Pediatric Emergency Medicine Flashcards
When evaluating a patient, what is the first question you should ask yourself every time?
How does the patient look–sick or not sick?
In well-appearing pediatric patients, where should you consider examining the child? What part(s) of the exam should you do first? Last?
In parent’s lap
Least invasive first
Ears and throat last
What are the 5 key interventions in a sick child?
O2 Pulse Ox Cardiorespiratory monitor IV access CXR/EKG
In a sick child, what should you treat first regardless of complaint/diagnosis?
Treat the greatest threat to life every time, usually airway!
Remember the primary survey? What does it consist of?
ABCDE
If a child is posturing and leaning forward, what could this indicate?
Issues with the airway (epiglottitis!)
What is the quickest and easiest way to assess a patient’s airway?
Ask them their name
What are characteristics of a pediatric airway that make it unique? Size, location, length, shape; what does this mean for the child?
Smaller (more prone to obstruction) More anterior and cephalad (higher up) in location Shorter (more prone to right main stem intubation) Funnel shaped (narrowest at sub glottis in kids < 8 yrs)
To help align the airway in an infant, how might one position the patient’s head?
Towel roll under the shoulders
To help align the airway in an older child, how might one position the patient’s head?
Towel roll under neck, in conjunction with jaw thrust
To ensure proper bag mask ventilation, you should observe what movement in the patient?
Chest rise with each breath
Do you need to remove the c collar to ventilate?
yes, a second provider will provide stabilization of the c spine during ventilation/intubation
If you do not not BMV at an appropriate rate, what does this increase the risk of?
Gastric air, regurgitation, and aspiration
May also result in barotrauma (PTX)
If you BMV at a rate that is too fast, this may increase intrathoracic pressure and impair venous return, which will in turn decreases what three things?
Cardiac output, cerebral blood flow, and coronary perfusion
What can grunting be indicative of?
Auto PEEP (positive end expiratory pressure) where too much air over inflates alveoli causing progressive air trapping
What can you administer to a patient with croup to reduce swelling of the airway around the vocal cords ?
Racemic Epinephrine (Neb)
T/F Pediatric arrest is rarely a sudden event
T
What are the two most common causes of pediatric arrest?
Respiratory failure and Shock
How often is pediatric arrest a primary cardiac event?
Rarely
What are potential causes of respiratory failure?
Intrinsic lung dz
Airway obstruction
Inadequate effort
Which comes first, respiratory failure or distress?
Distress
How can you diagnose respiratory failure?
Clinically
Is a blood gas a reliable way to diagnose respiratory failure?
No
What are mottled skin and delayed capillary refill signs of?
Poor circulation
Normal BP maintained until ____% of the child’s circulating volume is lost
over 30%
Hypotension is a late/early finding in children with shock
Late!!
___ is a big time sign of shock in children
AMS
Shock can occur with normal, increased, or decreased blood pressure?
Yup, all three
Mean systolic BP in kids: ___ mmHg + (2 x age in yrs)
90
Lower limit systolic BP in kids: ___mmHg + (2 x age in yrs)
70
What are three signs of poor tissue perfusion?
Cool or mottled skin
Tachycardia
Altered Mental Status
As part of fluid resuscitation, ___ ml/kg boluses of isotonic fluids, such as ___ or ___, should be administered until there are signs of improved perfusion, and resolution of tachycardia
20
NS or LR
If shock due to hemorrhage, after x2 boluses of isotonic fluids, give ____ at ___ ml/kg
Packed red blood cells (PRBC); 10
T/F Large volume resuscitation in the setting of shock is often required in children
True
What is the most common cause of death and disability in childhood?
Injury
What is the most common cause of death in children?
MVA (followed by drownings, fires, falls, and homicide)
What is the leading cause of death in pediatric trauma?
Head injury
What are three reasons why head injuries are so common in children?
Large head relative to body = more torque
Less myelin = more shearing forces and greater neuron injury
Soft cranium may result in intracranial injury without skull fx
Sunsetting eyes or one pupil larger than another are signs of ____
Increased ICP
Head injuries have a significantly worse outcome when ___ and ___ are present
Hypoxia and hypotension
____ of children with chest injury will have other injuries as well. Their___ is very mobile and they are at increased risk of developing a ___ or ___
2/3
Mediastinum
PTX or Hemothorax
Why is significant thoracic trauma possible without rib fractures in children?
Their ribs are very pliable
Most abd trauma occurs secondary to what type of trauma?
Blunt
What characteristics/anatomical differences make a child particularly vulnerable to abd injuries?
Children have thin muscular wall and less fat and a lower riding liver and spleen (below ribs)
If seatbelt sign is present, what should be ordered?
CT Abd
At what age do fontanelles close in infants?
12-18 months
Are spine injuries common or uncommon in children? Why?
Uncommon; Interspinous ligaments and joint capsules are much more flexible and pliable
Facet joints flat
Children have a smaller circulating blood volume compared to adults; a child’s blood volume is ___ ml/kg
70
Hypothermia worsens ___ and ___ in trauma patients
Coagulopathy and acidosis
