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ACP Practical Exam Preparation > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

What are formulas for estimating the weight and minimum SBP for children based on age?

A

Weight in kg: Age x 2 +8

Minimum SBP: 70 + 2 x Age

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2
Q

Give rough ranges for HR for:

  • neonates (0-28days)
  • infants (1-12 months)
  • toddlers (1-3 years)
  • pre-schoolers (3-6 years)
  • children (6-12 years)
A
  • neonates (0-28days)
    • 100-160
  • infants (1-12 months)
    • 100-180
  • toddlers (1-3 years)
    • 80-160
  • pre-schoolers (3-6 years)
    • 70-110
  • children (6-12 years)
    • 70-110
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3
Q

Give rough ranges for RR for:

  • neonates (0-28days)
  • infants (1-12 months)
  • toddlers (1-3 years)
  • pre-schoolers (3-6 years)
  • children (6-12 years)
A
  • neonates (0-28days)
    • 40-60
  • infants (1-12 months)
    • 25-45
  • toddlers (1-3 years)
    • 20-30
  • pre-schoolers (3-6 years)
    • 18-24
  • children (6-12 years)
    • 16-22
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4
Q

Give rough ranges for minimum SBP for:

  • neonates (0-28days)
  • infants (1-12 months)
  • toddlers (1-3 years)
  • pre-schoolers (3-6 years)
  • children (6-12 years)
A
  • neonates (0-28days)
    • 50-90
  • infants (1-12 months)
    • 65-110
  • toddlers (1-3 years)
    • 70-110
  • pre-schoolers (3-6 years)
    • 80-110
  • children (6-12 years)
    • 80-120

Use Minimum SBP = 70 + 2(age)

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5
Q

What are options for safely/appropriately conveying a child in the ambulance?

A
  • Preferred:
    • Child’s own car seat or Car bed
    • Pedimate (10-40lbs.)
  • Less preferred
    • In parent’s lap on stretcher
    • On stretcher with parent nearby
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6
Q

Give standard weight-based pediactric induction doses for ETI, including peri-intubation resuscitation, induction, and maintenance

A
  • Peri-intubation resuscitation
    • N/S bolus: 10mL/kg IV/IO
    • Epinephrine: 1.0mcg/kg IV/IO
  • Induction and maintenance
    • Ketamine: 1.0mg/kg IV/IO
      • Repeat 1/2 q.10-15
    • Midazolam: 0.1mg/kg
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7
Q

Give general dosing guidelines for pediatric Epinephrine administration:

  • Pressor
  • Intra-arrest
  • Anaphylaxis/asthma
  • Pre-arrest anaphylaxis/asthma
  • Croup
A
  • Pressor
    • 1mcg/kg IV/IO
    • 5mcg/kg IV/IO IF pre-arrest anaphylaxis (see below)
  • Intra-arrest
    • 0.01mcg/kg IV/IO (MAX 1mg)
    • 0.1mcg/kg ETT (MAX 10mg)
  • Anaphylaxis/asthma
    • 0.01mg/kg IM (MAX 0.5mg)
  • Pre-arrest anaphylaxis
    • 5mcg/kg IV/IO
  • Croup
    • 0.5mg/kg to a MAX of 5mg (most kids are 5mg in 5mL)
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8
Q

Give defibrillator and cardioversion energy doses for pediatrics

A
  • Synchronized cardioversion
    • 0.5-1.0J/Kg then 2J/Kg
  • Defibrillation
    • 2J/Kg then 4 J/Kg
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9
Q

Give general guidelines for pharmaceutical management of pediatric anaphylaxis (include doses and routes)

A
  • Epinephrine: 0.01mg/Kg IM (max 0.5mg)
  • N/S bolus: (5mL/kg bolus, repeat to max 20mL/Kg)
    • Target SBP = 70 + 2(Age)
  • Diphenhydramine
    • 1mg/kg IM/IV (MAX 50mg)
  • Salbutamol
    • None if <10kg
    • 5x100mcg if 10-20kg
    • 10x100mcg if >20Kg
  • Epinephrine: 5mcg/kg IV if PRE-ARREST
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10
Q

Give general guidelines for pharmaceutical management of pediatric asthma (include doses and routes)

A
  • Salbutamol (MDI)
    • None if <10kg
    • 5x100mcg if 10-20kg
    • 10x100mcg if >20Kg
  • Salbutamol (Neb)
    • 5mg neb or 2.5mg if <1yr
  • Ipratropium
    • Call clinicall for dosing
  • Epinephrine
    • 0.01mg/kg IM (MAX 0.5mg)
  • Magnesium Sulfate
    • Check guideline for dosing!!!!
    • 50mg/kg IV over 15 minutes
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11
Q

What is the medication you promise to not forget about in asthma?

A

Magnesium sulfate you dummy!

50mg/kg IV over 15 minutes for pediatrics (MAX 2mg)

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12
Q

Is nebulized Epi indicated for use in epiglottitis?

A

NO!

