Pediatric Respiratory Emergencies

Question 1

What are the three components of Pediatric Assessment Triangle?

PAT

Answer 1

1. appearance
2. work of breathing
3. circulation to skin

Question 2

What is the TICLS mnemonic when assessing the appearance in the PAT?

Answer 2

Tone

Is the patient:

• moving?
• limp?
• restless?
• What is the muscle tone?

Interactiveness

• How responsive?
• Paying attention?
• Does the child reach, grasp, or play?
• Uninterested?

Consolable

• Can the child be comforted?
• Is crying unrelieved?

Look/Gaze

Does the child:

• fix their gaze?
• just stares?

Speech/Cry

• Is the cry strong or weak?
• Is speech appropriate for their age?

Question 3

What do you look for when assessing the work of breathing in PAT?

Answer 3

• abnormal airway sounds
• abnormal posturing
• retractions
• flaring

Question 4

What do you look for when assessing the circulation of skin in PAT?

Answer 4

• Pallor
• Mottling
• Cyanosis

Question 5

List the steps in removing a foreign body airway obstruction.

Answer 5

1. Hold the face down on the forearm and support the head and face with your hand.
2. Give five back blows.
3. Switch the child upright.
4. Give five chest thrusts with two fingers.
5. Check the airway.

Question 6

Treatment

unresponsive upper airway obstruction

Answer 6

Immediately begin CPR.

Try to visualize with DL after compressions for removal with Magill forceps.

Question 7

Define:

croup

Answer 7

A viral infection of the upper airway.

Question 8

List assessment findings for croup.

Answer 8

• Age typically < 5 yrs old
• Auscultation: stridor
• Bark cough
• Difficulty breathing

Question 9

Treatment

croup

Answer 9

• Allow the child to be comfortable and do not irritate.
• Racemic Epinephrine (2.25%): 0.5 ml mixed in 3ml normal saline.

Question 10

List assessment findings for Anaphylaxis.

Answer 10

• mild: urticaria, wheezing.
• severe: wheezing, hypotension, diffuse edema, shortness of breath, tachycardia.

Question 11

Treatment

Anaphylaxis

Answer 11

• Epinephrine: 0.01 mg/kg IM (1:1,000), Max .3mg every 5 mins.
• Diphenhydramine: 1-2 mg/kg, Max 50mg IV.
• Albuterol: 1.25mg nebulized with 6 LPM O₂.

Question 12

Define:

Epiglottitis

Answer 12

A bacterial infection of supraglottic structures.

Question 13

List assessment findings for Epiglottitis.

Answer 13

• Sitting upright in sniffing position.
• drooling
• stridor
• muffled voice

Question 14

Treatment

Epiglottitis

Answer 14

• Rapid transport

Do not:

• agitate the pt
• start an IV
• visualize the oropharynx

Consider giving nebulized normal saline.

Question 15

Treatment

Asthma

Answer 15

• Albuterol/Atrovent: 1.25 mg / 250 mcg
• Epinephrine: 0.01 mg/kg IM, Max 0.3mg (1:1,000) every 5 mins.

Question 16

How can you deliver oxygen if a pediatric will not tolerate an NRB?

Answer 16

Blow-by technique

Question 17

How often do you ventilate a pediatric patient?

Answer 17

1 breath every 3-5 seconds

Question 18

What is the formula for the minimum systolic BP for children > 1 yr?

Answer 18

(Age x 2) + 80

Question 19

What is the minimum systolic BP for an infant?

Answer 19

> 70 mmHg