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Pinellas County Protocol 2023 > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

What acronym to assess ped breathing

A

FRAP

Flaring
Retractions
Audible sounds
Positioning

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2
Q

What survey to use on all peds during general assessment. What components?

A

PAT (pediatric assessment triangle)

Appearance
Work of breathing
Circulation

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3
Q

What acronym for assessing a ped’s appearance

A

TICLS

Tone
Interactive ness
Consolable
Look/gaze
Speech/cry

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4
Q

How to assess a ped’s circulation?

A

Skin

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5
Q

How does a pediatric assessment differ from an adult in the systematic approach?

A

Scene
General impressions (PAT)
Primary (quick vs not quick)
Secondary (toe to head assessment)

*consider abuse

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6
Q

how to assess if ped has low volume

A

Sunken eyes
Dry lips
Lack of tears
Skin tent
Cap refill

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7
Q

Who must you inform with a mandatory abuse

A

Cops
Hospital
FL DCF
Documentation

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8
Q

How to tell if ped is in distress failure or arrest?

A

Distress = 1 triangle side
Failure = 2
Arrest = 3

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9
Q

System 1 vs system 2 thinking

A

System 1 is fast and automatic

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10
Q

What is Restart the Heart? What acronym

A

CPR for peds:

ABCDE within 2 minutes

Arrive
BVM
Compress
Drill
Epi

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11
Q

What kid is considered an adult in CPR

A

13 years or puberty or >60kg

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12
Q

when do you use hand bore IO’s

A

<1year

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13
Q

What’s the vaso pressor of choice for peds?

A

Epi

OLMC for norepi

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14
Q

First thing to do for a neonate decompensating

A

Stimulate, position and warm

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15
Q

Neonate has HR <100. What Rx?

A

Airway, suction, and BVm (w/ oxygen)

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16
Q

Neonate has HR < 60, what Rx?

A

CPR

Epi (0.1mg/mL) if persistent

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17
Q

When to document APGAR on a neonate

A

At 1 and 10 minutes

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18
Q

why are BRUE’s serious

A

50% underlying medical condition

10% go to ICU

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19
Q

Main priority in ped drownings / submersion

Considerations?

A

Suction and oxygenation

Consider spinal injury and vomit risk

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20
Q

Should you allow caretaker to give insulin to a diabetic ped emergency? Why or why not?

A

NO. Rapid BGL drop can = brain damage

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21
Q

Ped sepsis indicator

A

Suspected infection AND 2 below:

Tachycardia / weak thready

Tachypnea or EtCO2 30 or less

Hypotension’s or cap refill >3s or mottled skin

Acute AMS

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22
Q

Ped sepsis Rx

A

Declare alert

MOVAB (BGL)

Fluid bolus - 10ml/kg

Epi drip infusion

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23
Q

Can you facilitate intubate a kid?

A

Yes but only after OLMC

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24
Q

How many weeks is a pregnancy

A

40

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25
Q

Pregnancy Pre-term, term, post-term (weeks)

A

<37 wks

38-42 wks

> 42wks

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26
Q

How do womens’ bodies change during pregnancy/

A

More CO

More clotting

More blood volume

ACID REFLUX = high aspiration risk during intubation

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27
Q

How do pregnant women’s vitals differ from normal women

A

Higher HR 10-15lpm

ETCO2 baseline can be lower (<30)

Higher O2 consumption

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28
Q

Pedi mild choking Rx

A

Mild = let them cough, position of comfort & monitor

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29
Q

Pedi severe choking (but still responsive) Rx

A

Child = abd thrusts

Infant = back slaps x5, chest compress x5

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30
Q

Pedi choking (unresponsive) Rx

A
  1. Direct laryngoscopy (magill forceps or intubate)
  2. Try to push object > R main stem bronchus w/ ET tube
  3. Last resort = cric
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31
Q

On a pedi unresponsive choking, where must the obstruction be in order for you to use the Magill forceps?

A

At or above the vocal cords

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32
Q

Which peds get a needle cric vs a surgical cric?

A

Needle cric = 10 or less

Surgical cric = >10

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33
Q

Pedi with acute onset resp distress w/ coughing, gagging, stridor, wheezing, but NO fever. What immediate concern?

A

Think choking

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34
Q

In pedi choking, which has higher priority?
Multiple intubations vs rapid transport

A

Rapid transport.

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35
Q

You can’t manage/control a pedi airway. What do you do?

A

Rapid transport to CLOSEST hospital

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36
Q

What concerns for a baby w/ mom hx gestational diabetes?

A

Blood sugar and oversized baby coming out

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37
Q

How long does it take a newborn baby’s SPO2 to go up to at least 85%

A

Up to 10minutes

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38
Q

What does APGAR stand for?

A

Activity
Pulse (100)
Grimace
Appearance (color)
Respirations

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39
Q

Pedi Asthma Rx?

