Pediatric Pearls 1 Flashcards
List the 3 components of the pediatric assessment triangle
The pediatric assessment triangle (PAT):
Appearance, Breathing, Circulatory Status
This is used for the first, from the door, general assessment
Restlessness, Anxiety and Combativeness: suggests hypoxia.
Somnolence or lethargy: suggests severe hypoxia, hypercarbia, and/or respiratory fatigue
The development of a slower, irregular respiratory pattern in the setting of respiratory distress is an omnious sign. What will quickly develop?
The development of a slower, irregular respiratory pattern in the setting of respiratory distress is an OMINOUS sign. Respiratory arrest will quickly develop if no intervention is made.
Initial response to respiratory compromise is usually tachypnea. As respiratory compromise progresses, RR often decreases and the pattern of respirations becomes irregular.
Identify the common clinical signs and symptoms seen in patients with asthma
Cough
Wheezing
Chest tightness
Prolonged exhalation
Shortness of breath
REVERSIBILITY OF AIRFLOW OBSTRUCTION
List common triggers for asthmatics
Atopy (strongest predisposing factor)
Exposure to inhaled allergens (triggers):
Dust mites
Cockroaches
Seasonal pollens
Nonspecific precipitants (triggers):
Exercise
URI
Sinusitis
Allergic rhinitis
Aspiration
GERD
Air pollution
Obesity
When a pediatric patient is compromised, one will initially see _____ to compensate
When ability to compensate is exceeded, one will see _____
Heart rate changes (general rule of thumb):
When a pediatric patient compromised, one will initially see tachycardia (HR increase) to compensate
When ability to compensate is exceeded, will see bradycardia (HR decrease)
What are the two key immediately life threatening conditions in children to remember?
Severe upper airway obstruction:
1) If complete there will be no audible speech, cry, or cough.
Ex:
Foreign body aspiration
Angioedema from anaphylaxis
Epiglottitis
2) If partial upper airway obstruction you will likely hear stridor with inspiration.
Ex:
Foreign body aspiration
Infection (croup, bacterial tracheitis)
Injury (thermal or chemical burn)
What is a tension pneumothorax? What are the hallmarks?
Tension Pneumothorax:
Air from lung leaks into the pleural cavity
Causes a shift of the mediastinal structures to the opposite side
Compresses the heart and good lung
Hallmarks are:
Severe respiratory distress
Ipsilateral chest hyper-expansion
Decreased or absent breath sounds on the side of the collapsed lung
Shift of mediastinal structures, sometimes the deviation of the trachea is visible externally.
Hyper-resonance to percussion over the collapsed lung
What is cardiac tamponade? What is Beck’s triad?
Cardiac Tamponade:
Blood, serous fluid, or air fill the pericardial sack with life threatening compromise of venous return and cardiac stroke volume.
Acute cardiac tamponade is rare in kids (unless traumatic).
Can be secondary to insidious build-up of fluid in the pericardial sack secondary to infection or oncologic disease (i.e. leukemia).
Respiratory distress and hypotension result.
Beck’s Triad :
Jugular venous distention, muffled cardiac sounds, hypotension (only in 1/3 of pts with cardiac tamponade)
What are the important characteristics of retropharyngeal and peritonsillar abscesses?
Retropharyngeal and peritonsillar abscesses
More typically cause sore throat, difficulty swallowing and local pain, swelling
Hoarse voice is common (hot potato voice)
A ENT urgency –> emergency
What is the is the most common cause of infectious airway obstruction in kids ages 6-36 months?
Croup (acute laryngotracheobronchitis):
Croup is the most common cause of infectious airway obstruction in kids ages 6-36 months.
Not confined to children
Most often viral (parainfluenza virus) less often allergic (spasmodic croup).
Tracheitis is most often a secondary bacterial infection to croup (kids are febrile, really sick)
Stridor –> think CROUP
Epiglottitis is typically associated with what pathogen?
Epiglottitis:
H. Flu type B
Vaccine has nearly eliminated HIB meningitis and HIB epiglottitis
Kids would be SICK
Would go to the OR for exam and possible intubation if needed
How do viral and atypical PNA present on a XR?
Pneumonia
Bacterial-more localized (lobar), generally higher fever, ill-appearance.
Most common in kids = Streptococcus pneumoniae
Viral and atypical (mycoplasma and chlamydia) tend to be diffuse interstitual / peribronchial processes on x-ray.
Don’t forget…viral and atypical pneumonia can at times be lobar
What is the treatment for anaphylaxis?
Retropharyngeal/laryngeal edema can be life threatening.
Symptoms are often sudden and associated with facial edema and urticaria
Bronchospasmin lower airways common
If an allergy is reported…ALWAYS ASK WHAT HAPPENS WHEN EXPOSED TO THE ALLERGEN Treat with: Epinephrine, oxygen, steroids
What is the triad associated with acute chest syndrome in sickle cell patients?
Sickle cell disease:
Acute chest syndrome:
1) Sudden onset respiratory distress and chest pain
2) New infiltrate on CXR
3) Fever
What are the essentials of asthma diagnosis?
Essentials of Diagnosis:
Episodic or chronic symptoms of airflow obstruction
Reversibility of airflow obstruction, either spontaneously or following bronchodilator therapy
Symptoms frequently worse at night or in the early morning.
Prolonged expirations and diffuse wheezes on PE
Limitation of airflow on pulmonary function testing or positive broncho-provocation challenge
Methacholine challenge
What are the signs that respiratory arrest is imminent?
How is asthma severity classified?
Level of severity is determined by assessment of both impairment and risk.
Assess impairment domain by patients/caregiver’s recall of previous two to four weeks and spirometry
Assign severity to the most severe category in which any feature occurs.
Patients who had >2 exacerbations requiring oral systemic glucocorticoids in the past year may be considered the same as patients who have persistent asthma…even in the absence of impairment levels consistent with persistent asthma.
what is the initial treatment for asthma at home?
