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Ontario PCP 2019/2020 > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Top causes of Pediatric Deaths

A 
MVC's
Burns
Drownings
Suicides
Homicides
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2
Q

Newborns range from…

A

First Hours after Birth

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3
Q

Neonates range from…

A

Ages Birth - 1 Month

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4
Q

Infants range from…

A

Ages 1 - 12 Months

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5
Q

Toddlers range from…

A

Ages 1 - 3 Years

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6
Q

Preschoolers range from…

A

Ages 3 - 5 Years

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7
Q

School - Aged children range from…

A

Ages 6 - 12 Years

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8
Q

Adolescents range from…

A

Ages 13 - 18 Years

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9
Q

Common Illnesses’s in Neonates are…

A

jaundice
vomiting
respiratory distress

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10
Q

Common illnesses’s in Infants are…

A 
foreign body airway obstructions (become a concern)
febrile seizures
vomiting
diarrhea
dehydration
bronchiolitis
car accidents
croup
child abuse
poisonings
falls
meningitis
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11
Q

only use an oral or nasal airway in pediatric patients only AFTER…

A

other manual manoeuvres have failed to keep the airway open

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12
Q

growth plate

A

the area just below the head of a long bone in which growth in bone length occurs; the epiphyseal plate

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13
Q

infants and children increase their cardiac output how?

A

increasing their heart rate.

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14
Q

pediatric assessment triangle

A

appearance
breathing
circulation

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15
Q

tachycardia is often the first …

A

manifestation of respiratory distress in infants

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16
Q

Normal Pulse Rate for Newborn

A

100-180

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17
Q

Normal Pulse Rate for Infant (0-5 months)

A

100-160

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18
Q

Normal Pulse Rate for Infant (6-12 months)

A

100-160

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19
Q

Normal Pulse Rate for Toddler (1-3 Years)

A

80-110

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20
Q

Normal Pulse Rate for Preschooler (3-5 Years)

A

70-110

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21
Q

Normal Pulse Rate for School Age (6-10 Years)

A

65-110

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22
Q

Normal Pulse Rate for Early Adolescence (11-14 Years)

A

60-90

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23
Q

Normal RR for Newborn

A

30-60

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24
Q

Normal RR for Infant (0-5 months)

A

30-60

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25
Q

Normal RR for Infant (6-12 months)

A

30-60

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26
Q

Normal RR for Toddler (1-3 Years)

A

24-40

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27
Q

Normal RR for Preschooler (3-5 Years)

A

22-34

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28
Q

Normal RR for School Age (6-10 Years)

A

18-30

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29
Q

Normal RR for Early Adolescence (11-14 Years)

A

12-26

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30
Q

Normal BP from Newborn - 3 Years

A 
systolic = 90 + 2 x age
Diastolic = app. 2/3 of systolic
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31
Q

Normal BP for Preschooler (3-5 Years)

A

Systolic average 98 (78 to 116)

Diastolic average 65

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32
Q

Normal BP for School Age (6-10 Years)

A

Systolic average 105 (80 to 122)

Diastolic average 69

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33
Q

Normal BP for Early Adolescence (11-14 Years)

A

Systolic average 114 (88 to 140)

Diastolic average 76

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34
Q

a low pulse in an infant or a child may indicate…

A

imminent cardiac arrest

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35
Q

Signs of Increased Respiratory Effort

A 
retraction
nasal flaring
head bobbing
grunting
wheezing
gurgling
stridor
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36
Q

retraction

A

visible sinking of the skin and soft tissues of the chest around and below the ribs and above the collarbone

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37
Q

nasal flaring

A

widening of the nostrils; seen primarily on inspiration

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38
Q

head bobbing

A

observed when the head lifts and tilts back as the child inhales and then moves forward as the child exhales

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39
Q

grunting

A

sound heard when an infant attempts to keep the alveoli open by building back pressure during expiration

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40
Q

wheezing

A

passage of air over mucous secretions in bronchi; head more commonly on expiration; a low or high pitched sound

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41
Q

gurgling

A

coarse, abnormal bubbling sound heard in the airway during inspiration or expiration; may indicate an open chest wound

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42
Q

stridor

A

abnormal, musical, high pitched sound, more commonly heard on inspiration.

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43
Q

conditions that place a pediatric pt. at risk of cardiopulmonary arrest..

