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Clinical Medicine > Pediatric Fever/Evaluation Study Guide > Flashcards

Pediatric Fever/Evaluation Study Guide Flashcards

1
Q

What are MSK anatomical differences between adults and pediatrics?

A
  1. Less muscle more skin (surface area) = cold fast
  2. Flexible bones, less muscle = trauma to solid organs
  3. Large head = dart heads
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2
Q

What are anatomical differences in the respiratory system?

A
  1. large tongue
  2. narrow glottic opening
  3. shorter trachea

Sniffing position

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3
Q

What are the cardiovascular differences with pediatric patients?

A
  1. Increase HR (not SV) to improve cardiac output
  2. Respiratory failure typically occurs before cardiac failure
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4
Q

Describe what typically happens prior to cardiac failure in pediatric patients.

A
  1. Respiratory failure –> hypoxia
  2. Hypercarbia —> acidosis
  3. Bradycardia and hypotension (due to cardiac ischemia and tissue acidosis)
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5
Q

What are the three components of the Pediatric assessment triangle?

A
  1. Appearance
  2. Work of breathing
  3. Circulation to skin
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6
Q

What components of appearance are assessed?

A

TICLS

Tone - floppy?
Interaction - irritable, feeding, listless?
Consolable - inconsolable?
Look/gaze - blank stare red flag
Speech/Cry - pitch, is caregiver concerned?

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7
Q

______ and _____ are late findings of pending respiratory failure.

A

Head bobbing, seesaw

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8
Q

What type of retractions indicate mild distress?

A

subcostal and substernal

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9
Q

What type of retractions indicate severe distress?

A

supraclavicular and suprasternal

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10
Q

A systolic BP or heart rate under __ is abnormal in any age group.

A

60

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11
Q

One of the earliest signs of pediatric distress is their appearance, as well as resistance to ______ and infants that are _______

A

Socialize, inconsolable

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12
Q

Narrowed pulse pressure is a ________(early/late) sign of distress.

A

Early
Pulse pressure = sys - dia

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13
Q

What is the difference between BLS in pediatrics and adults?

A

Adults –> CAB (arrest usually cardiac related)
Pediatrics —-> ABC (arrest usually due to respiratory failure)

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14
Q

What is commotio cordis and how is it treated?

A

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

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15
Q

Leading cause of death under 1

A

congenital causes (cyanotic cardiac conditions, inborn errors of metabolism, ect), SIDs

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16
Q

What are 3 risks for SIDs?

A

Prone position in bed, low birth weight, second hand smoking

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17
Q

Leading cause of death age over age 1

A

unintentional injury

18
Q

Other leading causes of death in pediatrics

A

drowning, suicide, malignancy

19
Q

Leading cause of death over age 4

A

MVA

20
Q

Dose of epi for 10-20kg

A

0.15 cc of 1:1000
-OR-
0.15 ml auto injector

21
Q

Dose of epi for >20kg

A

0.3 cc of 1:1000
-OR-
0.3 ml autoinjector

22
Q

Dose of epi for those under 1 year or 10 kg

A

0.1 mL of 1:1000

23
Q

What is a BRUE?

A

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.

24
Q

What makes a patient with a BRUE low risk and may require no further work up other than observation with O2 sat?

A
  • > 60 days
  • > 32 weeks gestational age or >45 weeks post conception age
  • 1 event of short duration
  • no concerning history
25
Q

What BRUE patients are considered high risk?

A
  • less than 2 months old
  • pre-term <32 weeks who are <45 weeks post conception
  • significant medical history
  • multiple events
26
Q

What is the work up for BRUE in high risk infants?

A

-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

27
Q

Pts with BRUE under ___ days gestational age or with high risk hx will need ____ analysis and admission.

A

60, CSF

28
Q

_______ is problematic as kids increase HR to improve cardiac output instead of increasing stroke volume.

A

Hypovolemia

29
Q

Pediatric patients can lose up to ___% of blood volume before they show signs of hypotension.

A

30%

30
Q

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.

A

20 cc/kg

31
Q

What should be considered in neonate resusciation?

A

congenital heart abnormalities –> prostaglandin

32
Q

The pressor of choice in pediatric resuscitation is ______ but make sure they are _______ loaded first.

A

epinephrine, volume

33
Q

What is the ratio for pediatric CPR?

A

Lone CPR - 30:2
2 Person - 15:2
(adults are always 30:2)

Start with rescue breath

34
Q

What is the rule of 50?

A

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

35
Q

What is the neonate infant dose of D10?

A

1 cc/kg (rule of 50 doesn’t work here)

36
Q

Toddler/preschool dose for D25?

A

2cc/kg

37
Q

School age and adolescence dose for D50?

A

1cc/kg

38
Q

Pediatric fevers, anyone under ____ days gets a full workup.

A

28 days

39
Q

Common pathogens for SBI ages 8-28 days are:

A

S. pneumonia, H. influ type b, N Meningitidis, Listeria

40
Q

What do you start with for pediatric fevers age 29-60 days?

A
  • UA, blood cultures, & IM

IM high –> LP —> +LP —-> admit IV Ab

IM low, but UA+ —> home w/ Ab

All negative can send home.

41
Q

Common bugs age 29 - 60 days:

A

S. pneumonia, H influenza, E. Coli

42
Q

What is the workup for SBI if PT is RSV/flu (bronchiolitis) positive?

A

Can do UA and make sure to follow up

Clinical Medicine (4 decks)

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