A

MOVAB (monitor, O2, Vitals & IV, airway, breathing)

  1. Duoneb x2
  2. Albuterol PRN
  3. Solu-medrol SIVP
  4. CPAP
  5. Epi 1mg/mL anterolateral thigh, repeat x1 3-5min (give FIRST if severe)
  6. OLMC = more epi, epi drip..
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40
Q

At what point during a pedi asthma, would you give epi?

A

ASAP if pt extreme, or after CPAP if pt slow improving

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41
Q

What to suction first on a baby? Mouth or nose? Why?

A

Mouth FIRST, then nose.

If you do opposite, they will instantly suck in their mouth.

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42
Q

What pneumonic for neonatal care if HR < 100

A

MR SOPA

Mask
Reposition
Suction
Open & bag
Pressure (increase until chest rise)
Airway (ETT or LMA)

43
Q

What is the optimum bagging rate for a neonate?

A

“1 and 2 and 3 and BREATHE”

44
Q

Compression / ventilation ratio on a neonate

A

3:1 until advanced airway

45
Q

What’s the lowest weight pt that can get an IO

46
Q

What preferred IO sites for a baby?

A

Distal femur or proximal tibia

47
Q

What age pts can you start using humoral IOS

48
Q

Practical age for hand bore IOS

A

<3 years old per EMS Pedi RN presenter (but protocol says <1)

49
Q

Most reliable HR monitoring method for neonates

50
Q

Where to put a pulse ox on a neonate?

A

Right hand/wrist

51
Q

Should you facilitate intubate a severe pedi asthma pt?

A

Protocol says DONT unless pt in respiratory arrest. Call OLMC for exceptions

52
Q

Your severe pedi asthma pt changes from severe respiratory distress/wheezing to a silent chest. What’s wrong?

A

Think pre-respiratory arrest

53
Q

Pedi asthmatic pt decompensates after intubation/CPAP. What’s up?

A

Think tension pneumothorax

54
Q

QA measures for Pedi asthmatic

A

EtCO2
Bilateral lung sounds x2 (4min apart)
Solu-medrol
Improvements (resp or SPO2)
CPAP?

55
Q

What age and weight limit for the CPR sensor puck?

A

<8 or <25g = DONT USE

56
Q

What age is considered to be a pediatric cardiac arrest?

A

1-13 years

<60kg

or no signs of puberty yet

57
Q

What drugs for a pediatric cardiac arrest

A

Vfib or pVtach =

Epi (0.1mg/mL), repeat per 3-5min (unlimited)

Amio, repeat x2 PRN

58
Q

Pedi arrest general Rx

A

Restart the heart (ABCDE - arrive, bag, CPR, drill, Epi <2min)

59
Q

What Rx for suspected hyper K during a pedi arrest

A

Sodium bicarb 4.2% (dilute 8.4% 1:1 w/ NS)

Calcium Chloride

60
Q

Opioid Overdose Rx during a pedi arrest?

61
Q

Hypoglycemia Rx during a pedi arrest

62
Q

Suspected Cyanide exposure Rx during a pedi arrest?

63
Q

Your pedi arrest has suspected tension pneumo. What Rx?

A

Needle decompress

64
Q

Pedi ROSC Rx

A

12 lead & BP

Maintain 90mmHg SBP via fluids & epi drip

Sedate with versed & fentanyl to maintain ETT

65
Q

You ROSC pedi pt is fighting the tube. What Rx?

A

Versed and fentanyl; repeat x1 PRN

66
Q

When to call OLMC during a pedi ROSC?

A

More sedation meds

Norepi

ECG interpretation assistance

67
Q

Baby is just born and appears normal. What Rx?

A

Stimulate, position, warm & dry

Clear secreations

Infant > mom until transport

68
Q

Can you transport a neonate with mom to the hospital?

A

NO. Call for 2 ambulances (there are 2 patients)

69
Q

Neonate pt has HR <100. What Rx

A

MR SOPA

Mask
Reposition
Suction
O2
Positive pressure (BAG)
Advance airway PRN

70
Q

Neonate has HR <60. What Rx?

A

MOVAB (monitor, O2, VS & IV, airway, breathing)

CPR x 1 min & re-assess

Epi (0.1mg/mL)

71
Q

How often to obtain an APGAR score on a neonate

A

At 1 and 10min mark

72
Q

We know to do CPR if a ped HR is <60… what age does that rule apply to?

A

Only INFANTS w/ signs of shock (<1 year)

73
Q

Pedi bradycardia Rx?

A

MOVAB - monitor, O2, VS and IV, airway, breathing

Treat reversible causes (hypoxia, hypoventilation, hypoglycemia, OD)

  • if still brady = epi (0.1mg/mL) per 3-5min unlimited
  • Atropine (primary AV block, vagal, cholinergic)
  • Pace (3rd degree AV block)
  • fluid bolus, repeat x1 PRN
74
Q

When would you give atropine to a bradycardic pt?