A 
RR > 60
HR > 180 or <80 (under 5 years)
HR > 180 or <60 (over 5 years)
respiratory distress
trauma
burns
cyanosis
altered LOC
seizures
fever with petechia (small purple spots resulting from skin hemorrhages)
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44
Q

suctioning in a pediatric patient decrease the pressure to less than … in Infants

A

100mmHg in

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45
Q

suction less than… in order to decrease the possibility of hypoxia

A

less than 10 seconds

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46
Q

Suction Catheter for age up to 1 year

A

8

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47
Q

suction catheter for age 2 to 6 years

A

10

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48
Q

suction catheter for age 7 to 15 years

A

12

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49
Q

suction catheter for age 16 years

A

12 to 14

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50
Q

what may indicate the presence of an infection in a pediatric patient.

A 
fever
chills
tachycardia
cough
sore throat
nasal congestion
malaise
tachypnea
cool or clammy skin
perechia
respiratory distress
poor appetite
vomiting
diarrhea
dehydration
hypo-perfusion
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51
Q

stages of respiratory compromise

A

respiratory distress
respiratory failure
respiratory arrest

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52
Q

respiratory distress

A

mildest form of respiratory impairment.

earliest indicators is an increase is RR.

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53
Q

Respiratory Failure

A

occurs when respiratory system is not able to meet the demands of the body for oxygen intake and for carbon dioxide removal.
it is characterize by inadequate ventilation and oxygenation.
This ultimately leads to respiratory acidosis.
** marked tachypnea later deteriorating to bradypnea
poor muscle tone
central cyanosis
marked tachycardia later deteriorating to bradycardia

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54
Q

Respiratory Arrest

A

the end result of respiratory impairment if untreated.
** unresponsiveness deteriorating into a coma
bradypnea deteriorating to apnea
absent chest wall motion
bradycardia deteriorating to asystole
profound cyanosis
** respiratory arrest will quickly dteriorate to full cardiopulmonary arrest if appropriate interventions are not made

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55
Q

Managing respiratory compromise

A

establishment of an airway
high-flow supplemental oxygen administration
mechanical ventilation with a BVM device attached to reservoir delivering 100% oxygen
** CALL ACP

56
Q

whenever you find an infant, toddler or a young child in respiratory or cardiac arrest assume…

A

complete upper airway obstruction until proven otherwise

57
Q

Croup

A

laryngotracheobronchitis; a common viral infection of young children, resulting in edema of the subglottic tissues; characterized by barking cough and inspiratory stridor

58
Q

Assessing a child with Croup

A 
slow onset
generally wants to sit up
barking cough
no drooling
fever approx. 37.7 - 38.3
59
Q

Managing a child with Croup

A

place child in comfortably position and administer oxygen at 4 - 6 delivered by facemask or blow by with a nasal
You can also administer nebulized epinephrine or salbutamol
* YOU CAN ALWAYS PLACE THE CHILD BY AN OPEN WINDOW, OR RUN A HOT SHOWER AND OPEN A WINDOW*

60
Q

Epiglottitis

A

bacterial infection of the epiglottis, usually occurring in children older than age four; a serious medical emergency

61
Q

Assessing a child with Epiglottitis

A 
rapid onset
prefers to sit up
no barking cough
drooling; painful to swallow
fever approx. 38.8 - 40
occasional stridor
62
Q

Managing Epiglottitis

A

oxygen blow by or facemask
transport
it is considered critical

63
Q

bacterial tracheitis

A

bacterial infection of the airway, in the subglottic region; in children most likely to appear after episodes of croup

64
Q

assessing a child with bacterial trachetis

A 
the child usually experienced croup in the last few days
high grade fever
coughing up of pus and/or mucus. 
may have hoarse voice or sore throat
may have inspiratory/expiratory stridor
65
Q

managing bacterial tachetis

A

manage airway and breathing, providing oxygenation via a facemask or by blow by technique.

66
Q

common causes of upper-airway obstructions

A

croup
epiglottitis
bacterial tacheitis
foreign body aspiration

67
Q

Assessing a child with foreign body aspiration

A

child may have minimal or no air movement
if obstruction is partial - inspiratory stridor, a muffled or hoarse voice, drooling, pain in the throat, retractions and cyanosis

68
Q

Managing a child with a suspected aspirated foreign body

A

if partial make pt. comfortable and administer humidified oxygen.
do not try to look in the mouth
transport child to hospital
if complete obstruction, follow BLS removal, attempt ventilation with BVM, Call ACP,

69
Q

Asthma

A

a condition marked by recurrent attacks of dyspnea with wheezing due to spasmodic constriction of the bronchi, often as a response to allergens or by mucous plugs in the arterial walls.

70
Q

Asthma Triggers

A 
environmental allergens
cold air
exercise
foods
irritants
emotional stress
certain medications
71
Q

assessing a child with asthma

A

often have an inhaler
sitting up, leaning forward, and tachypneic. often associated with an unproductive cough
accessory muscle usage is usually evident
wheezing MAY be heard
tachycardia

72
Q

managing a child with asthma

A

correct hypoxia, reverse bronchospasm, and decrease inflammation.

establish an airway
administer supplemental oxygen
administer a nebulized bronchodilator

73
Q

status asthmaticus

A

requires immediate transport with aggressive treatment administered en route.

