PEDS

Question 1

Febrile Seizure

Answer 1

Between 6 months and 6 years, with fever and without precipitating cause.
Simple Febrile: <15min, without underlying neuro abnormalities.
Complex Febrile: >15mins or Focal or occur with underlying neuro abnormalaties.

Question 2

Status Seizure

Answer 2

Historically >30min with a return to consciousness.
Treat if longer than 5 min.

Question 3

Acute Respiratory Failure

Answer 3

Severe retractions with hypoxia, bradycardia, or AMS are in respiratory failure.
ABCs.

Question 4

Meningitis

Answer 4

Bacterial or viral infection of meninges.
SS: Newborn-Fever
Children- headache, neck pain, photophobia.
Nuchal rigidity is rare. AMS and seizures are bad.
Meningitis with sepsis = petechia or purpura.
Risk of hypoglycemia.

Question 5

SVT

Answer 5

Congenital heart disease, known SVT, nonspecific symptoms.
>220 in infants
>180 in children
Ps absent or abnormal, RR interval is not variable, History of abrupt change.
CHF may be present.

Question 6

SVT Treatment

Answer 6

1. Vagal(ice to face)
2. Adenosine: 1st 0.1mg/kg, max 6mg, 2nd 0.2mg/kg, max 12mg
3. Sync Cardioversion 1st 0.5-1J/kg, 2nd 2J/kg

Question 7

Peds Pad Sizes

Answer 7

<12 Months or <10kg Peds pads

Question 8

Sinus Tachycardia

Answer 8

Fever, volume loss, hypoxia, pain, increased activity.
<220 in infants
<180 in children
Ps present and normal, variable RR interval,

Question 9

VT with a pulse

Answer 9

Serious Systemic Illness
>150, variable RR, wide QRS

Question 10

VT with a pulse Treatment

Answer 10

Unstable: Synchronized Cardioversion
Stable: If regular and monomorphic, consider adenosine.

Expert consultation is recommended

Question 11

CPR Quality

Answer 11

1/3 Diameter of the chest
100-120/min with complete chest recoil
Minimize interruptions and change every 2 mins
15:2 without advanced airway
Continuous compression with breaths 2-3sec with advanced airway

Question 12

Peds Defibrillation Shock Energy

Answer 12

First: 2J/kg
Second: 4J/kg
Subsequent: >4J/kg, Max 10J/kg

Question 13

Peds Bradycardia

Answer 13

Typically secondary to hypoxia.

ABCs, O2, ECG, Vitals
Start CPR if HR<60 despite oxygenation and ventilation.

If bradycardia persists:
Continue CPR, IV/IO,
Epi 0.01mg/kg q 3-5min,
atropine 0.01mg/kg (may repeat once, minimum 0.1mg, max 0.5mg).

Reassess, and check pulse. If pulseless, go to Cardiac Arrest Algorithm.

Question 14

Seizures

Answer 14

Repetitive movement: Lip-smacking, chewing, bicycling.
Apnea or cyanosis may suggest an underlying seizure.

ABC, IV, BGL, and vitals, Consider Benzo.

Question 15

AMS

Answer 15

Alcohol
Epilepsy / Electrolytes
Insulin
Opiates
Uremia
Trauma / Temp
Infection
Psychogenic
Poison
Shock / Stroke / SAH / Lesions

Question 16

Pediatric Assessment Triangle

Answer 16

Appearance: TICLS
Breathing: Retractions, Sounds, Positioning, Rate, Effort
Circulation: Pallor, Mottling, Cynosis

Question 17

Croup

Answer 17

Viral infection around glottis in subglottic space.
6months - 6years
It occurs late fall to winter

PAT: Alert with stridor, agitated, increased WOB, normal skin, and barky cough. If altered and cyanotic, consider obstruction

Question 18

Croup Treatment

Answer 18

Position of Comfort
Nebulized Epi (0.25-0.5mg/kg, max 5m)
May need assisted ventilation
Intubation is rarely needed, size down a tube.
Dexamethasone

Question 19

Bronchiolitis

Answer 19

Lower Airway
RSV is most common.
<2 years old.
Occurs late fall to winter

PAT: Mild- moderate retractions, tachypnea, wheezing, crackles, mild hypoxia.
Severe- AMS (sleepy obtunded), severe retractions, diminished breath sounds, SPO2 < 90%.

Difficult to distinguish from asthma(asthma rarely occurs under the age of 1). First time wheezing in winter, most likely bronchiolitis. The greatest risk for infants <1y, prematurity, congenital heart defect, or immunocompromised.

Question 20

Bronchiolitis Treatment

Answer 20

Position of comfort
02 and suction
Nebulized salbutamol and/or Epi
Prepare for BVM and intubation

Question 21

Epiglottitis

Answer 21

Upper Airway
PAT: Sick and anxious, sitting upright in sniffing, may be drooling, unable to swallow. Increased WOB, with pallor or cyanosis, stridor, and/or decreased or absent breath sounds.

Question 22

Epiglottitis Treatment

Answer 22

O2, do not disturb pt
Prepare for BVM and intubation. Choose a tube 2 sizes smaller.

Question 23

Atrial Septal Defect

Answer 23

Patent foramen ovale.
Sinus venosis (between SVC and Right Atria)
Ostium Secondum (Hole in center atrial septum, similar to PFO, but can be differentiated)
Ositum Primum (Hole in the lower portion of the atrial septum, associated with mitral and tricuspid valve defects).

Question 24

Ventricular Septal Defect

Answer 24

Several Types. One or more holes in the ventricular septum. The most common is Muscular VSD.

Question 25

Patent Ductus Arteriosis

Answer 25

Opening between the ascending aorta and pulmonary artery.

Question 26

Transposition