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Clin Med II - Exam 1 > Ross > Flashcards

Ross Flashcards

1
Q

what are the 3 components of the pediatric assessment triangle

A

appearance

work of breathing

circulation to skin

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2
Q

what are the 6 categories of the pediatric assessment tool

A
  1. stable
  2. respiratory distress
  3. respiratory failure
  4. shock
  5. CNS/metabolism disturbance
  6. cardiopulmonary failure
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3
Q

name the components of “appearance” in the pediatric assessment triangle (4)

A
  1. tone
  2. interaction
  3. consolable
  4. look (gaze and eye movement)
  5. speech/cry

TICLS

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4
Q

name the components of “work of breathing” in the pediatric assessment triangle (3)

A
  1. RR
  2. chest expansion
  3. symmetry
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5
Q

what does pediatric mild respiratory distress involve in terms of WOB

A

subcostal/substernal retraction

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6
Q

what does severe respiratory distress look like in terms of WOB

A
  1. supraclavicular and suprasternal retractions
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7
Q

what are signs of terminal respiratory distress in terms of WOB

A
  1. head bobbing
  2. seesaw breathing
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8
Q

what 2 vitals should you get to assess circulation to skin

A
  1. hr
  2. bp
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9
Q

what are signs of respiratory distress in terms of circulation to skin (3)

A
  1. pallor
  2. mottling
  3. cyanosis
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10
Q

what is the main cause of death in peds > 1 yo

A

unintentional injury

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11
Q

what is the main cause of death in peds > 4 yo

A

MVA

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12
Q

what are the steps in the spiral of death

A
  1. respiratory distress
  2. hypoxemia/hypercapnia
  3. acidodis
  4. bradycardia
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13
Q

kids increase what to improve CO

A

HR

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14
Q

adults increase what to improve CO

A

stroke volume

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15
Q

kids can lose __ % of blood volume before showing signs of hypotn

A

30

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16
Q

__ with normal bp is one of the first signs of severe distress in peds

A

narrowed pulse pressure

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17
Q

what are the 4 steps in ALS for peds

A
  1. place in proper position (sniffing if necessary)
  2. O2 via high flow NC
  3. fluid boluses of 20 cc/kg of NS
  4. if one bolus does not work, give another
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18
Q

what is the dosing for fluid boluses for a ped in distress

A

20 cc/kg NS

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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

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20
Q

what is the pressor of choice for peds

A

epinephrine

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21
Q

what should you do before administering epinephrine in a child in distress

A
  1. volume load
  2. epinephrine
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22
Q

what usually precedes respiratory failure in peds

A

hx of being ill for several hours/days

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23
Q

respiratory failure is skewed toward what pediatric patient population

A

infants

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24
Q

what is the most common cause of cardiac arrest in pediatrics

A

respiratory failure

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25
Q

what is the first step in BLS for peds

A

A → airway first

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26
Q

BLS for peds is __,

rather than __

A

ABC

CAB

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27
Q

__ is still recommended in peds CPR (unlike in adult CPR)

A

rescue breathing

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28
Q

what is the ratio for rescue breaths:chest compressions in peds CPR for lone and 2 person CPR

A

lone: 30:2

2 person: 15:2

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29
Q

what is dosing for glucose repletion for neonates/infants

A

D10 1 cc/kg

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30
Q

what is the dosing for glucose repletion for toddlers/preschool peds

A

D25 2 cc/kg

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31
Q

what is the dosing for glucose repletion for school age/adolescent pt

A

D50 1 cc/kg

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32
Q

what is the rule of 50 for glucose repletion dosing

A

a x b = 50

a = type of fluid

b = cc/kg

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33
Q

what are the dosages of epi pens by weight

A

10-20 kg: 0.15 cc of 1:1,000

>20 kg: 0.3 cc of 1:1,000

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34
Q

what is epi pen dosing for < 1 yo or < 10 kg

A

0.1 mL of 1: 1,000

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35
Q

what is the gold standard for temp taking in peds

A

rectal temps

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36
Q

what are the rough fever parameters for peds

A

28 days or older: >100.8 (38.2 C)

younger than 28 days: 100.4 (38 C)

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37
Q

what is the main pathological condition (do not miss) in pediatric fever

A

SBI (serious bacterial infxn)

38
Q

what is the tx for an infant < 28 days old w. fever >100.4

A

full work up:

CBC, UA, CXR, cultures, CSF

39
Q

what is the risk for SBI in infants < 28 days old w. fever > 100.4

A

~12%

40
Q

what 3 drugs should you give to an infant < 28 days old w. a fever > 100.4

A
  1. abx (Ampicillin, Gentamycin, Acyclovair)
  2. antivirals

ASAP

41
Q

what are the 5 pathogens of concern in an infant < 28 days old w. fever > 100.4

A
  1. Ecoli
  2. Klebsiella
  3. Listeria
  4. Herpes
  5. B Strep

E.coli Kills Happy Little Boys

42
Q

what test does Rochester criteria not include for low risk peds

A

LP

43
Q

in the Rochester criteria, what is the threshold for a work up for SBI (2)

