Pediatrics Flashcards
Top causes of Pediatric Deaths
MVC's Burns Drownings Suicides Homicides
Newborns range from…
First Hours after Birth
Neonates range from…
Ages Birth - 1 Month
Infants range from…
Ages 1 - 12 Months
Toddlers range from…
Ages 1 - 3 Years
Preschoolers range from…
Ages 3 - 5 Years
School - Aged children range from…
Ages 6 - 12 Years
Adolescents range from…
Ages 13 - 18 Years
Common Illnesses’s in Neonates are…
jaundice
vomiting
respiratory distress
Common illnesses’s in Infants are…
foreign body airway obstructions (become a concern) febrile seizures vomiting diarrhea dehydration bronchiolitis car accidents croup child abuse poisonings falls meningitis
only use an oral or nasal airway in pediatric patients only AFTER…
other manual manoeuvres have failed to keep the airway open
growth plate
the area just below the head of a long bone in which growth in bone length occurs; the epiphyseal plate
infants and children increase their cardiac output how?
increasing their heart rate.
pediatric assessment triangle
appearance
breathing
circulation
tachycardia is often the first …
manifestation of respiratory distress in infants
Normal Pulse Rate for Newborn
100-180
Normal Pulse Rate for Infant (0-5 months)
100-160
Normal Pulse Rate for Infant (6-12 months)
100-160
Normal Pulse Rate for Toddler (1-3 Years)
80-110
Normal Pulse Rate for Preschooler (3-5 Years)
70-110
Normal Pulse Rate for School Age (6-10 Years)
65-110
Normal Pulse Rate for Early Adolescence (11-14 Years)
60-90
Normal RR for Newborn
30-60
Normal RR for Infant (0-5 months)
30-60
Normal RR for Infant (6-12 months)
30-60
Normal RR for Toddler (1-3 Years)
24-40
Normal RR for Preschooler (3-5 Years)
22-34
Normal RR for School Age (6-10 Years)
18-30
Normal RR for Early Adolescence (11-14 Years)
12-26
Normal BP from Newborn - 3 Years
systolic = 90 + 2 x age Diastolic = app. 2/3 of systolic
Normal BP for Preschooler (3-5 Years)
Systolic average 98 (78 to 116)
Diastolic average 65
Normal BP for School Age (6-10 Years)
Systolic average 105 (80 to 122)
Diastolic average 69
Normal BP for Early Adolescence (11-14 Years)
Systolic average 114 (88 to 140)
Diastolic average 76
a low pulse in an infant or a child may indicate…
imminent cardiac arrest
Signs of Increased Respiratory Effort
retraction nasal flaring head bobbing grunting wheezing gurgling stridor
retraction
visible sinking of the skin and soft tissues of the chest around and below the ribs and above the collarbone
nasal flaring
widening of the nostrils; seen primarily on inspiration
head bobbing
observed when the head lifts and tilts back as the child inhales and then moves forward as the child exhales
grunting
sound heard when an infant attempts to keep the alveoli open by building back pressure during expiration
wheezing
passage of air over mucous secretions in bronchi; head more commonly on expiration; a low or high pitched sound
gurgling
coarse, abnormal bubbling sound heard in the airway during inspiration or expiration; may indicate an open chest wound
stridor
abnormal, musical, high pitched sound, more commonly heard on inspiration.
conditions that place a pediatric pt. at risk of cardiopulmonary arrest..
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)
suctioning in a pediatric patient decrease the pressure to less than … in Infants
100mmHg in
suction less than… in order to decrease the possibility of hypoxia
less than 10 seconds
Suction Catheter for age up to 1 year
8
suction catheter for age 2 to 6 years
10
suction catheter for age 7 to 15 years
12
suction catheter for age 16 years
12 to 14
what may indicate the presence of an infection in a pediatric patient.
fever chills tachycardia cough sore throat nasal congestion malaise tachypnea cool or clammy skin perechia respiratory distress poor appetite vomiting diarrhea dehydration hypo-perfusion
stages of respiratory compromise
respiratory distress
respiratory failure
respiratory arrest
respiratory distress
mildest form of respiratory impairment.
earliest indicators is an increase is RR.
