SPE2 Flashcards
hypervent/ for Child w/ brainstem herniation
hypervent/ for Infant w/ brainstem herniation
ETCO2 target:
= 30 breathes a min (>1yr)
= 35 breathes a min (1mth - 1yr)
= ETCO2 target 35 mmHg
Suction form:
= 2 x ETT
Estimate pedi weight:
(age X 3) +7=Kg <New>
(age +4) x2=Kg <Old></Old></New>
Pedi PPV BVM rate:
1 every 2-3secs ~20-30breaths /min
Pedi Resp distress:
Pedi Resp failure:
= “Huffing & Puffing Enough” to sustain life
= “failure to respirate to sustain life” >60RR
hypoglycemia Rx for neonate:
hypoglycemia Rx for infant:
= <45BGL infant 2mns - 1yr
= <60BGL 1-3toddler yrs
What is hypoglycemia in newborns?
BG < 40 mg/dL, treated with D10 (5-10 mL/kg).
What are the steps in newborn resuscitation?
Dry, warm, position, stimulate; if HR < 100, positive pressure ventilation (PPV); if HR < 60, CPR (3:1 compressions-to-ventilation ratio)
Neonatal Hypoglycemia Treatment
Dextrose 10% (D10) at 5-10 mL/kg IV bolus
Neonatal Fever Considerations
> 100.4°F (38.0°C) is concerning; workup for sepsis if present
Pedi HypoBP form/ & starts @
<70 + (Yrs x 2) Toddler: 1-3Yrs & up
Pediatric Bradycardia Treatment
- If hypoxic → Oxygen & ventilation
- If unstable → Epinephrine 0.01 mg/kg IV/IO
- Atropine (0.02 mg/kg) if vagal cause suspected
fluid replacement for PEDI trauma PT form:
Best way to rapidly admin fluids:
= give 20 cc/kg NS/LR even if BP norm, repeat bolus if HR, LOC, CR & other signs of systemic perfusion fail to improve.
= 20mL/kG push pull push pull 3way stop cock
A surgical cricothyrotomy is contraindicated in patients less than
less than 8 years old
Infant to 1 year)ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
3.5–4.0
Uncuffed
9.5–11.0 cm
1 straight
Pedi Normal Urine output:
1-2ml/kg/Hr urine output
Pedi Polyuria
> 3ml/kg
Child BVM bag vol/
Infant BVM bag vol/
= 800mL
= 300mL
Adults vocal cords @
Pedi Vocal cords @
C4 - 5
C2 - 3
Pedi intubation indications
Bad physical signs NOT MONITORS
What is the correct tidal volume for a pediatric patient?
5-7 mL’s/kg
What is the CPR rate for a 6-month-old infant found unconscious?
At least 100/minute; ratio 15:2; depth 1/3 to 1/2 the depth of the chest
What is the pulmonary dead space volume for a pediatric patient?
3 mL/kg
Neonatal CPR Indications
HR < 60 bpm despite ventilation & oxygenation
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
Newborn’s heart rate normally be at birth?
150–180 at birth, slowing to 130–140 thereafter.
Newborn’s respiratory rate average?
40–60 breaths per minute.
Premature infant) ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
2.5–3.0
Uncuffed
8.0 cm
0 straight
Dextrose Pediatric Dosing
Conversion) D50 to D25:
D50 to D10:
- Neonate (<2 months): D10W, 5-10 mL/kg IV
- Infant (2Mn-2Yrs): D25W, 2-4 mL/kg IV
- Child (>2Yrs): D50W, 1-2 mL/kg IV
= Dilute by a factor of 2 (add equal Vol of fluid)
= Dilute by a factor of 5 (add 4x Vol of fluid)
Croup Med dosing:
RaceEpi) 2.25% 0.5mL + 4mLs of NS Nebulized
Epi 1:1) 1mL w/ 4mL NS Nebulized
Epi 1:10) 5-10mLs of Epi (no dilution) Nebulized
Pedi Fluid doses) Hypovolemia& Distributive:
Cardiogenic Shock:
Poisoning CCB/BB:
DKA with Compensated Shock:
= 20 mL/kg / 5-10Mins PRN
= 5-10 mL/kg / 10-20Mins PRN
= 5-10 mL/kg / 10-20Mins PRN
= 10-20 mL/kg / 60-120 Minutes
Pediatric Age Classifications
- Newborn: Birth to hours old
-Neonate: Hours to 1 month
-Infant: 1 month - 1 year
-Toddler: 1-3 years
-Preschooler: 3-5 years
-School-age: 6-12 years
-Adolescent: 13-18 years
Pediatric Vital Signs Considerations
- HR, RR higher than adults
- BP lower than adults
- Hypotension is a late shock sign
Toddler:
Preschooler:
School-age:
Adolescent:
“Kid/Child”:
=1-3 years
= 3-5 years
= 6-12 years
= 13-18 years
= 8Yrs up, 45Kg up, before puberty
hypotension threshold for an 11-month-old infant?
