Pediatrics Critical Care Flashcards
1
Q
cardiopulmonary arrest
A
- most often associated with respiratory failure and arrest
- decreased oxygen concentrations:
- child becomes hypoxic
- heart slows down, becoming more and more bradycardic
2
Q
shock
A
- inadequate delivery of oxygen and nutrients to tissues to meet metabolic demand
- three types:
- hypovolemic
- distributive
- cardiogenic
3
Q
compensated shock
A
- critical abnormalities of perfusion
- body is able to maintain adequate perfusion to vital organs
- intervention is needed to prevent child from decompensating
4
Q
decompensated shock
A
- state of inadequate perfusion
- child will be profoundly tachycardic and show signs of poor peripheral perfusion
- hypotension is a late and ominous sign
- start resuscitation on scene
5
Q
hypovolemic shock
A
- most common cause of shock in infants and young children
- loss of volume due to illness or trauma
- once IV access is established, begin fluid resuscitation with isotonic fluids (normal saline or lactated ringers) only
- 20 cc/kg Boluses
- in decompensated shock with hypotension, begin initial fluid resuscitation on scene
- evaluates sites for IV access -> if this is unsuccessful, being IO infusion
- signs may include:
- listless or lethargic
- pale, mottled, or cyanotic
- dehydration
6
Q
IO needles
A
-usually consist of a solid-bore needle inside a sharpened hollow needle
7
Q
distributive shock
A
- decreased vascular tone develops
- vasodilation and third spacing of fluids occurs
- caused by sepsis in most pediatric cases -> fever is a key finding
- treatment is volume resuscitation
- with apparent sepsis and persistent hypotension, consider vasopressor support but only after fluid resuscitation
- treat anaphylactic shock with IM epinephrine
8
Q
cardiogenic shock
A
- result of pump failure
- may be present in children with:
- underlying congenital heart disease
- myocarditis
- rhythm disturbances
- Err on the side of fluid resuscitation unless you are sure of diagnosis
- the following confirms cardiogenic shock:
- increased work of breathing
- drop in oxygen saturation
- worsening perfusion after a fluid bolus
9
Q
signs and symptoms of cardiogenic shock
A
- listless or lethargic
- increased work of breathing
- impaired circulation
- skin pale, mottled, or cyanotic
- sweating with feeding
10
Q
initial management of cardiogenic shock
A
- position of comfort
- supplemental oxygen
- consider small fluid bolus (5-10 cc/kg)
- pressor
11
Q
cardiovascular emergencies
A
- relatively rare in children
- often related to volume or infection
- identify through primary assessment
12
Q
dysrhythmias
A
- classified based on pulse rate:
- too slow (bradydysrhythmias)
- too fast (tachydysrhythmias)
- absent (pulseless)
- signs and symptoms are often nonspecific
- pulse rate is lower than normal for age -> often secondary to hypoxia in children
13
Q
initial treatment for dysrhythmias
A
- airway management
- supplemental oxygen
- assisted ventilation as needed
- initially electronic cardiac monitoring
- if child is asymptomatic, no further treatment is indicated in the field
- if pulse rate is lower than 60 and perfusion is poor:
- begin chest compressions
- attempt IV or IO access
14
Q
tachydysrhythmias
A
- pulse rate is higher than normal for age
- interpret in the context of PAT and the primary assessment
- assessment should include pulse rate and an ECG or rhythm strip
15
Q
narrow complex tachycardia: tachydysrhythmias
A
- supraventricular tachycardia is identified by:
- narrow QRS complex
- unvarying pulse rate of more than 220 beats/min (infant) or more than 180 beats/min (child)
16
Q
SVT: tachydysrhythmias
A
- treatment depends on perfusion and stability
- if stable, consider vagal maneuvers while obtaining IV access
- if poor perfusion, synchronized cardioversion is recommended
17
Q
wide complex tachycardia: tachydysrhythmias
A
- wide QRS complex tachycardia and palpable pulse is likely V-tach
- if stable, consider antidysrhythmic medication
- if unstable, use synchronized cardioversion
- if pulseless, begin CPR
18
Q
congenital heart disease
A
- most common congenital disorder in newborns
- varying degrees of cardiorespiratory compromise
- may be diagnosed in utero
19
Q
cyanotic disease
A
- exs. include:
- hypoplastic left heart syndrome (HLHS)
- transposition of the great arteries (TGA)
- tetralogy of Fallot (TOF)
- total anomalous pulmonary vascularly return (TAPVR)
- truncus arteriosus
- initial management includes cardiorespiratory support and monitoring
- typically presents in neonatal period with:
- increasing respiratory distress
- poor perfusion
- cyanosis
- cardiovascular collapse if unrecognized
20
Q
noncyanotic disease
A
- exs. include:
- atrial septal defects (ASDs)
- ventricular septal defects (VSDs)
- patent ductus arteriosus (PDA)
- clinical presentation varies
21
Q
myocarditis
A
- condition due to inflammation of the heart
- results in myocardial dysfunction