74
Q

status asthmaticus is defines as what

A

a severe prolonged asthma attack that cant be broken by aggressive pharmacological management.

75
Q

Bronchiolitis

A

viral infection of the medium sized airways, occurring most frequently during the first year of life

76
Q

pneumonia

A

is an infection of the lower airway and lungs. may be caused by bacterium or a virus.

77
Q

Assessing a child with pneumonia

A

history of a respiratory infection such as a severe cold or bronchitis.
S&S include
low grade fever, decreased breath sounds, crackles, rhonchi, and pain in the chest area.

78
Q

Managing a child with pneumonia

A

place patient in position of comfort

administer supplemental oxygen with nonrebreather

79
Q

common causes of lower airway distress

A

asthma
bronchiolitis
pneumonia
lower airway foreign body obstruction

80
Q

predisposing factors of pediatric shock

A 
hypothermia
dehydration (vomiting, diarrhea)
infection
trauma
blood loss
allergic reactions
poisoning
cardiac events
81
Q

compensated shock

A 
early shock
the pt will be normotensive
S&amp;S
irritability or anxiety
tachycardia
tachypnea
weak peripheral pulses, full central pulses
delayed capillary refill (>2 seconds in children <6 years of age)
cool pale extremities
normotensive
decreased urinary output
82
Q

A slight increase in the heart rate is one of the …

A

earliest signs of shock

83
Q

Decompensated shock

A

develops when the body can no longer compensate for decreased tissue perfusion.

84
Q

what is the biggest hallmark of decompensated shock?

A

a fall in blood pressure

85
Q

Signs and symptoms of decompensated shock

A 
lethargy or coma
marked tachycardia or bradycardia
absent peripheral pulses, weak central pulses
markedly delayed capillary refill
cool, pale, dusky, mottled extremities
hypotension
markedly decreased urinary output
absence of tears
86
Q

managing decompensated shock

A

Aggressive treatment measures
BVM
100% Oxygen

87
Q

irreversible shock

A

when treatment measures are inadequate or too late to prevent significant tissue damage and death

88
Q

cardiogenic shock

A

the inability of the heart to meet the metabolic needs of the body, resulting in inadequate tissue perfusion

89
Q

noncardiogenic shock

A

types of shock that result from causes other than inadequate cardiac output

90
Q

hypovolemic shock

A

decreased amount of intravascular fluid in the body; often due to trauma that causes blood loss into a body cavity or frank external hemorrhage; in children, can be the result of vomiting and diarrhea

91
Q

distributive shock

A

marked decrease in peripheral vascular resistance with resultant hypotension; examples include septic shock, neurogenic shock, and anaphylactic shock

92
Q

what is sepsis ?

A

an infection of the blood stream by some pathogen, usually bacterial.

93
Q

signs & symptoms of sepsis?

A 
ill appearance
irritability or altered mental status
fever
vomiting and diarrhea
cyanosis, pallor, or mottled skin
nonspecific respiratory distress
poor feeding
94
Q

signs and symptoms of septic shock?

A 
very ill appearance
altered mental status
tachycardia
capillary refill time >2 seconds
hyperventilation, leading to respiratory failure
cool and clammy skin
inability of child to recognize parents
95
Q

treating sepsis

A

oxygen

IV 20ml/kg bolus

96
Q

anaphylactic shock

A 
results from exposure to an antigen. 
tachycardia
tachypnea
wheezing
urticaria
anxiety
edema
hypotension
97
Q

neurogenic shock

A

due to sudden peripheral vasodilation resulting from interruption of nervous control of the peripheral vasuclar system.

98
Q

cardiogenic shock results from what?

A

inadequate cardiac output. in children can be caused by such as near drowning or toxin ingestion

99
Q

congenital

A

present at birth.

100
Q

How does Congenital Heart Disease occur?

A

occurs when blood going to the lungs for oxygenation mixes with blood bound for other parts of the body. this may result from holes in the internal walls of the heart of from abnormalities of the great vessels.

101
Q

Tetralogy of Fallot, a type of congenital heart disease with a right to left shunt is often characterized by what?

A

cyanotic episodes which are relieved by squatting

102
Q

what is the most common dysrhythmias in children?

A

bradydysrythmias

103
Q

DONT FORGET TO REVIEW ALGORITHM

A

Brady’s
ALS
BLS
Companion Document

104
Q

status epilepticus

A

prolonged seizure or multiple seizures with no regaining of consciousness between them

105
Q

febrile seizures

A

seizures that occur as a result of a sudden increase in body temperature; occur most commonly between ages 6 months and 6 years

106
Q

seizures result from what?