Croup only

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13
Q

Give general guidelines for pharmaceutical management of pediatric PAIN (include doses and routes)

A
  • Acetaminophen
    • 15mg/kg (same as TXA) PO/PR
  • Entonox is second-line
  • Fentanyl
    • 1-2mcg/kg IV/IM/IO (MAX 50mcg single / 200mcg total)
    • 1.5-2mcg/kg IN (MAX 100mcg single)
  • Ketamine
    • 1.5mg/kg IN
    • 0.5mg/kg IM
    • 0.3mg/kg IV/IO
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14
Q

Do pediatric patients generally require higher or lower doses of opioids for equianalgesia?

A

HIGHER!

twice as much fentanyl!

  1. 0-2.0mcg/kg IM/IV/IO (Max 50mcg per dose)
  2. 5-2.0mcg/kg IN (Max 100mcg)
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15
Q

Describe Mark’s special 15/1.5/1.5/0.15 rule for pediatric analgesia!

A
  • 15mg/kg acetaminophen
  • 1.5 mcg/kg IM/IV/IO/IN Fentanyl
    • Actual is 1-2mcg/kg IV/IM/IO (MAX 50mcg single / 200mcg total) OR
    • 1.5-2mcg/kg IN (MAX 100mcg single)
  • 1.5 mg/kg IN Ketamine
    • 1.5mg/kg IN
  • 0.15 comes from 0.15 = (0.3)x(0.5) for IV/IM ketamine
    • 0.5mg/kg IM
    • 0.3mg/kg IV/IO

Rough starting point for pediatric dosing. The high-yield ones are in the middle (IN fentanyl and Ketamine)

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16
Q

Give general guidelines for pharmaceutical management of pediatric Seizures (include doses and routes)

A
  • Midazolam
    • 0.2mg/kg IM/IN (MAX 10mg)
    • 0.1mg/kg IV/IO (MAX 5mg)
  • D10W if warranted
    • 5mL/kg (same as fluid bolus dosing, but MAX of 250mL)
  • Acetaminophen (antipyresis)
    • 15mg/kg
17
Q

Give general guidelines for pharmaceutical management of pediatric Trauma (include doses and routes)

A
  • Shock
    • N/S bolus
      • 5-10mL/Kg, MAX 20mL/Kg
      • Target SBP > 70 + 2(Age)
    • TXA
      • 15mg/kg (MAX 1g) over 10 minutes)
      • Not for infants (<1yr)
  • Pain
    • Use the 15/1.5/1.5 rule
    • 15mg/kg tylenol, 1.5mcg/kg IN/IV/IM Fentanyl, OR 1.5mg/kg IN ketamine
  • PSA
    • 0.1-0.5mg/kg Ketamine (any route will do)
18
Q

Give general guidelines for pharmaceutical management of pediatric Croup (include doses and routes)

A
  • Epinephrine
    • 0.5mg/kg to a MAX of 5.0mg/kg Nebulized in 5mL N/S
  • Acetaminophen
    • 15mg/kg PO/PR
19
Q

Is there an age limit for needle thoracentesis in trauma?

A

No!

20
Q

What is the significance of the 5mm hashmarks on the EZ-io needle?

A

At least one must be visible above the skin when the needle hits bone, before beginning to drill. If not, the needle is too short.

21
Q

Is aspiration of blood/bone barrow recommended by the EZ/IO manufacturer?

A

YES! Both before AND after flushing the site

It may not be possible to aspirate prior to flushing, but you should still try.

22
Q

What is the preferred site of IO access in pediatrics?

A

The proximal medial tibial plateau, approximately 1cm below the patella

23
Q

Is CPAP indicated for pediatrics?

A

nope, 13 and up only

24
Q

Describe general management of pediatric tachyarrhythmia

A
  • Consider whether compensatory or primary arrhythmia (HR>180 for children or >220 for infants is likely arrhythmia)
  • If Compensatory, treat underlying cause (fluids, oxygenation, ventilation, etc.)
  • If NCT, only treat if unstable
    • Valsalva
    • Adenosine (0.1 & 0.1 mg/kg IV, MAX 6 & 12)
    • PSA and synchronized cardioversion
      • 0.5-1J/Kg, then 2J/Kg
    • PSA = 0.5mg/kg ketamine + 1.5mcg Fentanyl (regardless of route)
  • If WCT, pretty much the same….
    • Adenosine (0.1 & 0.1 mg/kg IV, MAX 6 & 12)
    • PSA and synchronized cardioversion
      • 0.5-1J/Kg, then 2J/Kg
    • PSA = 0.5mg/kg ketamine + 1.5mcg Fentanyl (regardless of route)
25
Q

Describe general management of pediatric Bradyarrhythmia

A
  • This is Badness, have a low threshold to do stuff NOW!
  • If HR<60, attempt to correct with oxygenation/ventilation for 30s, if no improvement move to CPR
  • Consider fluids if no Hx of CHD
  • Atropine
    • 0.01mg/kg IV or 0.02mg/kg ETT (max 0.6 or 1.2mg)
  • Epinephrine
    • Use intra-arrest dose
    • 0.01mg/kg IV or 0.1mg/kg ETT
  • Transcutaneous pacing
26
Q
A

ACP Practical Exam Preparation (10 decks)

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