Ross Flashcards
1
Q
what are the 3 components of the pediatric assessment triangle
A
appearance
work of breathing
circulation to skin
2
Q
what are the 6 categories of the pediatric assessment tool
A
- stable
- respiratory distress
- respiratory failure
- shock
- CNS/metabolism disturbance
- cardiopulmonary failure
3
Q
name the components of “appearance” in the pediatric assessment triangle (4)
A
- tone
- interaction
- consolable
- look (gaze and eye movement)
- speech/cry
TICLS
4
Q
name the components of “work of breathing” in the pediatric assessment triangle (3)
A
- RR
- chest expansion
- symmetry
5
Q
what does pediatric mild respiratory distress involve in terms of WOB
A
subcostal/substernal retraction
6
Q
what does severe respiratory distress look like in terms of WOB
A
- supraclavicular and suprasternal retractions
7
Q
what are signs of terminal respiratory distress in terms of WOB
A
- head bobbing
- seesaw breathing
8
Q
what 2 vitals should you get to assess circulation to skin
A
- hr
- bp
9
Q
what are signs of respiratory distress in terms of circulation to skin (3)
A
- pallor
- mottling
- cyanosis
10
Q
what is the main cause of death in peds > 1 yo
A
unintentional injury
11
Q
what is the main cause of death in peds > 4 yo
A
MVA
12
Q
what are the steps in the spiral of death
A
- respiratory distress
- hypoxemia/hypercapnia
- acidodis
- bradycardia
13
Q
kids increase what to improve CO
A
HR
14
Q
adults increase what to improve CO
A
stroke volume
15
Q
kids can lose __ % of blood volume before showing signs of hypotn
A
30
16
Q
__ with normal bp is one of the first signs of severe distress in peds
A
narrowed pulse pressure
17
Q
what are the 4 steps in ALS for peds
A
- place in proper position (sniffing if necessary)
- O2 via high flow NC
- fluid boluses of 20 cc/kg of NS
- if one bolus does not work, give another
18
Q
what is the dosing for fluid boluses for a ped in distress
A
20 cc/kg NS
19
Q
what conditions should you consider in a neonate in respiratory distress, and what med should you give them
A
congenital heart abnormality
prostaglandin
20
Q
what is the pressor of choice for peds
A
epinephrine
21
Q
what should you do before administering epinephrine in a child in distress
A
- volume load
- epinephrine
22
Q
what usually precedes respiratory failure in peds
A
hx of being ill for several hours/days
23
Q
respiratory failure is skewed toward what pediatric patient population
A
infants
24
Q
what is the most common cause of cardiac arrest in pediatrics
A
respiratory failure
25
what is the first step in BLS for peds
A → airway first
26
BLS for peds is \_\_,
rather than \_\_
ABC
CAB
27
\_\_ is still recommended in peds CPR (unlike in adult CPR)
rescue breathing
28
what is the ratio for rescue breaths:chest compressions in peds CPR for lone and 2 person CPR
lone: 30:2
2 person: 15:2
29
what is dosing for glucose repletion for neonates/infants
D10 1 cc/kg
30
what is the dosing for glucose repletion for toddlers/preschool peds
D25 2 cc/kg
31
what is the dosing for glucose repletion for school age/adolescent pt
D50 1 cc/kg
32
what is the rule of 50 for glucose repletion dosing
a x b = 50
a = type of fluid
b = cc/kg
33
what are the dosages of epi pens by weight
10-20 kg: 0.15 cc of 1:1,000
\>20 kg: 0.3 cc of 1:1,000
34
what is epi pen dosing for \< 1 yo or \< 10 kg
0.1 mL of 1: 1,000
35
what is the gold standard for temp taking in peds
rectal temps
36
what are the rough fever parameters for peds
28 days or older: \>100.8 (38.2 C)
younger than 28 days: 100.4 (38 C)
37
what is the main pathological condition (do not miss) in pediatric fever
SBI (serious bacterial infxn)
38
what is the tx for an infant \< 28 days old w. fever \>100.4
full work up:
CBC, UA, CXR, cultures, CSF
39
what is the risk for SBI in infants \< 28 days old w. fever \> 100.4
~12%
40
what 3 drugs should you give to an infant \< 28 days old w. a fever \> 100.4
1. abx (Ampicillin, Gentamycin, Acyclovair)
2. antivirals
## Footnote
**ASAP**
41
what are the 5 pathogens of concern in an infant \< 28 days old w. fever \> 100.4
1. Ecoli
2. Klebsiella
3. Listeria
4. Herpes
5. B Strep
E.coli Kills Happy Little Boys
42
what test does Rochester criteria not include for low risk peds
LP
43
in the Rochester criteria, what is the threshold for a work up for SBI (2)
1. 60 days or younger
2. temp 100.4 (38)
44
what does the Rochester criteria include in a full work up for SBI (4)
1. WBC
2. UA
3. CXR
4. CSF
45
what is the Rochester criteria and what is low risk criteria
identifies febrile infants 60 days or younger who are at low risk for SBI
satisfy all of the following criteria:
1) well-appearing
2) born at ≥ 37 weeks gestation and previously healthy
3) no source of infection present on exam
4) peripheral white blood cell (WBC) count 5,000 to 15,000/mm3
5) absolute band count ≤ 1500/mm3, and
6) ≤ 10 WBC on urine microscopy.17
46
rochester criteria is used for patients \< __ days old
with a fever \> __ C
60
38
47
what is considered low risk history in the Rochester criteria? (4)
1. term infant
2. no perinatal abx
3. no underlying dz
4. not hospitalized longer than MOC
48
what findings are considered low risk PE exam for rochester criteria (2)
1. well-appearing
2. no ear, soft tissue, or bone infxn
49
all high risk fever peds require what test
LP
50
if you prescribe abx for a ped with fever, you must also do what test
LP
51
for rochester criteria, you can skip a __ test if the pt is low risk
LP
52
for rochester criteria, what is the tx for low risk pt
home
no abx
f/u required
53
for rochester criteria, what is the tx for high risk pt
hospitalize
empiric abx
54
what are the most common pathogens in SBI for infants 29 days - 3 months
h. flu
e. coli
neisseria meningitidis
strep pneumo
HENS
55
what is the definition of a fever in a ped \< 28 days old
temp \>100.4
56
what is the definition of a fever in peds \> 28 days old
100.8
57
what are serious SBIs (4)
1. cellultis
2. UTI
3. bacteremia
4. bone and joint infxns
CUBB
58
what are IBIs (6)
1. meningitis
2. PNA
3. sepsis
4. osteomyelitis
5. bacterial enteritis
6. pyelonephritis
59
what is the most concerning viral pathogen in pediatric fever
herpes
60
in under 90 days old, majority of bacterial infxns are dt
UTI
61
what is the most common bacterial pathogen in SBI
e. coli
62
what age group are protocol eligible infants
29 days - 59 days
63
neonates \< 28 days old are __ occult
and __ occult
clinically
lab
64
infants 29 days - 59 days old are
\_\_ occult and
\_\_ positive
clinically occult
lab
65
infants older than 60 days old are
\_\_ positive and
\_\_ positive
clinically
lab
66
if there is a fever with no source, what medication should all treated peds get
acyclovair
67
unvaccinated peds \< 60 days old with fever all get
aggressive work up
probable admit
68
3 differences btw kids heads and adults heads
1. proportionally large
2. proportionally less brain mass
3. will tend to be hit first in trauma
69
what are 5 differences between peds and adult airways
1. relative small mouth and airways
2. narrow glottic opening
3. trachea shorter, smaller, more flexible
4. tongue proportionally larger
5. tonsil and adenoid swelling can cause respiratory distres
70
any pediatric hr \< __ is abnormal
60
71
what 2 meds are used for asystole or bradycardia in peds
epinephrine and atropine
72
what is commitio cordis
sudden blunt impact to the chest causes sudden death in the absence of cardiac damage
73
how do you treat commitio cordis
defibrillate →
unsynchronized: 150j
biphasic: 300j
74
in peds 57 days - 6 mo w. fever \> 102.2 what tests would you order
UA
CBC
→ LP if CBC is elevated
75
in peds 57 days - 6 mo w. fever \> 102.2 tx with __ if
WBC is \> \_\_
Cefriaxone
15,000
76
how do you manage peds \> 6 mo old with fever
consider UA only
77
what is BRUE (formerly ALTE)
Brief Resolved Unexplained Event →
1. change in color
2. change in tone
3. apnea?
4. altered level of responsiveness?
78
what are excluding criteria for a BRUE
other symptoms
respiratory distress
feeding problems
fever
> \> 1yo
79
criteria for low risk BRUE patient (5)
1. \> 60 days old
2. gestagional age \>32 weeks or 45 weeks post conception age
3. short duration and only 1 event
4. no concerning hx
5.
80
tx for low risk BRUE pt
no work up
briefly monitor w. O2 and obs
81
high risk BRUE criteria (4)
1. \< 2 months old
2. pre term \< 32 weeks or are \< 45 days post conception
3. infants w. significant med hx
4. multiple events
82
what is the tx for high risk BRUE pt (5)
1. monitor and admit
2. CBC, bld cx, lytes
3. cxr, ekg
4. LP
5. UA
6. check for pertussis and RSV
83
normal HR for newborn (0-1 month)
100-170 bpm
84
normal RR for newborn
35-60
85
normal heart rate for infant - 2 yo
103-140
86
normal RR for 12-18 months old
20 - 40
87
what is the age group for simple febrile sz
6 months - 5 yo
88
what are the parameters for a simple febrile sz (3)
1. only on
2. \< 15 min
3. fever
89
what is the tx for a low risk pt w. a simple febrile sz
antypyretics only
90
what is defined as high risk for a simple febrile sz (3)
1. btw 6 mo - 1 year old
2. not immunized
3. already on abx
91
what is the work up for high risk pt for simple febrile sz
CBC
UA
LP
92
what is the concern for high risk pt w. simple febrile sz
meningitis