A
  1. 60 days or younger
  2. temp 100.4 (38)
44
Q

what does the Rochester criteria include in a full work up for SBI (4)

A
  1. WBC
  2. UA
  3. CXR
  4. CSF
45
Q

what is the Rochester criteria and what is low risk criteria

A

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
Q

rochester criteria is used for patients < __ days old

with a fever > __ C

A

60

38

47
Q

what is considered low risk history in the Rochester criteria? (4)

A
  1. term infant
  2. no perinatal abx
  3. no underlying dz
  4. not hospitalized longer than MOC
48
Q

what findings are considered low risk PE exam for rochester criteria (2)

A
  1. well-appearing
  2. no ear, soft tissue, or bone infxn
49
Q

all high risk fever peds require what test

A

LP

50
Q

if you prescribe abx for a ped with fever, you must also do what test

A

LP

51
Q

for rochester criteria, you can skip a __ test if the pt is low risk

A

LP

52
Q

for rochester criteria, what is the tx for low risk pt

A

home

no abx

f/u required

53
Q

for rochester criteria, what is the tx for high risk pt

A

hospitalize

empiric abx

54
Q

what are the most common pathogens in SBI for infants 29 days - 3 months

A

h. flu
e. coli

neisseria meningitidis

strep pneumo

HENS

55
Q

what is the definition of a fever in a ped < 28 days old

A

temp >100.4

56
Q

what is the definition of a fever in peds > 28 days old

A

100.8

57
Q

what are serious SBIs (4)

A
  1. cellultis
  2. UTI
  3. bacteremia
  4. bone and joint infxns

CUBB

58
Q

what are IBIs (6)

A
  1. meningitis
  2. PNA
  3. sepsis
  4. osteomyelitis
  5. bacterial enteritis
  6. pyelonephritis
59
Q

what is the most concerning viral pathogen in pediatric fever

A

herpes

60
Q

in under 90 days old, majority of bacterial infxns are dt

A

UTI

61
Q

what is the most common bacterial pathogen in SBI

A

e. coli

62
Q

what age group are protocol eligible infants

A

29 days - 59 days

63
Q

neonates < 28 days old are __ occult

and __ occult

A

clinically

lab

64
Q

infants 29 days - 59 days old are

__ occult and

__ positive

A

clinically occult

lab

65
Q

infants older than 60 days old are

__ positive and

__ positive

A

clinically

lab

66
Q

if there is a fever with no source, what medication should all treated peds get

A

acyclovair

67
Q

unvaccinated peds < 60 days old with fever all get

A

aggressive work up

probable admit

68
Q

3 differences btw kids heads and adults heads

A
  1. proportionally large
  2. proportionally less brain mass
  3. will tend to be hit first in trauma
69
Q

what are 5 differences between peds and adult airways

A
  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
Q

any pediatric hr < __ is abnormal

A

60

71
Q

what 2 meds are used for asystole or bradycardia in peds

A

epinephrine and atropine

72
Q

what is commitio cordis

A

sudden blunt impact to the chest causes sudden death in the absence of cardiac damage

73
Q

how do you treat commitio cordis

A

defibrillate →

unsynchronized: 150j
biphasic: 300j

74
Q

in peds 57 days - 6 mo w. fever > 102.2 what tests would you order

A

UA

CBC

→ LP if CBC is elevated

75
Q

in peds 57 days - 6 mo w. fever > 102.2 tx with __ if

WBC is > __

A

Cefriaxone

15,000

76
Q

how do you manage peds > 6 mo old with fever

A

consider UA only

77
Q

what is BRUE (formerly ALTE)

A

Brief Resolved Unexplained Event →

  1. change in color
  2. change in tone
  3. apnea?
  4. altered level of responsiveness?
78
Q

what are excluding criteria for a BRUE

A

other symptoms

respiratory distress

feeding problems

fever

> > 1yo

79
Q

criteria for low risk BRUE patient (5)

A
  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
Q

tx for low risk BRUE pt

A

no work up

briefly monitor w. O2 and obs

81
Q

high risk BRUE criteria (4)

A
  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
Q

what is the tx for high risk BRUE pt (5)

A
  1. monitor and admit
  2. CBC, bld cx, lytes
  3. cxr, ekg
  4. LP
  5. UA
  6. check for pertussis and RSV
83
Q

normal HR for newborn (0-1 month)

A

100-170 bpm

84
Q

normal RR for newborn

A

35-60

85
Q

normal heart rate for infant - 2 yo

A

103-140

86
Q

normal RR for 12-18 months old

A

20 - 40

87
Q

what is the age group for simple febrile sz

A

6 months - 5 yo

88
Q

what are the parameters for a simple febrile sz (3)

A
  1. only on
  2. < 15 min
  3. fever
89
Q

what is the tx for a low risk pt w. a simple febrile sz

A

antypyretics only

90
Q

what is defined as high risk for a simple febrile sz (3)

A
  1. btw 6 mo - 1 year old
  2. not immunized
  3. already on abx
91
Q

what is the work up for high risk pt for simple febrile sz

A

CBC

UA

LP

92
Q

what is the concern for high risk pt w. simple febrile sz

A

meningitis

Clin Med II - Exam 1 (7 decks)

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