Pediatrics Flashcards
1
Q
What acronym to assess ped breathing
A
FRAP
Flaring
Retractions
Audible sounds
Positioning
2
Q
What survey to use on all peds during general assessment. What components?
A
PAT (pediatric assessment triangle)
Appearance
Work of breathing
Circulation
3
Q
What acronym for assessing a ped’s appearance
A
TICLS
Tone
Interactive ness
Consolable
Look/gaze
Speech/cry
4
Q
How to assess a ped’s circulation?
A
Skin
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
6
Q
how to assess if ped has low volume
A
Sunken eyes
Dry lips
Lack of tears
Skin tent
Cap refill
7
Q
Who must you inform with a mandatory abuse
A
Cops
Hospital
FL DCF
Documentation
8
Q
How to tell if ped is in distress failure or arrest?
A
Distress = 1 triangle side
Failure = 2
Arrest = 3
9
Q
System 1 vs system 2 thinking
A
System 1 is fast and automatic
10
Q
What is Restart the Heart? What acronym
A
CPR for peds:
ABCDE within 2 minutes
Arrive
BVM
Compress
Drill
Epi
11
Q
What kid is considered an adult in CPR
A
13 years or puberty or >60kg
12
Q
when do you use hand bore IO’s
A
<1year
13
Q
What’s the vaso pressor of choice for peds?
A
Epi
OLMC for norepi
14
Q
First thing to do for a neonate decompensating
A
Stimulate, position and warm
15
Q
Neonate has HR <100. What Rx?
A
Airway, suction, and BVm (w/ oxygen)
16
Q
Neonate has HR < 60, what Rx?
A
CPR
Epi (0.1mg/mL) if persistent
17
Q
When to document APGAR on a neonate
A
At 1 and 10 minutes
18
Q
why are BRUE’s serious
A
50% underlying medical condition
10% go to ICU
19
Q
Main priority in ped drownings / submersion
Considerations?
A
Suction and oxygenation
Consider spinal injury and vomit risk
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
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
22
Q
Ped sepsis Rx
A
Declare alert
MOVAB (BGL)
Fluid bolus - 10ml/kg
Epi drip infusion
23
Q
Can you facilitate intubate a kid?
A
Yes but only after OLMC
24
Q
How many weeks is a pregnancy
A
40
25
Pregnancy Pre-term, term, post-term (weeks)
<37 wks
38-42 wks
>42wks
26
How do womens’ bodies change during pregnancy/
More CO
More clotting
More blood volume
ACID REFLUX = high aspiration risk during intubation
27
How do pregnant women’s vitals differ from normal women
Higher HR 10-15lpm
ETCO2 baseline can be lower (<30)
Higher O2 consumption
28
Pedi mild choking Rx
Mild = let them cough, position of comfort & monitor
29
Pedi severe choking (but still responsive) Rx
Child = abd thrusts
Infant = back slaps x5, chest compress x5
30
Pedi choking (unresponsive) Rx
1. Direct laryngoscopy (magill forceps or intubate)
2. Try to push object > R main stem bronchus w/ ET tube
3. Last resort = cric
31
On a pedi unresponsive choking, where must the obstruction be in order for you to use the Magill forceps?
At or above the vocal cords
32
Which peds get a needle cric vs a surgical cric?
Needle cric = 10 or less
Surgical cric = >10
33
Pedi with acute onset resp distress w/ coughing, gagging, stridor, wheezing, but NO fever. What immediate concern?
Think choking
34
In pedi choking, which has higher priority?
Multiple intubations vs rapid transport
Rapid transport.
35
You can’t manage/control a pedi airway. What do you do?
Rapid transport to CLOSEST hospital
36
What concerns for a baby w/ mom hx gestational diabetes?
Blood sugar and oversized baby coming out
37
How long does it take a newborn baby’s SPO2 to go up to at least 85%
Up to 10minutes
38
What does APGAR stand for?
Activity
Pulse (100)
Grimace
Appearance (color)
Respirations
39
Pedi Asthma Rx?
