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Clin Med II > Pediatric Evaluation ED- Ross > Flashcards

Pediatric Evaluation ED- Ross Flashcards

1
Q

What are the six developmental stages of kids

A 
Newborn
Infancy
Toddler
Preschool
School-age
Adolescence
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2
Q

What stage is 0-30 days of age

A

neonate

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3
Q

What stage is 1 month to 1 year

A

Infant

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4
Q

What stage is 1-3 yrs

A

Toddler

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5
Q

What stage is 3-5 years

A

Preschool

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6
Q

What stage is 3-12 yrs

A

School age

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7
Q

What stage is 12-18 years

A

Adolescent

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8
Q

How long are infants immunologically dependent on maternal humoral protection

A

Until about 3 months old

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9
Q

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

A

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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10
Q

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

A

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

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11
Q

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

A

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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12
Q

How do kids improve cardiac output (vs adults)

A

Kids increase heart rate to compensate

Adults increase stroke volume

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13
Q

What is the most common cause of cardiac arrest in kids

A

Resp failure

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14
Q

What are the side effects of resp failure

A 
Initially hypoxemia
hypercapnia
acidosis-->bradycardia
hypotension
cardiac arrest (secondary to resp)
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15
Q

What are the three corners of the pediatric assessment triangle

A

Appearance
WOB
Circulation to skin

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16
Q

What is assessed when looking at a childs appearance

A 
tone
interactiveness
consolability
look/gaze
speech/cry
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17
Q

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

A

Responds to light, temp, hunger, and sound

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18
Q

What is the T in TICLS assessing

A

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

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19
Q

What is TICLS

A

Acronym for assessing a childs appearance

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20
Q

What is the I in TICLS

A

Interactive- are the irritable? Feeding Poorly? Listless?

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21
Q

What is the C in TICLS

A

Are they consolable or not

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22
Q

What is the L in TICLS

A

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

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23
Q

What is the S in TICLS

A

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

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24
Q

What age group are obligate nose breathers

A

Newborns

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25
Q

When do people start breathing with their diaphragm

A

Infants/small children

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26
Q

What is the normal RR for Newborn

A

30-80

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27
Q

What is the normal RR for 1 y/o

A

20-40

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28
Q

What is the normal RR for 3 y/o

A

20-30

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29
Q

What is the normal RR for a 6 year old

A

16-22

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30
Q

What is the normal RR for 10 year old

A

16-20

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31
Q

What are you looking for when examining a childs breathing

A

Look for symmetrical chest expansion

Listening for intensity of breathing- (stridor, grunting, gurgling, wheezing, crackles)

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32
Q

What sounds are most concerning when a child is breathing

A

Grunting (short low pitched expiratory sounds)

Crackles heard with alveolar fluid build up

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33
Q

What are considered mild retractions

A

Sub costal
Sub sternal
Intercostal

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34
Q

What are considered severe retractions

A

Supra-clavicular
Supra-sternal
Sternal

35
Q

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

A 
Tripod
Sniffing
Drooling
Use of accessory muscles
Grunting
36
Q

What are signs of resp failure

A

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

37
Q

What WON’T a pulse ox detect

A

CarboxyHgb

MetHgb

38
Q

Where should you take a pulse on an infant

A

Brachial pulse

Femoral pulse

39
Q

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

A

<2 seconds

40
Q

How do you test cap refill in young pts

A

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

41
Q

What is the NR of HR for newborn

A

100-170

42
Q

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

A

80-130

43
Q

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

A

70-120

44
Q

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

A

70-110

45
Q

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

A

60-100

46
Q

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

A

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

47
Q

What is ALWAYS a concerning systolic BP in peds

A

<60

48
Q

What is narrowed pulse pressure a sign of

A

distress (even in a pt with a normal BP)

49
Q

What is considered systolic hypotension in neonates

A

<70

50
Q

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

A

<70

51
Q

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

A

<70+(age in years x 2)

52
Q

How do you tx hypotension in kids

A

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

53
Q

What are the concerning skin signs in infants

A

pallor
mottling
cyanosis

54
Q

What is the least concerning form of cyanosis

A

peripheral

55
Q

What is acrocyanosis

A

cyanosis of hands and feet in a newborn

56
Q

Why is shock an immediate concern for peds

A

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

57
Q

What is the leading cause of death in neonates and infants

A

Congenital defects

SIDS

58
Q

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

A

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

59
Q

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

A 
Proper airway positioning- sniffing position if young enough
Suction early and frequently for vomitus
NP/OPS
Peds BVM
LM
60
Q

How do you address an airway obstruction in a responsive toddler

A

5 back blows
5 chest thrusts

until resolved

61
Q

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

A

Chest thrust

CPR

62
Q

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

A

Airway comes befroe compression- ABC not CBA

63
Q

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

A

hypoxemia

64
Q

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

A

defib pt

65
Q

What are the steps of ALS in kids

A

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

66
Q

What is broselow tape

A

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

67
Q

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

A

2 times

68
Q

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

A

20cc/kg NS

69
Q

What is the rule for giving glucose to peds pts

A

.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

70
Q

What are the five cyanotic heart lesions in neonates

A 
Tetralogy of Fallot
Tricupsid atresia
Transposition of the great vessel
Truncus arteriousus
Total anomalous transposition
71
Q

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

A

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

72
Q

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

A

prostaglandin E1

73
Q

What is a BRUE

A

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

74
Q

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

A 
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?
75
Q

What would make a BRUE low risk

A 
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
76
Q

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

A

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

77
Q

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

A 
Monitor/admit
CBC/BC/BMP
CXR
EKG
LP - cx, gram stain
UA with urine organic acids
Check for pertussis and RSV
78
Q

What are the most common allergens in kids

A

fish
nuts
bees

79
Q

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

A

0.1 cc of 1:1000 concnetration

80
Q

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

A

0.15ml auto injector epi or

0/15ml of 1:1000 soln

81
Q

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

A
  1. 3mL autoinjector epi or

0. 3mL of 1:1000 soln

82
Q

What is commotio cordis

A

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

83
Q

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

A

bradycardia with resp distress

Clin Med II (8 decks)

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