Peds Emergencies

Question 1

Define a pediatric patient by age

Answer 1

<18 yo

Question 2

What are the three overarching etiologies that constitute ped emergencies?

Answer 2

• Respiratory
• Shock
• Cardiac

Question 3

4 types of respiratory emergencies

Answer 3

1. Upper airway obstruction
2. Lower airway obstruction
3. Lung parenchyma diseases
4. Disordered control of breathing

Question 4

Respiratory Distress

- sx

Answer 4

• Tachypnea
• Increased resp. effort (nasal flaring, retractions)
• Inadequate resp. effort (hypoventilation, bradypnea)
• Abnormal sounds (stridor, wheezing, grunting)
• Tachycardia
• Pale and cool skin
• Changes in LOC

Question 5

Respiratory Failure

- sx

Answer 5

• Marked tachypnea (early sx)
• Bradypnea/apnea (late)
• Increased/decreased/no respiratory effort
• Poor to absent distal air movement
• Tachycardia (early), bradycardia (late)
• Cyanosis
• Stupor, coma (late)

Question 6

General management respiratory distress

Answer 6

• Airway (head tilt, chin lift)
• Oxygen
• pulse oximetry
• IV/IO access
• ECG monitor
• BLS if needed

Question 7

Three examples of upper airway obstruction

Answer 7

• Croup/RSV
• Anaphylaxis
• Aspiration of foreign body

Question 8

Tx for croup/RSV

Answer 8

• nebulizer epinephrine (racemic epi)
• Dexamethasone
• Humidified air

Question 9

Tx for anaphylaxis

Answer 9

• IM epi
• Albuterol
• Antihistamines (diphenhydramine and ranitidine)
• Methypredisolone

Question 10

Where is an aspirated foreign body most likely to lodge in a kid

Answer 10

right main bronchi

Question 11

Upper airway obstruction s/sx

Answer 11

• Increased respiratory effort
• Stridor (usu inspiratory)
• barking cough
• hoarseness
• tachycardia
• pallor/cool skin early and cyanosis late
• Anxiety/agitation early and lethargy/unresponsiveness late
• temp possible, depending on cause

Question 12

Two common causes of lower airway obstruction

Answer 12

1. bronchiolotis/RSV

2. Asthma

Question 13

Bronchiolitis/RSV

- tx

Answer 13

• Nasal suctioning

- bronchodilator

Question 14

Asthma

- tx

Answer 14

• Albuterol w/ or w/o ipratropium (duoneb)
• Corticosteroids
• SQ epi
• Mag sulfate
• Terbutaline
• Humidified air

Question 15

Lower airway obstruction s/sx

Answer 15

• Increased respiratory effort
• Wheezing (usu expiratory)
• prolonged expiratory phase
• Tachycardia
• pallor/cool skin early and cyanosis late
• Anxiety/agitation early and lethargy/unresponsiveness late
• temp possible, depending on cause

Question 16

Two common causes of lung parenchymal disease

Answer 16

1. Pneumonia/pneumonitis

2. Pulmonary edema

Question 17

Pneumonia/pneumonitis

- types

Answer 17

• infectious
• chemical
• aspiration

Question 18

Pneumonia/pneumonitis

- tx

Answer 18

• albuterol

- abx as needed

Question 19

Pulmonary edema

- two types

Answer 19

• cardiac (CHF dt CHD)

- Non-cardiac (ARDS)

Question 20

Non-cardiac pulmonary edema treatment

Answer 20

• noninvasive/invasive ventilator support with PEEP
• vasoactive support
• diuretic

Question 21

Lung parenchymal dz s/sx

Answer 21

• increased resp. effort
• grunting
• crackles
• decreased breath sounds
• Tachycardia
• pallor/cool skin early and cyanosis late
• Anxiety/agitation early and lethargy/unresponsiveness late
• temp possible, depending on cause

Question 22

Disordered control of breathing

- three common causes

Answer 22

1. ICP
2. Poisoning/OD
3. Neuromuscular disease

Question 23

4 causes of ICP that cause disordered control of breathing

Answer 23

1. trauma/abuse
2. Meningitis/encephalitis
3. tumor
4. brain bleed

Question 24

Common causes of poisoning/OD that cause disordered control of breathing

Answer 24

Opioids
CCB
BB
crack
TCA

Question 25

Three neuromuscular diseases that cause disordered control of breathing

Answer 25

- epilepsy - Cerebral palsy - brain injury

Question 26

4 Types of shock

Answer 26

1. Hypovolemic 2. Distributive 3. Cardiogenic 4. Obstructive

Question 27

Two kinds of hypovolemic shock

Answer 27

- non-hemorrhagic | - hemorrhagic

Question 28

Three kinds of distributive shock

Answer 28

- septic - anaphylactic - neurogenic

Question 29

5 conditions that can cause cardiogenic shock

Answer 29

- Bradyarrythmia or tachyarrhythmia - CHD - myocarditis - cardiomyopathy - poisoning

Question 30

4 types of obstructive shock

Answer 30

- ductal-dependent - tension pneumothorax - cardiac tamponade - PE

Question 31

Shock resuscitation

Answer 31

- O2, maintain sat 94-99% - ECG monitor - IV/IO access - BLS as needed - Bedside glucose if needed - Specific therapies based on cause of shock

Question 32

Medications to admin during shock

Answer 32

- 20 ml/kg NS or LR iV bolus (5-20 min) - if cardiomyopathy: 10 ml/kg - if CCB/BB OD 5 ml/kg

Question 33

Types of cardiac emergencies (rhythms)

Answer 33

- v-fib - v-tach - bradycardia - supra ventricular tachycardia - pulseless electrical activity - asystole

Question 34

Peds Glascow coma scale

Answer 34

Eye: same as adult Verbal: 5: cries and babbles 4: irritable, cries 3: cries to pain 2: moans to pain 1: nothing Motor: 6: moves spontaneously and purposefully 5: withdraws in response to touch 4-1 same as adult