- can lead to heart failure
- viral infections are common cause
22
Q
cardiomyopathy: dilated cardiomyopathy (DCM)
A
- heart becomes weakened and enlarged
- affects pulmonary. hepatic, other systems
- typically due to viral infection or medication toxicity
23
Q
cardiomyopathy: hypertrophic cardiomyopathy (HCM)
A
- heart muscle is unusually thick
- heart has to pump harder to get blood to leave
- patients can present with chest pain, hypertension, syncope, and/or cardiac arrest
24
Q
assessment and management of cardiovascular emergencies
A
- begin with PAT and ABCs
- an abnormal appearance may indicate the need for rapid intervention
- tachypnea is common with a primary cardiac problem
- increased work of breathing and a fast respiratory rate is common with CHF
25
Q
neurologic emergencies
A
- can be benign or life threatening
- medical history is important, including:
- previous seizures
- shunts
- cerebral palsy
- recent trauma or ingestions
26
Q
altered LOC and mental status
A
- may be difficult to determine the underlying cause
- run through PAT and ABCs quickly
- pay attention to disability and dextrose issues
- check glucose
27
Q
AEIOU-TIPPS: possible causes of altered level of consciousness and mental status
A
- A- alcohol
- E- epilepsy, endocrine, electrolytes
- I- insulin
- O- opiates and other drugs
- U- uremia
- T- trauma, temperature
- I- infection
- P- psychogenic
- P- poison
- S- shock, stroke, space-occupying lesion, subarachnoid hemorrhage
28
Q
seizures
A
- result from abnormal electrical discharges in the brain
- may be redisposed, or result from:
- trauma
- metabolic disturbances
- ingestion
- infection
29
Q
febrile seizures
A
- child must:
- be age 6 months to 6 years
- have a fever
- have a no identifiable precipitating cause
- strongest predictor is a history in a first degree relative
30
Q
seizure assessment
A
- give special attention:
- compromised oxygenation and ventilation
- signs of ongoing seizures activity
- status epilepticus: seizure lasting more than 20 minutes or two or more seizures without return to baseline
31
Q
seizure management
A
- provide 100% supplemental oxygen; bag mask ventilation as indicated for hypoventilation
- consider administering a benzodiazepine -> lorazepam, diazepam, or midazolam
- measure serum glucose -> treat hypoglycemia
32
Q
meningitis
A
- inflammation or infection of the meninges
- viral meningitis- rarely life threatening
- bacterial meningitis- potentially fatal
- always proceed as if bacterial meningitis
- symptoms vary
- the younger the child, the more vague
33
Q
meningitis signs and symptoms
A
- fever
- altered mental status
- bulging fontanelle
- photophobia
- infection control is important
34
Q
hydrocephalus
A
- results from impaired circulation and absorption of cerebrospinal fluid (CSF)
- leads to increased ventricles and ICP
- cerebral shunt often used to decrease ICP:
- ventriculoperitoneal (VP) shunts
- ventriculoatrial (VA) shunts
- complications of cerebral shunts includes, blockages and over drainage
35
Q
hydrocephalus signs and symptoms
A
- vomiting
- headache
- altered LOC
- visual changes
36
Q
fever emergencies
A
- fever is a common pediatric complain
- symptoms of infectious or inflammatory process
- can have multiple causes
- most caused by viral infections
- general impression and primary assessment will help determine severity
- may require little intervention:
- support ABCs
- provide temperature control -> consider acetaminophen or ibuprofen
37
Q
sudden infant death syndrome
A
-sudden and unexpected death of an infant younger than 1 year for whom a thorough autopsy fails to demonstrate and adequate cause of death
38
Q
risk factors for sudden infant death syndrome
A
- prematurity; low birth weight
- young maternal age
- sleeping prone with soft, bulky blankets
- exposure to tobacco smoke
39
Q
apparent life-threatening event
A
- episode during which an infant:
- becomes pale or cyanotic
- chokes, gages, or has an apneic spell, or
- loses muscle tone
- causes range from benign to serious diagnosis
40
Q
pediatric trauma emergencies
A
- leading cause of death among children older than 1 year
- anatomy and physiology make injury patterns and responses different from those seen in adults
- developmental stage will affect response
41
Q
assessment and management of traumatic injuries
A
- begin with a thorough scene size up
- use PAT to form a general impression
- if findings are grossly abnormal, move to ABCs
- initiate life support interventions
42
Q
fluid management
A
- airway management and ventilatory support take priority over circulation management
- tachycardia is usually the first sign of circulatory compromise in a child
- hypotension is a late finding
43
Q
an ounce of prevention
A
- emergency care for children involves a team approach by health professionals
- to be an effective child safety advocate, you must be knowledgeable about local and national prevention programs
