Pediatrics

Question 1

PALS shock energy

Answer 1

• First shock: 2 J/kg

- Subsequent shocks: 4 J/kg

Question 2

PALS epinephrine dose

Answer 2

0.01 mg/kg (1:10,000 solution)

Question 3

PALS meds that can be given via ETT

Answer 3

Lidocaine, atropine, naloxone & epinephrine (LANE)

Question 4

What is Legg-Calvé-Perthes disease?

Answer 4

Avascular necrosis of the femoral head

Question 5

What is Osgood-Schlatter syndrome?

Answer 5

Tibial tubercle apophysitis (inflammation/stress injury on or around growth plates)

Question 6

Difference between epiglottitis and bacterial tracheitis?

Answer 6

Both involve toxic-appearing children, however epiglottitis is RAPID in progression versus bacterial tracheitis, which has a URI prodrome similar to croup that gradually intensifies

Question 7

Cuffed ETT size

Answer 7

(Age/4) + 3.5

For uncuffed tube, add 0.5; only used in premature neonates

Question 8

Anatomic differences of pediatric airway

Answer 8

• Airway is funnel shaped with cricoid cartilage being the narrowest part
• Epiglottis is longer and narrower
• Larynx is more anterior and cephalad

Question 9

ETT depth formula

Answer 9

(3 x age)/2 + 12

Question 10

Hemolytic uremic syndrome etiology, presentation & management

Answer 10

• Etiology: E. Coli O157:H7 —> shiga-like toxin (verotoxin); can also be caused by S. pneumo (higher mortality)
• Presentation: prodrome of abdominal pain, vomiting & bloody diarrhea —> triad of AKI, thrombocytopenia & MAHA (schistocytes) —> seizures & lethargy
• Treatment: supportive with aggressive fluid resuscitation; eculizumab if severe CNS involvement (antibiotics worsen toxin release)

Question 11

Rubella presentation

Answer 11

(German measles)

Mild illness with low-grade fever, sore throat, HA, erythematous papular rash beginning on face and spreading to trunk & posterior cervical LAD.

Question 12

Kawasaki disease diagnosis

Answer 12

Fever for 5+ days and at least 4 of 5:

1. Bilateral bulbar conjunctival injection
2. Oral mucous membrane changes
3. Peripheral extremity changes (erythema/edema)
4. Polymorphous rash
5. Cervical LAD

(“CRASH” & burn)

Question 13

Pediatric anaphylaxis epinephrine dosing

Answer 13

0.01 mg/kg (1:1,000 concentration) IM q5-15m

Question 14

Pediatric dextrose dosing in hypoglycemia

Answer 14

<1 yr: D10, 5 mL/kg
1-8 yr: D25, 2 mL/kg
>8 yr: D50, 1 mL/kg

Estimate wt = (2 x age) +8

(“50 rule:” dose administered = 50 divided by concentration)