Peds Emergency Stabilization Flashcards
Describe blood pressure changes in kids with a critical illness
BP is maintained until very late in critical illness
- initial CO modulation is done via HR
Cardiac arrest is most commonly secondary to ______ _______ in kids
respiratory failure
Describe the steps of neonatal resuscitation in the first 30 seconds
- provide warmth
- position head & neck
- suction
- dry the skin
- stimulate gently
Describe the steps of neonatal resuscitation in the first 30 - 60 seconds
- initiate positive pressure ventilation if HR <100
primary measure of initial ventilation is prompt improvement in heart rate
Poor response? Mr. Sopa
M: mask adjustment
R: reposition
S: suction
O: open mouth
P: pressure increase
A: airway
Describe the steps of neonatal resuscitation in the first 60 - 90 seconds
If despite optimal assisted ventilation for 30 sec HR remains <60 bpm begin compressions
Stop when HR >60 bpm
Describe chest compressions for a neonate
- lower 1/3 of sternum at 1/3 depth of AP diameter of chest
- 3:1 ratio for 90 compressions & 30 breaths per minute
- two thumb technique
- 100% oxygen
Describe the dose of epinephrine given in neonatal resuscitation
0.01 to 0.03 mg/kg IV/IO (vasopressor of choice)
(never give naloxone or sodium bicarbonate or amiodarone)
What is the best indicator of successful intubation
prompt increase in HR
Describe hypotension in a neonate
SBP <60
- treat with volume resuscitation with NS at 10 mL/kg
What is the MC metabolic abnormality in newborns
Hypoglycemia
- glucose at birth is ~60 and falls to ~ 40 within 1-2 hrs
- should be >= 45 at 4 hrs
Problem! Mild = 25-55 (feed), Significant = <25 (bolus dextrose + continuous 10% dextrose in water IV)
Which neonates in the US should NOT be resuscitated or transported
Less than 23 weeks, weighing less than 400 grams, with gelatinous/translucent skin
- also if resuscitation is not successful after 10 mins, can withdraw resuscitation
Describe the management of choking/foreign body aspiration in kids
alternating 5 back blows & 5 chest thrusts in infants
Heimlich in kids (>1)
Begin compressions as soon as kid loses consciousness
What are most pediatric dysrhythmias due to
hypoxia
What is the MC chief complaint in kids presenting to the ED
fever (38C or greater, 39C is a high fever/significant)
What is the MC serious bacterial illness in kids presenting to the ED
UTI (w/wo pyelo)
Bronchiolitis, enterovirus, & parainfluenza have a significant incidence of concurrent ____
UTI
Describe the treatment of fever in infants <3 mos (worse dispo)
admission with ampicillin and cefotaxime OR gentamicin
Describe when to admit a kid with a fever age 3-36 mos
- WBC >15k or <5k with >20% bands
- positive UA
- CSF WBC >10 cells
- CXR or fecal leuk positive
- appears ill, toxic, can’t maintain oral hydration, has inadequate follow up
What starts to become a more common cause of fever in kids >36 mos
Group A strep & mono
What is the most important cause of sepsis in a neonate
Group B strep (that’s why mom is tested and there’s prophylactic erythromycin ointment on bb eyes)
Describe some treatment options for pediatric sepsis
- Ampicillin (for Group B strep & listeria)
- Gentamicin (for E coi)
- Ceftriaxone if >3 os
- Acyclovir (for maternal HSV history)
What are the most common causes of meningitis in neonates vs kids 1 month+
Neonates: group B strep (Tx with ampicillin + cefotaxine OR gentamicin)
1+ month kids: neisseria meningitidis (Tx with cefotaxime OR ceftriaxone with vanco if strep)
What else can be give alongside antibiotic treatment in infants and kids with meningitis from Hib
dexamethasone
Describe the treatment of acute mastoiditis in kids
IV piptazo & vanco with myringotomy
