

Earliest and most reliable sign of shock

Answer 4

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

Question 5

Remarks on airway obstruction

Answer 5

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

Question 6

An appropriately sized bag-valve-mask is

Answer 6

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

Question 7

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

Answer 7

neutral sniffing position without hyperextension of the head

Question 8

The most important phase of the intubation procedure is

Answer 8

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

Question 9

Mnemonic for preprocedural preparation for intubation

Answer 9

SOAP-MM
Suction
Oxygen
Airway
People
Monitor
Medications

Question 10

Formula for selectding the appropriately sized ET tube

Answer 10

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

Cuffed ETTs should generally be 0.5 m smaller

Question 11

Cricoid cartilage pressure is also known as

Answer 11

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

Question 12

Analgesic that may cause inffective ventilation

Answer 12

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

Question 13

Analgesic that may lead to hypotension in hypovolemic patients

Answer 13

Morphine
(though might be nonspecific to morphine?)

Question 14

Remarks on shock

Answer 14

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.

Question 15

Most common type of shock in children worldwide

Answer 15

Hypovolemic shock

Question 16

Most common prearrest rhythms in young children

Answer 16

Bradyarrhythmias

Question 17

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

Answer 17

<60 beats/min

Question 18

Features of probably SVT

Answer 18

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

Question 19

Adenosine dose

Answer 19

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

Question 20

If SVT needs shock, administer

Answer 20

synchronized cardioversion 0.5 - 1.0 J/kg