Pediatric Fever/Evaluation Study Guide Flashcards
What are MSK anatomical differences between adults and pediatrics?
- Less muscle more skin (surface area) = cold fast
- Flexible bones, less muscle = trauma to solid organs
- Large head = dart heads
What are anatomical differences in the respiratory system?
- large tongue
- narrow glottic opening
- shorter trachea
Sniffing position
What are the cardiovascular differences with pediatric patients?
- Increase HR (not SV) to improve cardiac output
- Respiratory failure typically occurs before cardiac failure
Describe what typically happens prior to cardiac failure in pediatric patients.
- Respiratory failure –> hypoxia
- Hypercarbia —> acidosis
- Bradycardia and hypotension (due to cardiac ischemia and tissue acidosis)
What are the three components of the Pediatric assessment triangle?
- Appearance
- Work of breathing
- Circulation to skin
What components of appearance are assessed?
TICLS
Tone - floppy?
Interaction - irritable, feeding, listless?
Consolable - inconsolable?
Look/gaze - blank stare red flag
Speech/Cry - pitch, is caregiver concerned?
______ and _____ are late findings of pending respiratory failure.
Head bobbing, seesaw
What type of retractions indicate mild distress?
subcostal and substernal
What type of retractions indicate severe distress?
supraclavicular and suprasternal
A systolic BP or heart rate under __ is abnormal in any age group.
60
One of the earliest signs of pediatric distress is their appearance, as well as resistance to ______ and infants that are _______
Socialize, inconsolable
Narrowed pulse pressure is a ________(early/late) sign of distress.
Early
Pulse pressure = sys - dia
What is the difference between BLS in pediatrics and adults?
Adults –> CAB (arrest usually cardiac related)
Pediatrics —-> ABC (arrest usually due to respiratory failure)
What is commotio cordis and how is it treated?
Blunt trauma to the chest during ventricular repolarization (beginning of T wave) causes ventricular depolarization before the ventricles fully repolarize
Sends heart into V fib or arrest, TX is to shock 150j for biphasic, or 300j
Leading cause of death under 1
congenital causes (cyanotic cardiac conditions, inborn errors of metabolism, ect), SIDs
What are 3 risks for SIDs?
Prone position in bed, low birth weight, second hand smoking
Leading cause of death age over age 1
unintentional injury
Other leading causes of death in pediatrics
drowning, suicide, malignancy
Leading cause of death over age 4
MVA
Dose of epi for 10-20kg
0.15 cc of 1:1000
-OR-
0.15 ml auto injector
Dose of epi for >20kg
0.3 cc of 1:1000
-OR-
0.3 ml autoinjector
Dose of epi for those under 1 year or 10 kg
0.1 mL of 1:1000
What is a BRUE?
Brief resolved unexplained event
Change in color, tone, responsiveness, or apnea for 1-2 minutes that resolves on its own with no other symptoms such as feeding problems or fever in PT under 1 years old.
What makes a patient with a BRUE low risk and may require no further work up other than observation with O2 sat?
- > 60 days
- > 32 weeks gestational age or >45 weeks post conception age
- 1 event of short duration
- no concerning history
What BRUE patients are considered high risk?
- less than 2 months old
- pre-term <32 weeks who are <45 weeks post conception
- significant medical history
- multiple events
What is the work up for BRUE in high risk infants?
-monitor and admit
-CBC, Blood cultures, electrolytes
-CXR & EKG
-LP w/ CSF culture, abc, gram stain
-UA with organic acids (inborn errors of metabolism)
-Check pertussis and RSV
Pts with BRUE under ___ days gestational age or with high risk hx will need ____ analysis and admission.
60, CSF
_______ is problematic as kids increase HR to improve cardiac output instead of increasing stroke volume.
Hypovolemia
Pediatric patients can lose up to ___% of blood volume before they show signs of hypotension.
30%
In pediatric resuscitation you should place in the sniffing position, give high flow O2 via NC, and initiate a fluid bolus of ____cc/kg of NS.
20 cc/kg
What should be considered in neonate resusciation?
congenital heart abnormalities –> prostaglandin
The pressor of choice in pediatric resuscitation is ______ but make sure they are _______ loaded first.
epinephrine, volume
What is the ratio for pediatric CPR?
Lone CPR - 30:2
2 Person - 15:2
(adults are always 30:2)
Start with rescue breath
What is the rule of 50?
Glucose dose in pediatric patients:
a x b = 50
a = type of fluid b = cc/kg (solve for this)
example: D25
25 x b = 50, dose is 2 cc/kg
What is the neonate infant dose of D10?
1 cc/kg (rule of 50 doesn’t work here)
Toddler/preschool dose for D25?
2cc/kg
School age and adolescence dose for D50?
1cc/kg
Pediatric fevers, anyone under ____ days gets a full workup.
28 days
Common pathogens for SBI ages 8-28 days are:
S. pneumonia, H. influ type b, N Meningitidis, Listeria
What do you start with for pediatric fevers age 29-60 days?
- UA, blood cultures, & IM
IM high –> LP —> +LP —-> admit IV Ab
IM low, but UA+ —> home w/ Ab
All negative can send home.
Common bugs age 29 - 60 days:
S. pneumonia, H influenza, E. Coli
What is the workup for SBI if PT is RSV/flu (bronchiolitis) positive?
Can do UA and make sure to follow up
