PEDIATRICS Flashcards
Week 4
What are the ages for the Pediatric Stages of Development?
Neonate:
Infant:
Child:
Adolescent:
Neonate: Birth -> 1 month
Infant: 1 month -> 1 year of age
Child: 1 -> 12 years of age
Adolescent: 12 -> 18 years of age
True or false:
Nonspecific concerns about a young infant’s behavior, feeding, or sleeping pattern may be tip-offs to a serious underlying illness or injury
true
Describe the larynx’s location in a child
It is high and anterior, at the level of C3-C4
Describe the epiglottis in a child
It is long, stiff and U-shaped
True or false:
In pediatrics, cardiac output is rate dependent
true
What is the narrowest part of a child’s airway?
The cricoid (ring)
What are 2 reasons why infants may appear o have a distended abdomen?
- Weak abdominal muscles
- The size of solid organs (vulnerable to blunt trauma)
In infants, where do they liver and spleen extend below?
Below the rib cage
What is the formula to estimate the amount of blood in pediatrics?
80ml/kg
True or false:
Pediatrics have a good ability to compensate by constricting their peripheral vasculature = increase to systemic vascular resistance (maintaining BP & increased HR)
true
In pediatrics, what is a very late sign that they are compensating very poorly?
Hypotension/low blood pressure
In pediatrics, what if bulging of the fontanelle a sign of?
Spinal meningitis
Why are pediatrics prone to febrile seizures?
Because their immature CNS system makes them susceptible to an influx in temperature regulation
Until what age does the fontanelle remain open?
18 months
What are 6 things that can result from a low body temperature in babies and infants (pediatrics)?
- Respiratory depression
- Acidosis
- Decreased cardiac output
- Increases the duration of action of drugs
- Decreases platelet function
- Increases the risk of infection
Pediatrics/neonates have a poorly formed blood brain barrier, what effect do drugs have on their blood brain barrier as a result of it being poorly formed?
Drugs such as barbiturates, opioids and antibiotics, and bilirubin are able to cross the blood brain barrier easier causing a prolonged and variable duration of action
In pediatrics, why are fractures more common than sprains?
Because their bones are weaker than their ligaments
True or false:
Babies and infants have poorly developed shivering, sweating and vasoconstriction mechanisms
true
By what stage in life will most growth plates be closed?
Late adolescence
What are the heart rate values for the following ages:
0-3 months
3-6 months
6-12 months
1-3 years
6 years
10 years
0-3 months: 90-180
3-6 months: 80-160
6-12 months: 80-140
1-3 years: 75-130
6 years: 70-110
10 years: 60-90
What is the formula to help estimate what a pediatrics’ pulse should be?
150 - (5 x age)
What are the respiratory rate values for the following ages:
0-3 months
3-6 months
6-12 months
1-3 years
6 years
10 years
0-3 months: 30-60
3-6 months: 30-60
6-12 months: 25-45
1-3 years: 20-30
6 years: 16-24
10 years: 14-20
What is the formula that estimates the normotension value in pediatrics, based on their age?
(2 x age) + 90
What is the formula that estimates the hypotension value in pediatrics, based on their age?
(2 x age) + 70
What is the formula to estimate the weight of a pediatric patient, based on their age?
(2 x age) + 10 kg
As per the BLS, what are the blood glucose level values for <2 years and >or=2 years?
< 2 years: <3.0 mmol/L
>or= 2 years: <4.0 mmol/L
What are the 3 categories in the Pediatric Assessment Triangle?
- Appearance
- Circulation
- Work of Breathing
What are the criteria for the Appearance category of the Pediatric Assessment Triangle?
- Tone
- Interactiveness
- Consolability
- Look/Gaze
- Speech
What are the criteria for the Work of Breathing category of the Pediatric Assessment Triangle?
- Breath Sounds
- Positioning
- Retractions
- Flaring
- Apnea/Gasping
What does the TICLS mnemonic, used to scale appearance in pediatrics, stand for?
T: Tone
I: Interactiveness
C: Consolability
L: Look or gaze
S: Speech or cry
What are the criteria for the Circulation category of the Pediatric Assessment Triangle?