A

If primary AV block, increased Vagal tone, cholinergic drug toxicity

75
Q

When would you pace a bradycardic pt?

A

If 3rd degree AV block

76
Q

How does a ped compensate for shock compared to an adult

A

Peds are heart rate dependent and can’t change their blood pressures as well.

77
Q

Pedi tachycardia Rx

A

MOVAB (monitor/12 lead, O2, VS /Vascular access, airway, breathing )

  • consider underlying causes
  • determine stable vs unstable & treat accordingly (CHAPS - chest pain, hypotension, altered, pulm edema (acute heart failure), shock)
78
Q

How to determine if a ped is unstable vs stable in a cardiac emergency?

A

CHAPS

Chest pain, hypotension (SBP < 90), altered, Pulmonary edema (acute heart failure), shock signs/symptoms

79
Q

How to treat stable (wide or narrow) tachycardic peds?

A
  1. Fluid bolus
  2. Infant >220 or Child >180 = vagal, adenosine RIVP, amio drip over 20min (last resort)
80
Q

What HR is considered a tachycardic emergency in infants and peds?

A

Infants > 220

Peds > 180

81
Q

Pedi Unstable tachycardia Rx?

A

Consider versed sedation

Sync. Cardiovert > repeat until successful or rhythm corrects

82
Q

Primary vs secondary tachycardia

A

Primary = direct heart issue

Secondary = indirect heart issue from dehydration, fever, pain, drugs, etc…

Secondary rates are USUALLY <150 bpm

83
Q

What is higher priority in an unstable tachycardic pedi pt? 12-lead or cardioversion

A

Cardioversion

84
Q

How to vagal an infant?

A

Bag of ice over upper half of infant’s face

85
Q

Pedi allergic reaction and anaphylaxis Rx (severe vs moderate)

A

Severe or anaphylactic (2+ organ systems)…

  1. Epi (1mg/mL) IM mid-anterolateral thigh, repeat x2 per 3-5min PRN
  2. Fluid bolus, repeat x1 PRN

Moderate…

  1. Benadryl IV/IM
  2. Solu-medrol SIVP
  3. Albuterol, repeat x1
86
Q

What to do next if you throw the kitchen sink at a pedi allergic reaction?

A

OLMC = more epi doses, or epi drip 1-4mcg/min

87
Q

Moderate /mild pedi allergic Rx

A

Benadryl (IV or IM)

Solu-medrol SIVP

Albuterol x2

88
Q

SS of severe allergic reaction

A

Swollen face, stridor/wheezing, low SBP & AMS

89
Q

Pedi Altered Mental Status Rx

A

MOVAB (monitor/12-lead, O2, Vitals/IV, airway, breathing)

Treat the causes: shock, sugar, OD, arrhythmia, seizure, dehydration)

90
Q

When would you consider an advanced airway on an altered pediatric?

A

All reversible causes (sugar, OD, dehydration, seizure) have been treated and BVM is ineffective

91
Q

Your ped pt is altered and you’ve already check their rhythm, glucose, temp, and pupils. What’s a non-intuitive thing to consider?

A

Accidental ingestion of medication or foreign body

92
Q

Why should you be cautious of using narcan on a kid whose mom was an addict.

A

The narcan could drive the ped into withdrawal symptoms

93
Q

What is a BRUE?

A

Brief resolved unexplained event

94
Q

BRUE Rx?

A

MOVAB (monitor/12-lead, O2, vitals/IV, airway, breathing)

  • Full toe to head assessment
  • convince mom to allow transport
95
Q

Why are BRUE’s serious? Who experiences them the most?

A

Infants < 1year, especially 10-12mg s

50% have underlying med condition

10% end up in the ICU

96
Q

Mom is refusing transport of her child who just had a BRUE. What next?

A

OLMC. Try to get her to consent transport.

97
Q

What BGL is considered hypoglycemic in peds? Neonates?

A

Peds = <60mg/dL

Neonates = <45 mg/dL

98
Q

You suspect hypoglycemia in a ped with an insulin pump. What to do next?

A

Turn it off

99
Q

Pedi hypoglycemic Rx

A

IV

Oral glucose OR D10

Glucagon (last resort)

Reassess per 5-10min and repeat Rx PRN

100
Q

What constitutes hypoglycemia in peds?

A

BGL < 60mg/dL (<45 in neonates) OR suspected hypoglycemia.

101
Q

You can’t get a line on a hypoglycemic pt and are thinking of an IO. What must you do?

102
Q

Which types of babies are HIGHLY susceptible to hypoglycemia

A

Mom has hx gestational diabetes

103
Q

Ped airway difference from adult when intubating

A

Ped is more anterior and superior and floppy

104
Q

You suspect a ped of having DKA and mom wants to administer insulin. Yay or nay?

A

NAY. Rapid drop in BGL can cause brain damage or death

Pinellas County Protocol 2023 (9 decks)

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