Respiratory Failure
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
Respiratory Arrest
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
Managing respiratory compromise
establishment of an airway
high-flow supplemental oxygen administration
mechanical ventilation with a BVM device attached to reservoir delivering 100% oxygen
** CALL ACP
whenever you find an infant, toddler or a young child in respiratory or cardiac arrest assume…
complete upper airway obstruction until proven otherwise
Croup
laryngotracheobronchitis; a common viral infection of young children, resulting in edema of the subglottic tissues; characterized by barking cough and inspiratory stridor
Assessing a child with Croup
slow onset generally wants to sit up barking cough no drooling fever approx. 37.7 - 38.3
Managing a child with Croup
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*
Epiglottitis
bacterial infection of the epiglottis, usually occurring in children older than age four; a serious medical emergency
Assessing a child with Epiglottitis
rapid onset prefers to sit up no barking cough drooling; painful to swallow fever approx. 38.8 - 40 occasional stridor
Managing Epiglottitis
oxygen blow by or facemask
transport
it is considered critical
bacterial tracheitis
bacterial infection of the airway, in the subglottic region; in children most likely to appear after episodes of croup
assessing a child with bacterial trachetis
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
managing bacterial tachetis
manage airway and breathing, providing oxygenation via a facemask or by blow by technique.
common causes of upper-airway obstructions
croup
epiglottitis
bacterial tacheitis
foreign body aspiration
Assessing a child with foreign body aspiration
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
Managing a child with a suspected aspirated foreign body
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,
Asthma
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.
Asthma Triggers
environmental allergens cold air exercise foods irritants emotional stress certain medications
assessing a child with asthma
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
managing a child with asthma
correct hypoxia, reverse bronchospasm, and decrease inflammation.
establish an airway
administer supplemental oxygen
administer a nebulized bronchodilator
status asthmaticus
requires immediate transport with aggressive treatment administered en route.
status asthmaticus is defines as what
a severe prolonged asthma attack that cant be broken by aggressive pharmacological management.
Bronchiolitis
viral infection of the medium sized airways, occurring most frequently during the first year of life
pneumonia
is an infection of the lower airway and lungs. may be caused by bacterium or a virus.
Assessing a child with pneumonia
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.
Managing a child with pneumonia
place patient in position of comfort
administer supplemental oxygen with nonrebreather
common causes of lower airway distress
asthma
bronchiolitis
pneumonia
lower airway foreign body obstruction
predisposing factors of pediatric shock
hypothermia dehydration (vomiting, diarrhea) infection trauma blood loss allergic reactions poisoning cardiac events
compensated shock
early shock the pt will be normotensive S&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
A slight increase in the heart rate is one of the …
earliest signs of shock
Decompensated shock
develops when the body can no longer compensate for decreased tissue perfusion.
what is the biggest hallmark of decompensated shock?
a fall in blood pressure
Signs and symptoms of decompensated shock
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
managing decompensated shock
Aggressive treatment measures
BVM
100% Oxygen
irreversible shock
when treatment measures are inadequate or too late to prevent significant tissue damage and death
cardiogenic shock
the inability of the heart to meet the metabolic needs of the body, resulting in inadequate tissue perfusion
noncardiogenic shock
types of shock that result from causes other than inadequate cardiac output
hypovolemic shock
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
distributive shock
marked decrease in peripheral vascular resistance with resultant hypotension; examples include septic shock, neurogenic shock, and anaphylactic shock
what is sepsis ?
an infection of the blood stream by some pathogen, usually bacterial.
signs & symptoms of sepsis?
ill appearance irritability or altered mental status fever vomiting and diarrhea cyanosis, pallor, or mottled skin nonspecific respiratory distress poor feeding
signs and symptoms of septic shock?
