Pediatrics Flashcards
When does the Anterior Fontanelle close?
12-18 months
When does the Posterior Fontanelle close?
2 months
Anatomic specifics
Bones of the skull are softer and separated by cartilage until age 5.
Blunt force trauma and broken bones indicate significant MOI and potential of bleeding.
Children will not demonstrate hypotension until acute blood loss totals?
25% of circulating volume
What influences heat loss?
Larger ratio of body surface area to volume
Pediatric assessment triangle
Appearance
work of Breathing
Circulation
Respiratory/Airway differences?
Larger tongue
<10 years, narrowest portion of airway is cricoid
O2 consumption in infants is double of an adult.
ETT sizing formula over 1 year
(Age + 16) / 4
ETT sizing norms <1 year
Premature Neonate = 2.5-3.0
Term Neonate = 3.0-3.5
3 mo - 1 year = 3.5-4.0
Estimated Blood Volume (EBV)
Premature Neonate = 90-100 ml/kg
Term Neonate = 80-90 ml/kg
3 mo - 1 year = 70-80 ml/kg
>1 year = 70 ml/kg
Maximum Allowable Blood Loss (MABL)
EBV x (current Hct - minimum acceptable Hct) / Current Hct
Emergency Fluid Resuscitation
Infant / neonate = 10 ml/kg
Child = 20 ml/kg
3:1 ratio of crystalloids to blood. Use blood early in trauma
Iv Maintenance Infusion Rates
4 ml/kg for 1st 10kg
2 ml/kg for 11th -20th kg
1 ml/kg for every kg >20
(Example: 25kg =65 ml/hr)
Hypoglycemia in pediatrics
Neonates = <40 mg/dl Child = <60 mg/dl
Hypoglycemia treatment
1-2 mg/kg
Neonates use D10
Child use D25
How to make D10 and D25
D25% = Discard 25ml of D50, replace with 25ml of NS D10% = Discard 40 ml of D50, replace with 40ml of NS
Cardioversion Joules?
0.5-1.0 J/kg (on sync)
Defibrillation Joules?
2 J/kg, then 4 J/kg
Resuscitation drug doses?
Adenosine, Atropine, Epi 1:10, Epi 1:10
Adenosine = 0.1-0.2 mg/kg
Atropine = 0.02 mg/kg (min 0.1, max 0.5)
Epi 1:10 = 0.01mg/kg
Epi 1:1 = 0.1 mg/kg
1 cause of pediatric traumatic deaths?
Motor vehicle accidents
Child abuse injuries
Most common injuries are skin
Most common fatal injuries are head
Skeletal injuries best to determine long term abuse.
Comminuted Fracture
Bone broken into fragments
Compound Fracture
Bone is broken and piercing skin
Compressed Fracture
One bone is forced against the other
Displaced Fracture
End of bones are not aligned
Greenstick Fracture
Periosteum divided on only one side
Pathological Fracture
Occurs because of bone deficit
Simple Fracture
Straight and in good alignment
Spiral Fracture
Results from twisting motion
Isolette use
<10 lbs or 30 days
Thermoregulation issues
Sound / light /stimulus discipline
Stay out of it!
Status changes with temperature
Hot = fussy, tachycardic.
Cold = Bradycardic, hypotension, obtunded.
Define and Treat Diaphragmatic Hernia
Bowels causing lung compression
Intubation / PPV for resp distress.
OG tube with suction
NPO
Define and Treat Choanal Atresia
Bony structure occluding nasopharyngeal airway. Oral airway access using OPA or ETT if needed.
Treatment of Aspiration Pneumonia
If brisk, monitor only.
If lethargic, intubate
ET suctioning acceptable but discouraged unless necessary.
Consider risk of Tracheal-Esophageal fistula.
What is the most common Congenital Heart Defect?
Ventricular Septal Defect
What drug maintains patency of the PDA?
Prostaglandin
What drug closes the PDA?
Oxygen and Indomethacin
What is the PDA?
Patent Ductus Arteriosus : Vessel connecting the Pulmonary Artery to Aorta.
Functionally closes at birth, anatomically at 21 days.
What are Cyanotic lesions?
Any condition with mixing of unoxygenated and oxygenated blood.
Commonly causing a cyanotic appearance.
What are Acyanotic lesions?
Blood returning to the right atrium has passed through the lungs like normal.