Less than 70 mmHg systolic
hypotension threshold for a 19-month-old pediatric patient?
Less than 70 + (2 x age in years)
hypotension threshold for a neonate?
Less than 60 mmHg systolic
hypotension threshold for a 2-month-old infant?
Less than 70 mmHg systolic
hypotension threshold for a 12-year-old pediatric patient?
Less than 90 mmHg systolic
Neonatal CPR technique?
3:1 compression-ventilation ratio, 120 bpm rate, Two-thumb technique, Depth: 1/3 AP diameter.
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
Pedi Hypovolemia& Distributive fluid Form:
= 20 mL/kg / 5-10Mins PRN
Pedi Cardiogenic Shock fluid form
= 5-10 mL/kg / 10-20Mins PRN
Pedi Poisoning CCB/BB fluid form
= 5-10 mL/kg / 10-20Mins PRN
Pedi DKA Comp Shock fluid form
= 10-20 mL/kg / 60-120 Minutes
Infant def
1 month till 1 year)
1-3 years =
3-5 years =
6-12 years =
13-18 years =
Toddler:
Preschooler:
School-age:
Adolescent:
newborn age range
Birth to the 1st couple Hrs of life
Adolescent age range
13 years and 18 years
School-aged child age range
6Yrs - 12Yrs
Toddler age range
1 year & 3 years
Neonate age range
1st few hours of life to 1 month
What are the definitions of Newborn, Neonate, and Infant?
Newborn: birth till a few hours old; Neonate: few hours till 1 month; Infant: 1 month till 1 year
What does the APGAR score assess?
Appearance (color), Pulse (HR), Grimace (reflex), Activity (muscle tone), Respiration (effort); scored at 1 & 5 minutes
Neonatal Airway Management
Position airway, suction only if obstruction present, intubate if necessary
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
How to clamp & cut the umbilical cord after delivery:
What to do immediately after the baby is delivered:
= Delay clamping 30Secs after delivery, Clamp cord 4in. (10 cm) from navel; place 2nd clamp 2in (5 cm) from 1st &
Cut cord between clamps
= Dry baby; cover w/ warm, dry blankets or towels.
Position baby on side.
Record time of birth.
Fetal Circulation) Foramen ovale:
Function:
Blood @ this time is De or oxygenated:
= hole between fetus’s atrias “fetal shunt”
= allows mixing of oxygenated blood in R-atrium, leaving the L-ventricle bound for the aorta. This serves to aid in blood flow bypassing the lungs.
= At this time, the blood is still oxygenated.
mLs range in uterus
= 50mLs-1.5Ls in uterus
Pediatric GCS Differences
- Modified for age
- Verbal & motor responses changed for age
Pediatric Synchronized Cardioversion Dosing
- SVT/VT w/ Pulse: Start @ 0.5-1 J/kg, increase to 2 J/kg if needed
How to estimate weight:
= (Age x 3) + 7 = Approximate weight in kg
What is the rescue breathing rate for a pediatric patient?
1 breath every 2-3 seconds
What is the correct compression to ventilation ratio for CPR on an infant?
30:2
What is the appropriate depth for chest compressions in an infant?
1 1/2 inches
Cuffed ET:
Indications:
Monometer cuff
Usually start at:
(Age /4) + 3.5
= Increased pulmonic P} Anaphylaxis, Burn, drown
= never over 30 mmHg
= 6.0 ~1st
Infant tachycardia
Children tachycardia
Note
> 220
180
get Hx, if sudden & random onset then SVT
Croup vs Epiglottitis) Temp
Usually occurs @:
Common age:
=(C)Low fever101-2 (E)High fever 102-4
=(C)Before bed (E) in Morning/middle of night
=(C)6Mns - 4Yrs (E) 3Yrs - 7Yrs
Pediatric GCS (Glasgow Coma Scale):
= Modified to assess eye opening, verbal response, motor response
Pedi Tension Pneumo decomp:
3rd rib 2nd ICS Chest wall thickness in anterior chest varies from 1.4 – 1.6 cm (0.55 - .63 inches)
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
Estimating upper limit of RR:
= Age# - 40
Age & French Suction Catheter Size) Up to 1 year:
1 to 6 years:
7 to 15 years:
16 years:
= 8
= 8-10
= 10-12
= 12
<1Yr pulse check @
Carotid
Pediatric GCS 0-24Mns changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
Pediatric GCS 2-5Yrs changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
febrile seizures result from
Most commonly between ages of
= a sudden increase in body temperature.
= 6Mns & 6Yrs often, guardians report a recent onset of fever or cold symptoms.
OG tube (French) Premature
Neonate
6 Months
1–4 Years
5 Years
5–10 Years
5
5–8
8
10
10–12
14–18
Laryngoscope blade) Premature
Neonate
6 Months
1–4 Years
5 Years
5–10 Years
0 (straight)
1 (straight)
1 (straight)
1–2 (straight)
2 (straight or curved)
2–3 (straight or curved)
What is the appropriate depth for chest compressions in a child?