- Pallor
- Mottling
- Cyanosis
What are 5 abnormal airway sounds?
- Snoring
- Muffled or hoarse speech
- Stridor
- Grunting
- Wheezing
What are 3 examples of abnormal posturing?
- Sniffing position
- Tripod position
- Refusing to lie down
What are 2 examples of retractions?
- Supraclavicular, intercostal, or substernal retractions of the chest wall
- Head bobbing in infants
How is flaring observed in pediatrics?
Flaring of the nares on inspiration
What is Blow by Oxygen?
When you hold the oxygen tubing close to the patient’s face
What 5 things do you look for when assessing circulation adequacy?
- Pallor
- Mottling
- Cyanosis
- Determine the adequacy of cardiac output and core perfusion
- Circulation to the skin reflects the overall status of core perfusion
What is gurgling a result of?
Air moving thru a liquid; common with mucus in oropharynx
What is snoring a result of?
Air moving thru a partial obstruction; can be positional
What is stridor? What is it a result of?
It is a high pitch sound usually during inspiration, caused by blockage to the airway; larynx/trachea
When is audible wheezing heard?
During expiration
What are the 4 things you assess when determining ventilation adequacy?
- Depth: indicates volume, hyperventilating can cause hypoxia
- Hypoventilation: is not a number, but rather based on minute volume, which is Tidal volume x Resp. rate
- Rate: look at abdomen or chest rise while counting
- Effort: tracheal tugging, diaphragmatic breathing, sternal restrictions, nasal flaring, sternal retractions, etc..
What is pyrexia?
Febrile convulsions
What age are febrile convulsions most commonly seen?
< 6 years of age, the average is the 1st 2 years of life
What are 5 Signs/Symptoms of Febrile Convulsions?
- <5 minute, generalized tonic-clonic seizure activity
- Full body uncoordinated muscle activity
- Grunting
- Incontinence
- Increased secretions followed by a postictal phase
What is the postictal phase of febrile seizures?
When the child usually returns to normal over a period of time 2-10 minutes but ca be longer. They may cry, be irritable and/or lethargic
What is epilepsy?
A condition where a patient has recurrent seizures not provoked by any other illness, due to abnormal neural firing. Normally more than 2 seizures within 24 hours are required for a diagnosis
What type of seizure occurs in an isolated area of the brain?
A focal seizure
What type of seizure can occur throughout the brain?
A generalized seizure
What type of seizure is a result of the latter causing the classic tonic?
A stiffening seizure
What type of seizure is known as the “twitching” seizure?
A clonic seizure
What is Meningitis?
Inflammation of the meninges (the fluid membrane that surrounds the spinal cord and brain)
What can cause Meningitis?
Bacteria, viruses, or other microorganisms
What signs/symptoms can Meningitis present with?
- Decreased LOA
- Projectile vomiting
- Fever
- Petechial rash
- Headache
6 Nuchal rigidity (stiff neck) - Cold hands and feet
- Sensitivity to light
Regarding Meningitis, what is Kernig’s Sign?
Loss of ability to flex leg when supine or sitting
Regarding Meningitis, what is Brudzinski’s Sign?
Involuntary flexion of the arm, hip knee with neck is flexed
What are 9 signs/symptoms that can indicate dehydration in adults/children?
- Dizziness
- Tiredness
- Headache
- Thirst
- Dry mouth
- Crankiness
- Dark-colored pee
- Dry skin/poor skin turgor
- Constipation
What are 5 signs/symptoms that can indicate dehydration in infants?
- NO WET DIAPERS!!
- Dry mouth
- No tears
- Unusual tiredness
- Fever
True or false:
Regarding Asthma….bronchospasm, mucus production, and airway inflammation lead to obstruction and poor gas exchange which can/results in hypoxia
true
What are 6 common triggers of Asthma?
- Upper respiratory infections
- Environmental allergies
- Exposure to cold
- Changes in weather
- Physical activity
- Secondhand smoke
What are 3 general, clinical signs of Asthma?
- Frequent cough
- Wheezing
- General signs of respiratory distress
In what age in Bronchiolitis most common?
