PEDUC rotation Flashcards
location of pediatric glottis
cephalad, or anterior
oxygen flow rates for less than 2 years? 2-12? over 12?
apneic oxygenation can reduce hypoxemia at the following agebased flow rates: 4 L/min for ≤2 y of age, 6 L/min for >2 to ≤12 y of age, 8
L/min for >12 y of age
Advanced trauma life support maintains their recommendation for needle
decompression where in peds? adults?
needle decompression in the second intercostal space at the midclavicular line
for children, even though the fifth intercostal space at the midaxillary line is
now recommended for adults
Compensatory mechanisms (tachycardia and vasoconstriction) may
maintain blood pressure in pediatric trauma patients until?
until 40% of the blood
volume has been lost, at which point decompensation abruptly occurs. Do
not rely on hypotension alone to identify shock
preferred site for intraosseous (IO) access in children?
anterior tibia, followed by the distal femur and medial malleolus- if peripheral IV placement is unsuccessful
evidence of hemorrhage or shock signs?
delayed capillary refill, cool
extremities, diminished peripheral pulses, hypotension (= <70 + [age2]),
tachycardia, peritonitis, pelvic fracture, and external hemorrhage
perform intubation for GCS less than?
9 or if presence of rapid decline.
if increased ICP is expected? steps?
raise the head of the bed to 30°, give hypertonic saline or mannitol, and
avoid hypotension and hypoxia.
pediatric abdomen?
The pediatric spleen and liver are large, anterior, poorly protected, and thus
prone to injury
Children’s kidneys are less protected, more mobile, and more susceptible
to deceleration injury than adult kidneys.
fluid resuscitation guideline
Initiate fluid resuscitation for partial/full thermal injuries involving >20% TBSA (total body surface area) with 2-3 mL/kg lactated Ringer’s %TBSA
(rather than 2 mL/kg for adults) divided equally between the first 8 h and the following 16 h using an age-specific TBSA reference.
Maintenance
fluids with dextrose should be added if the child weighs less than 30 kg
Initiate pediatric massive transfusion protocol when
Initiate pediatric massive transfusion protocol when 40 mL/kg of blood products
have been, or are expected to be, transfused within 24 h.
When blood loss reaches, or is expected to reach, 40 mL/kg in 24 h, initiate a
massive transfusion protocol using a fixed 1:1:1 or 1:1:2 ratio of plasma, platelets, and
packed RBCs (pRBCs) or as guided by thromboelastography
Cryoprecipitated Antihemophilic Factor? and dose
Cryoprecipitated Antihemophilic Factor, also called cryo, is a portion of plasma, the liquid part of our blood. Cryo is rich in clotting factors, which are proteins that can reduce blood loss by helping to slow or stop bleeding. The blood clotting proteins found in cryo include: Fibrinogen. Factor VIIIFibrinogen. Factor VIII
10 mL/kg
size for ETT tubes? miller or macs? foleys? chest tube? NG tubes?
Cuffed ETT is safe for all ages; however, uncuffed ETT is appropriate for <1 y of age only
Size: ([Age/4] + 4) = uncuffed;
([age/4] + 3.5) = cuffed
Depth: 3 the uncuffed ETT size (cm)
Laryngoscope
Miller/Mac 1 for 0-2 y of age
Miller/Mac 2 for 2-8 y of age
Miller/Mac 3 for >8 y of age
Chest tube: ~3-4× uncuffed ETT size
Foley catheter: ~2× uncuffed ETT size
Naso/orogastric tube: ~2× uncuffed ETT size
GSC rank
eye opening
spontaneous (4)
response to verbal
response to pain
none
best verbal response
oriented (5)
confused
inappropriate words
incomprehensible words
no verbal response
best motor response
obeys commands (6)
localizes response to pain
withdrawal response to pain
flexion to pain
extension to pain
no motor response
age-adjusted shock index
(heart rate/systolic blood pressure) may help identify children with compensated shock and can predict the need for operative intervention, intubation, blood transfusion, severe injury, and mortality better than either hypotension alone or the unadjusted shock index
a shock index >1.22 for children 4-6 y of age and >1.0 for children ≥7 y of age should
heighten the emergency provider’s suspicion for severe injury and significant blood
loss
