Pediatric Evaluation ED- Ross Flashcards by Tessa Herbert

What are the six developmental stages of kids

Newborn
Infancy
Toddler
Preschool
School-age
Adolescence

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What stage is 0-30 days of age

neonate

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What stage is 1 month to 1 year

Infant

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What stage is 1-3 yrs

Toddler

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What stage is 3-5 years

Preschool

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What stage is 3-12 yrs

School age

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What stage is 12-18 years

Adolescent

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How long are infants immunologically dependent on maternal humoral protection

Until about 3 months old

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What are the skin, muscle, and bone differences in kids (less than 6) vs adults

Surface area is proportionally greater and the skin is thinner
Less muscle, more fat
Bones, ligaments and joints are more flexible
Higher rate of internal injury

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What are the differences between a kids head and an adults (<6)

Proportionally larger (dart heads)
Proportionally less brain mass
Will tend to be hit first in trauma

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What are the differences between an adults resp system and a childs (<6 years)

Relatively small mouth and airways
tongue is proportionally larger and bulbous until 8 years
Tonsils and adenoids are proportionally larger (more prone to resp distress)
Glottic opening is narrow
Trachea is shorter, smaller, and narrower

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How do kids improve cardiac output (vs adults)

Kids increase heart rate to compensate

Adults increase stroke volume

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What is the most common cause of cardiac arrest in kids

Resp failure

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What are the side effects of resp failure

Initially hypoxemia
hypercapnia
acidosis-->bradycardia
hypotension
cardiac arrest (secondary to resp)

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What are the three corners of the pediatric assessment triangle

Appearance
WOB
Circulation to skin

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What is assessed when looking at a childs appearance

tone
interactiveness
consolability
look/gaze
speech/cry

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What are the physical development milestones for 0-1 month old

Responds to light, temp, hunger, and sound

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What is the T in TICLS assessing

Tone- are the flopping, moving all extremeties, or is their body stiffening?

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What is TICLS

Acronym for assessing a childs appearance

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What is the I in TICLS

Interactive- are the irritable? Feeding Poorly? Listless?

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What is the C in TICLS

Are they consolable or not

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What is the L in TICLS

Look/Gaze (is the stare blank? or are they following you with their eyes)

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What is the S in TICLS

Speech/cry
-what is the pitch of the cry?
Is the caregiver concerned?

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What age group are obligate nose breathers

Newborns

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When do people start breathing with their diaphragm

Infants/small children

What is the normal RR for Newborn

30-80

What is the normal RR for 1 y/o

20-40

What is the normal RR for 3 y/o

20-30

What is the normal RR for a 6 year old

16-22

What is the normal RR for 10 year old

16-20

What are you looking for when examining a childs breathing

Look for symmetrical chest expansion | Listening for intensity of breathing- (stridor, grunting, gurgling, wheezing, crackles)

What sounds are most concerning when a child is breathing

Grunting (short low pitched expiratory sounds) | Crackles heard with alveolar fluid build up