A

an abnormal discharge or neurons in the brain

107
Q

febrile seizure should be suspected if what?

A

the temperature is >39.2

108
Q

Managing a child with a seizure

A 
place patient on floor or on bed
lay them on their side away from furniture
do not restrain
administer supplemental oxygen
take and record all vital signs

if patient is febrile remove excess layers of clothing while avoiding extreme cooling.

109
Q

If status epilepticus is present what should you do?

A 
start an iv of normal saline
administer diazepam (CALL AN ACP)
110
Q

what is meningitis

A

infection of the meninges, the lining of the brain and spinal cord. can result from both bacteria and viruses.

111
Q

Assessing a child with meningitis

A 
child may be ill for one day to several
recent ear or resp. tract infection
high fever
lethargy or irritability
severe headache
stiff neck
2nd assessment - child will appear very ill
fontanelle may be bulging or full
112
Q

hyperglycemia

A

abnormally high concentration of glucose in the blood.

113
Q

diabetic ketoacidosis

A

complication of diabetes due to decreased insulin secretion or intake; characterized by high levels of blood glucose, metabolic acidosis and in advanced stages, coma; often referred to as diabetic coma.

114
Q

Early signs of hyperglycemia

A

increased thirst
increased urination
weight loss

115
Q

late signs of hyperglycemia

A 
weakness
abdominal pain
generalized aches
loss of appetite
nausea
vomiting
signs of dehydration. except increased urinary output
fruity breath odour
tachypnea
hyperventilation
tachycardia
116
Q

signs of ketoacidosis

A

continued decreased level of consciousness progressing to coma
kussmaul respiration’s (deep and slow)
signs of dehydration

117
Q

What should you look for if you have suspicion of ingestion poisoning in a child?

A 
level of responsiveness
pupil size
skin and mucosa findings 
mouth signs (burns/pain when swallowing)
nausea/vomiting
diarrhea (blood present)
118
Q

Managing a poisoned child

A 
responsive patient
   administer oxygen
   obtain IV access
   transport (take all pills substances and containers to hospital)
   monitor patient continuously

Unresponsive patient
ensure airway is patent. apply suctioning if needed
administer oxygen
be prepared to provide artificial ventilation’s if
respiratory failure or cardiac arrest is present
contact medical direction and/or the poison control centre
transport
monitor the patient

119
Q

trauma is the ______________ of death in infants and children.

A

number one cause

120
Q

most common pediatric mechanisms of injury

A 
falls
MVC's
car pedestrian collisions
drownings and near-drownings
penetrating injuries
burns
physical abuse
121
Q

what are the signs of ICP

A

elevated blood pressure
bradycardia
rapid, deep respiration’s progressing to slow, deep respiration’s.
bulging fontanelle in infants

122
Q

what is a MILD brain injury in a child according to the GCS ?

A

13 - 15

123
Q

What is a MODERATE brain injury in a child according to the GCS?

A

9 - 12

124
Q

What is a SEVERE brain injury in a child according to the GCS?

A

equal to or less than 8

125
Q

signs and symptoms of herniation are..

A

asymmetrical pupils
decorticate posturing
decerebrate posturing

126
Q

how do you manage traumatic head injuries in a child?

A

high flow oxygen for mild to moderate

intubate a child with a GCS score of equal to or less than 8

127
Q

60-70% of pediatric fractures occur in what?

A

C1 - C2

128
Q

Most injuries to the chest and abdomen result from what ?

A

blunt trauma

129
Q

tension pneumothorax signs and symptoms

A

diminished breath sounds over the affected lung
shift of the trachea to the opposite side
a progressive decrease in ventilatory compliance

130
Q

signs and symptoms of a splenic injury

A

tenderness in LUQ
abrasions on the abdomen
hematoma of the abdomen wall

131
Q

signs and symptoms of liver injury

A

Pain in the RUQ or right lower chest pain

132
Q

bend fractures

A

fractures characterized by angulation and deformity in the bone without an obvious break

133
Q

buckle fractures

A

fractures characterized by a raised or bulging projection at the fracture site

134
Q

greenstick fractures

A

fractures characterized by an incomplete break in the bone

135
Q

Rule of 9’s for a child

A 
head = 18%
arms = 9 % each
back = 18%
front = 18%
legs = 14% each
136
Q

SIDS

A

sudden infant death syndrome

illness of unknown eticology that occurs during the first year of life, with the peak at ages 2 - 4 months

Ontario PCP 2019/2020 (8 decks)

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