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
treating sepsis
oxygen
IV 20ml/kg bolus
anaphylactic shock
results from exposure to an antigen. tachycardia tachypnea wheezing urticaria anxiety edema hypotension
neurogenic shock
due to sudden peripheral vasodilation resulting from interruption of nervous control of the peripheral vasuclar system.
cardiogenic shock results from what?
inadequate cardiac output. in children can be caused by such as near drowning or toxin ingestion
congenital
present at birth.
How does Congenital Heart Disease occur?
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.
Tetralogy of Fallot, a type of congenital heart disease with a right to left shunt is often characterized by what?
cyanotic episodes which are relieved by squatting
what is the most common dysrhythmias in children?
bradydysrythmias
DONT FORGET TO REVIEW ALGORITHM
Brady’s
ALS
BLS
Companion Document
status epilepticus
prolonged seizure or multiple seizures with no regaining of consciousness between them
febrile seizures
seizures that occur as a result of a sudden increase in body temperature; occur most commonly between ages 6 months and 6 years
seizures result from what?
an abnormal discharge or neurons in the brain
febrile seizure should be suspected if what?
the temperature is >39.2
Managing a child with a seizure
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.
If status epilepticus is present what should you do?
start an iv of normal saline administer diazepam (CALL AN ACP)
what is meningitis
infection of the meninges, the lining of the brain and spinal cord. can result from both bacteria and viruses.
Assessing a child with meningitis
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
hyperglycemia
abnormally high concentration of glucose in the blood.
diabetic ketoacidosis
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.
Early signs of hyperglycemia
increased thirst
increased urination
weight loss
late signs of hyperglycemia
weakness abdominal pain generalized aches loss of appetite nausea vomiting signs of dehydration. except increased urinary output fruity breath odour tachypnea hyperventilation tachycardia
signs of ketoacidosis
continued decreased level of consciousness progressing to coma
kussmaul respiration’s (deep and slow)
signs of dehydration
What should you look for if you have suspicion of ingestion poisoning in a child?
level of responsiveness pupil size skin and mucosa findings mouth signs (burns/pain when swallowing) nausea/vomiting diarrhea (blood present)
Managing a poisoned child
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
trauma is the ______________ of death in infants and children.
number one cause
most common pediatric mechanisms of injury
falls MVC's car pedestrian collisions drownings and near-drownings penetrating injuries burns physical abuse
what are the signs of ICP
elevated blood pressure
bradycardia
rapid, deep respiration’s progressing to slow, deep respiration’s.
bulging fontanelle in infants
what is a MILD brain injury in a child according to the GCS ?
13 - 15
What is a MODERATE brain injury in a child according to the GCS?
9 - 12
What is a SEVERE brain injury in a child according to the GCS?
equal to or less than 8
signs and symptoms of herniation are..
asymmetrical pupils
decorticate posturing
decerebrate posturing
how do you manage traumatic head injuries in a child?
high flow oxygen for mild to moderate
intubate a child with a GCS score of equal to or less than 8
60-70% of pediatric fractures occur in what?
C1 - C2
Most injuries to the chest and abdomen result from what ?
blunt trauma
tension pneumothorax signs and symptoms
diminished breath sounds over the affected lung
shift of the trachea to the opposite side
a progressive decrease in ventilatory compliance
signs and symptoms of a splenic injury
tenderness in LUQ
abrasions on the abdomen
hematoma of the abdomen wall
signs and symptoms of liver injury
Pain in the RUQ or right lower chest pain
bend fractures
fractures characterized by angulation and deformity in the bone without an obvious break
buckle fractures
fractures characterized by a raised or bulging projection at the fracture site
greenstick fractures
fractures characterized by an incomplete break in the bone
Rule of 9’s for a child
head = 18% arms = 9 % each back = 18% front = 18% legs = 14% each
SIDS
sudden infant death syndrome
illness of unknown eticology that occurs during the first year of life, with the peak at ages 2 - 4 months
