Peds

Question 1

Status Epilepticus (>5m)

Answer 1

1) Lorazepam (ativan) IV 0.1mg/kg or midazolam (versed) 0.1mg/kg

2) Lorazepam IV 0.1mg/kg or midazolam 0.1mg/kg
+levetiracetam(keppra) IV 40mg/kg

3) Lorazepam IV 0.1mg/kg or midazolam 0.1mg/kg
+fosphenytoin IV 20PE/kg

4) Lorazepam IV 0.1mg/kg or midazolam 0.1mg/kg
+valproate IV 20mg/kg

Question 2

C Spine R/o and Imaging rules

Answer 2

NEXUS (must not have any of these to clear)

• Focal neurologic deficit
• Midline spinal tenderness
• AMS
• Intoxication
• Distracting injury

Canadian C-spine Rules

CANNOT HAVE Age ≥ 65 years
extremity paresthesias or
dangerous mechanism (fall from ≥ 3ft / 5 stairs, axial load injury, high speed MVC/rollover/ejection, bicycle collision, motorized recreational vehicle)

AND, MUST HAVE Low risk factor present:
Sitting position in the ED, ambulatory at any time, delayed (not immediate onset) neck pain, no midline tenderness.

Question 3

Most common cause of shock in kids

Answer 3

hypovolemia

Question 4

Peds cardiac arrest sequence (6)

Answer 4

Hypoxemia → hypercapnia → acidosis → bradycardia → hypotension → arrest

Question 5

PALS:
1 provider ratio
2 provider ratio
How deep to compress chest?

Answer 5

Single provider 30:2
Dual provider 15:2
Depth ⅓ chest size
5 cm in child
4 cm in infant

Question 6

ET tube sizing formula

Answer 6

Uncuffed: (age/4) + 4
or
[16+age]/4

<1 yo: 3.5, 4
1 yo = 4
2 yo = 4.5
3 yo = 4.5,5
4 yo = 5
6 yo = 5.5
8 yo =  6
10 yo = 6.5

Cuffed: (age/4) + 3.5

Question 7

Defibrillation energy level for pediatric cardiac arrest

Answer 7

2-4-6-8-10J/kg max

Question 8

Drug and dose for pediatric SVT

Answer 8

*After vagal maneuvers

adenosine
0.1 mg/kg
max 1st dose 6 mg (adult). Double for second dose.

If doesn’t work → synchronized cardioversion 1J/kg –> 2J/kg

Question 9

List 5 causes of neonatal shock.

Answer 9

Sepsis 
Congenital heart disease 
Endocrine and metabolic disease  (like CAH)
Abdominal congenital defects 
Non-accidental trauma

Question 10

List 6 causes of shock using the mnemonic A SHOCK.

Answer 10

Anaphylaxis 
Sepsis 
Hypovolemia 
Obstruction of venous return 
Cardiogenic 
metabolicK

Question 11

What is the most reliable indicator of the degree of dehydration?

Answer 11

Weight!

Question 12

What fluid should be bolused in neonatal shock?

Answer 12

20 cc/kg NS x2 then blood

Question 13

List 3 ways you can estimate a child’s size for drug dosing and proper equipment.

Answer 13

Broselow tape
ask parents
use table

Newborn → 3.5 kg
1 yo --> 10 kg
5 yo → 20 kg
10 yo → 30 kg
11+ yo → Agex4 kg

Question 14

Standard peds pRBC transfusion amount

Answer 14

10c/kg

Question 15

Rank from youngest to oldest RPA, PTA, epiglottitis, bacterial tracheitis, croup

Answer 15

croup, RPA, bact. trach < epiglottitis < PTA

Croup: 6m – 3y (1-2 y)
RPA: 6m – 4y (<1y, rare >4y)
Bacterial tracheitis: 3m – 13y (<3y)
Epiglottitis: 1-7y (7y)
PTA: 10-18y (rare 6m – 5y)

1 year olds
Retropharyngeal abscess
Croup
Bacterial tracheitis
7-9 yo
Epiglottitis (unvaccinated)
Teen
Peritonsillar abscess (very large ones)

Question 16

List 3 medications that can be added to albuterol, ipratropium, and steroids in severe asthma.

Answer 16

Aminophylline
Terbutaline
MgSO4
Epinephrine

Question 17

List 3 solid reasons for admitting patients with bronchiolitis.

Answer 17

SpO2 <91%
RR>60
↑WOB
unable to take PO
early in illness
Lower threshold if < 3 months

Question 18

What age group to you pretreat with atropine for intubation? Dose?

Answer 18

kids <1 yo

0.02 mg/kg, max of 0.1

Question 19

Calculate low BP in children?

Answer 19

70 + (2 x age)
(up to 10 yo)

Example: 3 yo → 70 + (2 x 3) = 76

Question 20

Pediatric dosing for epi for asthma

Answer 20

Given IM

10 kg = 0.1 mg
20 kg = 0.2 mg
30+ kg = 0.3 mg

Question 21

Neonatal defibrillation - Joules rate?

Answer 21

2J/kg