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Cumulative > Peds Emergency Stabilization > Flashcards

Peds Emergency Stabilization Flashcards

1
Q

Describe blood pressure changes in kids with a critical illness

A

BP is maintained until very late in critical illness
- initial CO modulation is done via HR

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2
Q

Cardiac arrest is most commonly secondary to ______ _______ in kids

A

respiratory failure

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3
Q

Describe the steps of neonatal resuscitation in the first 30 seconds

A
  1. provide warmth
  2. position head & neck
  3. suction
  4. dry the skin
  5. stimulate gently
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4
Q

Describe the steps of neonatal resuscitation in the first 30 - 60 seconds

A
  • 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

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5
Q

Describe the steps of neonatal resuscitation in the first 60 - 90 seconds

A

If despite optimal assisted ventilation for 30 sec HR remains <60 bpm begin compressions

Stop when HR >60 bpm

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6
Q

Describe chest compressions for a neonate

A
  • 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
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7
Q

Describe the dose of epinephrine given in neonatal resuscitation

A

0.01 to 0.03 mg/kg IV/IO (vasopressor of choice)

(never give naloxone or sodium bicarbonate or amiodarone)

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8
Q

What is the best indicator of successful intubation

A

prompt increase in HR

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9
Q

Describe hypotension in a neonate

A

SBP <60
- treat with volume resuscitation with NS at 10 mL/kg

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10
Q

What is the MC metabolic abnormality in newborns

A

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)

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11
Q

Which neonates in the US should NOT be resuscitated or transported

A

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

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12
Q

Describe the management of choking/foreign body aspiration in kids

A

alternating 5 back blows & 5 chest thrusts in infants

Heimlich in kids (>1)

Begin compressions as soon as kid loses consciousness

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13
Q

What are most pediatric dysrhythmias due to

A

hypoxia

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14
Q

What is the MC chief complaint in kids presenting to the ED

A

fever (38C or greater, 39C is a high fever/significant)

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15
Q

What is the MC serious bacterial illness in kids presenting to the ED

A

UTI (w/wo pyelo)

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16
Q

Bronchiolitis, enterovirus, & parainfluenza have a significant incidence of concurrent ____

A

UTI

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17
Q

Describe the treatment of fever in infants <3 mos (worse dispo)

A

admission with ampicillin and cefotaxime OR gentamicin

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18
Q

Describe when to admit a kid with a fever age 3-36 mos

A
  • 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
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19
Q

What starts to become a more common cause of fever in kids >36 mos

A

Group A strep & mono

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20
Q

What is the most important cause of sepsis in a neonate

A

Group B strep (that’s why mom is tested and there’s prophylactic erythromycin ointment on bb eyes)

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21
Q

Describe some treatment options for pediatric sepsis

A
  • Ampicillin (for Group B strep & listeria)
  • Gentamicin (for E coi)
  • Ceftriaxone if >3 os
  • Acyclovir (for maternal HSV history)
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22
Q

What are the most common causes of meningitis in neonates vs kids 1 month+

A

Neonates: group B strep (Tx with ampicillin + cefotaxine OR gentamicin)

1+ month kids: neisseria meningitidis (Tx with cefotaxime OR ceftriaxone with vanco if strep)

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23
Q

What else can be give alongside antibiotic treatment in infants and kids with meningitis from Hib

A

dexamethasone

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24
Q

Describe the treatment of acute mastoiditis in kids

A

IV piptazo & vanco with myringotomy

25
Q

Describe the treatment of orbital cellulitis in kids

A

IV cefuroxime or Unasyn

26
Q

Describe the treatment of dacrocystitis in kids

A

IV cefuroxime or cefazolin

27
Q

Describe the treatment of ophthalmia neonatorum

A

Gonococcal: erythromycin ointment at birth

Give PO erythromycin & ophthalmic ointment if chlamydial (onset 7-14 days after birth)

28
Q

Describe the treatment of croup

A
  • cool humidified air
  • oral steroids (dexamethasone) if mild, nebulized epinephrine with oral dexamethasone if severe

NO albuterol

29
Q

Describe the treatment of epiglottitis

A

EMERGENCY
- nebulized epinephrine
- IV ceftriaxone
- steroids

30
Q

Describe the treatment of bacterial tracheitis (aka bacterial croup)

A

EMERGENCY
- nebulized epinephrine
- IV ceftriaxone
- steroids

*ideally sedated & intubated for bronchoscopy

31
Q

Describe how button batteries can cause destruction if in the ear

A

electrical currents & pressure necrosis

32
Q

When is irrigation contraindicated for ear foreign body removal in kids

A

kids with tympanostomy tubes or perforation & for the removal of vegetable matter & button batteries