What are considered mild retractions

Sub costal Sub sternal Intercostal

What are considered severe retractions

Supra-clavicular Supra-sternal Sternal

What positioning is most concerning when a child is having difficulty breathing

``` Tripod Sniffing Drooling Use of accessory muscles Grunting ```

What are signs of resp failure

Seesaw breathing (chest retracting and abdomen expanding during inspiration) Head bobbing Use of neck muscles to extend neck during inspiration

What WON'T a pulse ox detect

CarboxyHgb | MetHgb

Where should you take a pulse on an infant

Brachial pulse | Femoral pulse

How long should cap refill take on an infant in warm air

<2 seconds

How do you test cap refill in young pts

lift the extremity above the heart press on skin-->count how long it takes to fill

What is the NR of HR for newborn

100-170

What is the NR for HR in 1 mon- 2year range

80-130

What is the NR for HR in 2-6 year olds

70-120

What is the NR for HR in 6-10 year olds

70-110

What is the NR for HR in 10-16 year olds

60-100

How big does a peds BP cuff bladder need to be to get an accurate BP

40% of midarm circumference and 50-75% the length of the arm

What is ALWAYS a concerning systolic BP in peds

<60

What is narrowed pulse pressure a sign of

distress (even in a pt with a normal BP)

What is considered systolic hypotension in neonates

<70

What is considered systolic hypotension in infants (1mon-1 year)

<70

How do you calculate a systolic hypotension cut off for pts between 1yr-9yr

<70+(age in years x 2)

How do you tx hypotension in kids

vasopressor- first choice is epinephrine but can also used atropine for asystole or bradycardia

What are the concerning skin signs in infants

pallor mottling cyanosis

What is the least concerning form of cyanosis

peripheral

What is acrocyanosis

cyanosis of hands and feet in a newborn

Why is shock an immediate concern for peds

The have proportionally less blood but still bleed like adults so they initially compensate better but deteriorate quickly because they have less volume

What is the leading cause of death in neonates and infants

Congenital defects | SIDS

What is the most common cause of death in kids 1-14 years old

unintentional injury (drowning in <4, MVA >4) Malignancy Suicide

What are the first steps in working with a pt that shows distress on assessment triangle (in order)

``` Proper airway positioning- sniffing position if young enough Suction early and frequently for vomitus NP/OPS Peds BVM LM ```

How do you address an airway obstruction in a responsive toddler

5 back blows 5 chest thrusts until resolved

How do you address airway obstruction in an unresponsive infant or toddler

Chest thrust | CPR

What is the most important difference between BLS in children vs adults

Airway comes befroe compression- ABC not CBA

If the cardiac arrest is not witness in kids what is the most likely cause

hypoxemia

If cardiac arrest is witnessed in kids what is the first step

defib pt

What are the steps of ALS in kids

asses responsiveness Properly position airway attend to circulation then drugs (albuterol and glucose)

What is broselow tape

a color coded method of estimating weight that allows for you to dose drugs quickly

How many times can you try to get peds peripheral access before you insert an intraosesous line

2 times

What is the first med you should give an ill appearing kid after establishing their airway

20cc/kg NS

What is the rule for giving glucose to peds pts

.5g/kg (rule of 50) so: if D50 then 1cc/kg =50 if D10 then 5cc/kg to =50 if D5 then need 10cc/kg to = 50

What are the five cyanotic heart lesions in neonates

``` Tetralogy of Fallot Tricupsid atresia Transposition of the great vessel Truncus arteriousus Total anomalous transposition ```

What are the ductal dependent lesions of the heart in neonates (requiring PDA)

All the T's Coarctation of the aorta Hypoplastic left ventricle Aortic stenosis

What do you tx pts with if you need to keep a PDA

prostaglandin E1

What is a BRUE

Brief Unresolved Unexplained Event- cannot be caused by infection, must be unexplained

What details do you need for hx in a pt with BRUE

``` exact age, and gestational age sz like movement? Newborn metabolic ok? Previous SIDS or unexplained death in sibling Previous event or clustered event CPR done or not? ```

What would make a BRUE low risk

``` pt is >60 days old Gestational age >32 weeks or 45 weeks post conception age Short duration of event and sole event No concerning hx No CXR ```

When do you have to do a full work up on a BRUE

If the pt is less than 2 months old If the pt is preterm <32 weeks or <45 weeks post conception Infants with significant medical hx Multiple events -concern for infection

What is the work up for a BRUE in a pt that is high risk and less than one year old

``` Monitor/admit CBC/BC/BMP CXR EKG LP - cx, gram stain UA with urine organic acids Check for pertussis and RSV ```

What are the most common allergens in kids

fish nuts bees

If a pt is <10Kg and having anaphylaxis, what does of epi do you administer

0.1 cc of 1:1000 concnetration

If a pt is 10-20 kg and experiencing anaphylaxis what do you administer

0.15ml auto injector epi or | 0/15ml of 1:1000 soln

If a pt is >20kg and experiencing anaphylaxis, what do you administer

0. 3mL autoinjector epi or | 0. 3mL of 1:1000 soln

What is commotio cordis

Cardiac arrest when a child experiences blunt trauma while in T wave of cardiac cycle (vent repolarization)

What is the last step in kids before going into cardiac arrest

bradycardia with resp distress