< 2 years
What is Bronchiolitis?
It is inflammation of the small airways in the lungs (bronchioles)
How can you differentiate Bronchiolitis from Asthma?
Bronchiolitis normally proceeds a viral infection, and is associated with fever
What is the most common cause of Bronchiolitis?
RSV
What is Croup?
A viral illness that causes swelling of the trachea, larynx, and bronchi causing respiratory distress (often inspiratory stridor) and a barking cough
What is the most common cause of Croup?
The most common cause in parainfluenza but is CAN also be bacterial
What is Epiglottitis?
A life threatening inflammatory condition of the epiglottis and nearby structures which can lead to near or complete airway obstruction
What are the 3 D’s associated with Epiglottitis?
- Drooling
- Dysphagia
- Distress
Does Epiglottitis or Croup have a rapid onset?
Epiglottitis
What is 1 non-pharmacological way you as a Paramedic can help manage Croup symptoms in your patients?
By exposing them to cool, humidified air (when you take them outside to you vehicle)
What are the 2 medication options that can be used to help manage Croup?
- EPINEPHrine
- Dexamethasone
What does Dexamethasone do?
it decreases inflammatory mediators and reverses increased capillary permeability; it can dramatically reduce the inflammation of airway obstruction secondary to Croup in pediatrics
What does EPINEPHrine do?
It reduces swelling in the airway and begins to work faster than Dexamethasone
What is Sudden Infant Death Syndrome (SIDS)?
It is used to define a healthy infant who dies by unknown causes
What is believed to be the suspected cause of SIDS?
An inappropriate response to hypoxia and hypercapnia
Why is blunt trauma the responsible MOI in more than 90% of pediatric injury cases?
Because pediatrics possess less muscle and fat mass compared to adults leaving them with less protection against forces transmitted in blunt trauma
What is the leading cause of death among children older than 1 year of age?
Pediatric trauma (MVCs, falls, and then submersions)
95% of SIDS cases have at least 1 risk factor which include:
Name 7 examples
- Sleeping prone
- Co-sleeping
- Maternal smoking during pregnancy
- Low birth weight
- Maternal age <20 years
- No prenatal care
- Overheating
What are 7 signs of head injuries in pediatrics?
- Bradycardia
- Hypoventilation
- Apnea
- Hypertension
- Seizures
- Bulging fontanelle in very young pt.s
- Vomiting
True or false:
Low GCS scores may not be as serious as in an adult pt. because they can still recover well even if decerebrate posturing is present
true
What is Commotio Cordis?
A condition where ventricular fibrillation and cardiac arrest occurs immediately upon an object (ball, baseball, hard hit from another person, etc..) striking the chest during the relative refractory period of the cardiac cycle
True or false:
Regarding MOI - Pediatric Struck vs vehicle…….Adults are often thrown up & over the hood while children tend to be thrown in front of the vehicle
true
What are the 3 injury/impact sites involved with a Pediatric being struck by a motor vehicle? What area of the body is affected at each site?
1st impact site: Bumper of car - Abdomen, pelvis, femurs
2cd impact site: Hood of car - Chest, head, face
3rd impact site: ground or road - Striking head
What type of injuries to bicycle handlebars typically cause in pediatric patients? Provide 3 specific examples
Compression injuries to the intra-abdominal organs
1. Duodenal hematomas
2. Pancreatic injuries
3. Vertebral fractures
What are 4 negative first impressions of a child that MAY indicate child abuse?
- Avoiding the parent(s) or caregiver(s)
- Avoiding eye contact with parent or caregiver
- Appears excessively fearful of parent/caregiver
- May be very compliant & easy to examine (almost too quiet)
True or false:
In pediatric shock patients, elevated HR is a late sign of compensated shock
true
True or false:
It is the legal obligation of the Paramedic/Paramedic crew to contact the Children’s Aid Society if they suspect child abuse
true
What are 3 negative physical examination finding that MAY indicate child abuse?
- Unusual scare in unusual areas (old burns/abrasions/bites)
- Bruising in various stages & located in unusual areas
- Deformed extremities from old #’s