33
Q

Describe the treatment for peritonsillar abscess in kids

A

oral PCN or clindamycin if mild

I&D with aspiration

IV ampicillin sulbactam OR clikndamycin

Single high dose steroids

34
Q

Describe the treatment of Ludwig’s angina

A

airway control early

PCN + flagyl, unasyn & oral surgery

35
Q

Describe the etiology & treatment of bronchiolitis

A

Eti: RSV
Tx: nasal suction (nose frida), dexamethasone + epinephrine, humidified air (NO albuterol)

Admit if apneic

36
Q

Describe the treatment of airway foreign body in kids

A

rigid bronchoscopy procedure of choice for dx & tx (MC in right main bronchus!)

37
Q

Describe the main criterion for admission in kids with suspected bronchiolitis

A

Pulse ox <96%

38
Q

What is the gold standard diagnosis of pneumonia

A

chest xray

39
Q

Describe the treatment of pneumonia in neonates

A

admission for IV ampicillin + gentamicin

40
Q

Describe the treatment of pneumonia in kids 1-3 mos

A

admission with ampicillin or ceftriaxone

41
Q

describe the treatment of pneumonia in kids 3 mos+

A

amox clav outpatient

ampicillin or ceftriaxone IV

42
Q

What do you suspect in a neonate with unexplained cardiorespiratory collapse, cyanosis, tachypnea without chest retractions/accessory muscle use for breathing

A

congenital heart disease
- 1st week: HLHS, coarctation
- 2nd week: VSD, ASD

43
Q

List the 5 Ts of cyanotic heart disease

A
  • tricuspid atresia
  • truncus arteriosis
  • tetralogy of fallot
  • total anomalous pulmonary venous return
  • transposition of the great arteries

(R to L shunting)

44
Q

What commonly causes myocarditis in kids

A

Viral: parvovirus B19, herpesvirus 6
Noninfectious: kawasaki, JIA

45
Q

Describe the workup for myocarditis

A
  • CBC, BMP, cultures, troponin
  • EKG: nonspecific changes
  • CXR: pulmonary edema & cardiomegaly
  • echo: eval cardiac function
46
Q

Describe the etiology & presentation of staph scalded skin syndrome

A

toxin mediated erythroderma via staph
- usually <2
- malaise, fever, irritability, extensive erythroderma w/wo nikolsky sign (separation of epidermis with pressure)

ADMIT for nafcillin, dicloxacillin, or augmentin

47
Q

Describe the treatment for erysipelas/cellulitis

A

cephalexin with or without bactrim (MRSA)

48
Q

Describe the presentation & Tx of meningococcemia

A

petechial rash that may evolve to hemorrhagic over a few hours, evolve into palpable purpura

Tx: ceftriaxone then can switch to PCN G or ampicillin

49
Q

Describe what to do as soon as you sus out anaphylaxis

A

IM epinephrine 0.01 mg/kg immediately

50
Q

What is the most common cause of acquired cardiac disease in kids in north america and japan

A

Kawasaki disease
- phase 1: acute febrile w/ tachycardia & murmur (2 wks)
- phase 2: subacute coronary artery aneurysms (1 month)
- phase 3: convalescence (6 wks)

51
Q

Describe the presentation of kawasaki disesase

A
  • 5 days of high fever
  • strawberry tongue
  • conjunctivitis/iritis
  • red mucous membranes with dry cracked lips
  • swollen lymph nodes (cervical)
  • peeling skin on extremities in late stages
52
Q

Describe the treatment of kawasaki disease

A
  • high dose ASA
  • IVIG

Steroids not helpful & increase risk of aneurysm

53
Q

What is one of the most common causes of AKI in kids occurring <10 years old

A

Hemolytic uremic syndrome (E coli)
- this can develop if we give abx for diarrhea when we shouldn’t

54
Q

Describe the lab findings of pyloric stenosis

A

metabolic alkalosis that is hypochloremic, hypokalemic

Tx: correct alkalosis & lyte imbalance & do surgery

(non-bilious projectile vomiting, olive shaped mass)

55
Q

describe the treatment of malrotation & volvulus

A

emergent surgery

(bilious vomiting,a brupt abd pain & distention)

56
Q

What is the single best rehydration therapy in kids

A

sodium containing fluids (Chicken broth!!!! pedialyte okay)

57
Q

what is the most common surgical emergency in kids

A

appendicitis

Surgery with unasyn (non-perf) or zosyn (perf)

58
Q

Describe some components of the ouchless ED

A
  • topical remedies (EMLA or buzzy)
  • intranasal meds
  • inhaled nitrous oxide
  • child life specialists
  • parent involvement

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