Types of Acyanotic lesions
Atrial Septal Defect Ventricular Septal Defect Atrial / Ventricular Septal Defect Aortic Stenosis Pulmonary Stenosis
Types of Cyanotic lesions
Transposition of Great Vessels Tetralogy of Fallot Total Anomalous Pulmonary Venous Return Truncus Arteriosus Tricuspid Atresia Hypoplastic Left Heart Syndrome
Endotracheal tube suctioning guidelines
Suction 0.5-1cm past ETT depth
80-100 mmHg of pressure
Hyperoxygenate to prevent desaturation
Use new tube each time
10, 11, 12 rule
Uncuffed tube under 10
Needle cricothyrotomy only under 11
No nasal intubation under 12
Rule of 9’s for pediatrics
Arm- 9% Head and neck- 18% Leg- 14% Anterior trunk - 18% Posterior trunk - 18%
Most common predictor of sepsis in a neonate
Neutropenia
Most common side effect of prostaglandin therapy
Hypoventilation or apnea
Treatment of esophageal atresia
Elevate head of bed
NG/OG
Common sign of neonate distress
Hiccoughing
In transporting an infant with neural defects, which position is optimal?
Prone-kneeling position
In which position should an infant with gastrointestinal anomalies be transported?
Side laying with head slightly elevated
Prostaglandin dose
0.03 - 0.1 mcg/kg/min
Why do children under 10 require uncuffed ETT?
Their cricoid cartilage acts as a functional cuff
Cuffs add increased pressure on soft tissues
Top 3 killers of neonates in the first 24 hours
- Sepsis
- Respiratory complications
- Cardiac problems
Neonatal sepsis
Occurs in utero often due to Premature Rupture Of Membranes (PROM)
Most commonly caused by Group B Strep
S/S of infant seizures
Lip smacking
Tounge thrusting
Eye fluttering
Lowered O2 sats
Common causes of infant seizures
Hypoglycemia
Opiod withdrawal
Interventricular hemorrhage (preterm infant bleeding inside brain)
What causes febrile seizures?
RATE of temperature increase (not overall temp)
Respiratory Distress Syndrome (RDS)
1 killer of premature infants
Surfactant deficiency
Surfactant ____ surface tension in the alveoli
Reduces
Omphalocele
Protrusion of viscera (arrest development of the abdominal wall)
Worse than Gastroschesis
Treat like an abdominal evisceration
Treatment of Omphalocele
Treat like abdominal evisceration:
Maintain body temp
Cover with moist, sterile dressings
Keep NPO
Will require surgical repair
Gastroschesis
Defect with completed development of internal organs.
Abdominal contents are coming out of the body on one side of the umbilical cord
Treatment of Gastroschesis
Treat like an abdominal evisceration:
Maintain normal body temp
Cover with moist, sterile dressings
Keep NPO
Will require surgical repair
Presentation of Ventriculoperitoneal shunt occlusion
Gastric distention Mental status change Decrease LOC Vomiting Seizures
Treatment of VP shunt
Give Mannitol
Raise head of bed 30*
S/S of shaken baby syndrome
Bulging fontanelles
Increased ICP
Retinal hemorrhages
Tetralogy of Fallot
Pulmonary Stenosis
Aortic Coarctation
Transposition of Great Vessels
Ventricular Septal Defect
An umbilical cord normally has 2 ____ and 1 ____.
Arteries
Vein (the big vessel on the umbilical cord)
Presentation of Tet spells
Sudden cyanosis and syncope
Treatment of Tet spells
Knees to chest
Morphine (decrease workload and calming effects)
If unsuccessful, then RSI with 100% O2
Normal pediatric systolic BP
90 + (2×Age)
Hypotensive systolic BP
70 + (2xAge)
Presentation of Croup (Swelling around vocal cords)
Gradual onset with URI, no drooling
Seal like barking cough
Steeple sign on neck x-ray
Treatment of Croup
Racemic Epinephrine
Decadron
Presentation of Epiglottitis (swelling of the epiglottis)
Sudden onset , drooling
Tripod position
Thumb sign on neck x-ray
Do not disturb child due to rapid airway loss!
Treatment of Epiglottitis
Keep child calm
Antibiotics
Humidified O2
Waddel’s Triad (child hit by car)
Car hits them
They hit the car
They hit the ground