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..
40
At what point during a pedi asthma, would you give epi?
ASAP if pt extreme, or after CPAP if pt slow improving
41
What to suction first on a baby? Mouth or nose? Why?
Mouth FIRST, then nose.
If you do opposite, they will instantly suck in their mouth.
42
What pneumonic for neonatal care if HR < 100
MR SOPA
Mask
Reposition
Suction
Open & bag
Pressure (increase until chest rise)
Airway (ETT or LMA)
43
What is the optimum bagging rate for a neonate?
“1 and 2 and 3 and BREATHE”
44
Compression / ventilation ratio on a neonate
3:1 until advanced airway
45
What’s the lowest weight pt that can get an IO
3 kg
46
What preferred IO sites for a baby?
Distal femur or proximal tibia
47
What age pts can you start using humoral IOS
About 8
48
Practical age for hand bore IOS
<3 years old per EMS Pedi RN presenter (but protocol says <1)
49
Most reliable HR monitoring method for neonates
ECG leads
50
Where to put a pulse ox on a neonate?
Right hand/wrist
51
Should you facilitate intubate a severe pedi asthma pt?
Protocol says DONT unless pt in respiratory arrest. Call OLMC for exceptions
52
Your severe pedi asthma pt changes from severe respiratory distress/wheezing to a silent chest. What’s wrong?
Think pre-respiratory arrest
53
Pedi asthmatic pt decompensates after intubation/CPAP. What’s up?
Think tension pneumothorax
54
QA measures for Pedi asthmatic
EtCO2
Bilateral lung sounds x2 (4min apart)
Solu-medrol
Improvements (resp or SPO2)
CPAP?
55
What age and weight limit for the CPR sensor puck?
<8 or <25g = DONT USE
56
What age is considered to be a pediatric cardiac arrest?
1-13 years
<60kg
or no signs of puberty yet
57
What drugs for a pediatric cardiac arrest
Vfib or pVtach =
Epi (0.1mg/mL), repeat per 3-5min (unlimited)
Amio, repeat x2 PRN
58
Pedi arrest general Rx
Restart the heart (ABCDE - arrive, bag, CPR, drill, Epi <2min)
59
What Rx for suspected hyper K during a pedi arrest
Sodium bicarb 4.2% (dilute 8.4% 1:1 w/ NS)
Calcium Chloride
60
Opioid Overdose Rx during a pedi arrest?
Narcan
61
Hypoglycemia Rx during a pedi arrest
D10
62
Suspected Cyanide exposure Rx during a pedi arrest?
Cyanokit
63
Your pedi arrest has suspected tension pneumo. What Rx?
Needle decompress
64
Pedi ROSC Rx
12 lead & BP
Maintain 90mmHg SBP via fluids & epi drip
Sedate with versed & fentanyl to maintain ETT
65
You ROSC pedi pt is fighting the tube. What Rx?
Versed and fentanyl; repeat x1 PRN
66
When to call OLMC during a pedi ROSC?
More sedation meds
Norepi
ECG interpretation assistance
67
Baby is just born and appears normal. What Rx?
Stimulate, position, warm & dry
Clear secreations
Infant > mom until transport
68
Can you transport a neonate with mom to the hospital?
NO. Call for 2 ambulances (there are 2 patients)
69
Neonate pt has HR <100. What Rx
MR SOPA
Mask
Reposition
Suction
O2
Positive pressure (BAG)
Advance airway PRN
70
Neonate has HR <60. What Rx?
MOVAB (monitor, O2, VS & IV, airway, breathing)
CPR x 1 min & re-assess
Epi (0.1mg/mL)
71
How often to obtain an APGAR score on a neonate
At 1 and 10min mark
72
We know to do CPR if a ped HR is <60… what age does that rule apply to?
Only INFANTS w/ signs of shock (<1 year)
73
Pedi bradycardia Rx?
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
When would you give atropine to a bradycardic pt?
If primary AV block, increased Vagal tone, cholinergic drug toxicity
75
When would you pace a bradycardic pt?
If 3rd degree AV block
76
How does a ped compensate for shock compared to an adult
Peds are heart rate dependent and can’t change their blood pressures as well.
77
Pedi tachycardia Rx
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
How to determine if a ped is unstable vs stable in a cardiac emergency?
CHAPS
Chest pain, hypotension (SBP < 90), altered, Pulmonary edema (acute heart failure), shock signs/symptoms
79
How to treat stable (wide or narrow) tachycardic peds?
1. Fluid bolus
2. Infant >220 or Child >180 = vagal, adenosine RIVP, amio drip over 20min (last resort)
80
What HR is considered a tachycardic emergency in infants and peds?
Infants > 220
Peds > 180
81
Pedi Unstable tachycardia Rx?
Consider versed sedation
Sync. Cardiovert > repeat until successful or rhythm corrects
82
Primary vs secondary tachycardia
Primary = direct heart issue
Secondary = indirect heart issue from dehydration, fever, pain, drugs, etc…
Secondary rates are USUALLY <150 bpm
83
What is higher priority in an unstable tachycardic pedi pt? 12-lead or cardioversion
Cardioversion
84
How to vagal an infant?
Bag of ice over upper half of infant’s face
85
Pedi allergic reaction and anaphylaxis Rx (severe vs moderate)
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…
3. Benadryl IV/IM
4. Solu-medrol SIVP
5. Albuterol, repeat x1
86
What to do next if you throw the kitchen sink at a pedi allergic reaction?
OLMC = more epi doses, or epi drip 1-4mcg/min
87
Moderate /mild pedi allergic Rx
Benadryl (IV or IM)
Solu-medrol SIVP
Albuterol x2
88
SS of severe allergic reaction
Swollen face, stridor/wheezing, low SBP & AMS
89
Pedi Altered Mental Status Rx
MOVAB (monitor/12-lead, O2, Vitals/IV, airway, breathing)
Treat the causes: shock, sugar, OD, arrhythmia, seizure, dehydration)
90
When would you consider an advanced airway on an altered pediatric?
All reversible causes (sugar, OD, dehydration, seizure) have been treated and BVM is ineffective
91
Your ped pt is altered and you’ve already check their rhythm, glucose, temp, and pupils. What’s a non-intuitive thing to consider?
Accidental ingestion of medication or foreign body
92
Why should you be cautious of using narcan on a kid whose mom was an addict.
The narcan could drive the ped into withdrawal symptoms
93
What is a BRUE?
Brief resolved unexplained event
94
BRUE Rx?
MOVAB (monitor/12-lead, O2, vitals/IV, airway, breathing)
- Full toe to head assessment
- convince mom to allow transport
95
Why are BRUE’s serious? Who experiences them the most?
Infants < 1year, especially 10-12mg s
50% have underlying med condition
10% end up in the ICU
96
Mom is refusing transport of her child who just had a BRUE. What next?
OLMC. Try to get her to consent transport.
97
What BGL is considered hypoglycemic in peds? Neonates?
Peds = <60mg/dL
Neonates = <45 mg/dL
98
You suspect hypoglycemia in a ped with an insulin pump. What to do next?
Turn it off
99
Pedi hypoglycemic Rx
IV
Oral glucose OR D10
Glucagon (last resort)
Reassess per 5-10min and repeat Rx PRN
100
What constitutes hypoglycemia in peds?
BGL < 60mg/dL (<45 in neonates) OR suspected hypoglycemia.
101
You can’t get a line on a hypoglycemic pt and are thinking of an IO. What must you do?
OLMC
102
Which types of babies are HIGHLY susceptible to hypoglycemia
Mom has hx gestational diabetes
103
Ped airway difference from adult when intubating
Ped is more anterior and superior and floppy
104
You suspect a ped of having DKA and mom wants to administer insulin. Yay or nay?
NAY. Rapid drop in BGL can cause brain damage or death