2 inches
ETT) Premature (1–2.5 kg; 2.2–5.5 lb*)
Neonate (2.5–4 kg; 5.5–8.8 lb)
6 Months (6–8 kg; 13.2–17.
1–4 Years (10–14 kg; 22–30.8 lb)
5 Years (16–18 kg; 35.2–39.6 lb)
5–10 Years (24–30 kg; 52.8–66 lb)
= 2.5–3.0 (uncuffed) formula
3.0–3.5 (uncuffed) formula
3.5–4.0 formula
4.0–4.5 formula
5.0–5.5 formula
5.5–6.5 formula
French Suction/Stylet) Premature (1–2.5kg; 2.2–5.5 lb)
Neonate (2.5–4 kg; 5.5–8.8 lb)
6 Months (6–8 kg; 13.2–17.
1–4 Years (10–14 kg; 22–30.8 lb)
5 Years (16–18 kg; 35.2–39.6 lb)
5–10 Years (24–30 kg; 52.8–66 lb)
6–8/6
8/6
8–10/6
10/6
14/14
14/14
Pediatric CPR Compression Depth & Rate
- Depth: 1/3 to 1/2 of chest AP diameter
- Rate: 100-120/min
- Ratios: 30:2 (1 rescuer), 15:2 (2 rescuers), 3:1 (newborns)
Pedi Defibrillation
Initial 2 J/kg, then 4 J/kg increasing to max 10J/Kg
hypoglycemia Rx for infant:
= <60BGL infant
Ped Epi 1:10 dose:
Pedi Epi 1:1 dose
- Cardiac Arrest: 0.01 mg/kg IV/IO (1:10,000) - Anaphylaxis: 0.01 mg/kg IM (1:1,000)
Pediatric Weight Estimation Formulas
- Old: (Age + 4) × 2 = kg
- New: (Age × 3) + 7 = kg
Pedi Uncuffed ETT form:
Pedi Cuffed ETT form:
= (Age in years ÷ 4) + 4.
= (Age in years ÷ 4) + 3.5
fluid replacement after perfusion rule:
4 2 1rule/ formula :
= normovolemia Used for every hr after to maintain
4ml/kg 1st 10kg
2m/Kg 2nd 10kg
1ml/kG 3rd
hypoglycemia for neonate:
= <45BGL neonate
- Dextrose Infant (2Mn-2Yrs):
D25W, 2-4 mL/kg IV
Dextrose Child (>2Yrs):
D50W, 1-2 mL/kg IV
What are the normal newborn vitals?
RR: 40-60 bpm,
HR birth: 150-180 bpm & after birth: 130-140 bpm
HR < 100 bpm = distress
Neonatal CPR Indications
HR < 60 bpm despite ventilation & oxygenation
Neonatal Hypovolemia Shock Signs
Pale, cool skin, poor capillary refill, weak pulses, lethargy
Neonatal Shock Treatment
Fluid resuscitation (10 mL/kg bolus NS or LR), treat underlying cause
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
posterior fontanelle usually closes
anterior fontanelle closes
= in 2 or 3 months
= between 9 and 18 months
Key Steps in Pediatric Primary Assessment (ABCDE)
- Airway: Position in neutral sniffing, remove obstructions
- Breathing: Assess rate, effort, SpO₂
- Circulation: HR, pulses, perfusion
- Disability: AVPU/GCS, pupil response
- Exposure: Full assessment, prevent heat loss
hypervent/ for Child w/ brainstem herniation
hypervent/ for Infant w/ brainstem herniation
ETCO2 target:
= 30 breathes a min (>1yr)
= 35 breathes a min (1mth to 1yr)
= ETCO2 target should be 35 mmHg
Infants sings of comp/ shock & entering decomp/:
Hypoxica > Tachycardic > Bradycardic
Croup vs Epiglottitis) Virus type:
Onset:
Defining S/S:
= (C)Viral (E)Bacterial
=(C)Slow (E)Fast
=(C)Seal cough & Steeple (E)Drooling
Croup vs Epiglottitis) Temp
Usually occurs @:
Common age:
=(C)Low fever101-2 (E)High fever 102-4
=(C)Before bed (E) in Morning/middle of night
=(C)6Mns - 4Yrs (E) 3Yrs - 7Yrs
What is the GCS score for a 5-year-old with Eye Opening: To verbal, Motor Response: Localizes, Verbal: Inappropriate words?
12
When does the posterior fontanelle of a pediatric patient generally close?
3 months
When does the anterior fontanelle of a pediatric patient generally close?
9-18 months
What is the GCS score for a 2-year-old with Eye Opening: To pain, Motor Response: Withdrawal, Verbal: Cries and Screams?
9
What is the GCS score for a 7-year-old with Eye Opening: To pain, Motor Response: Extension, Verbal: Incomprehensible sounds?
6
Infant tachycardia
Children tachycardia
Note
> 220
180
get Hx, if sudden & random onset then SVT
Respiratory Distress:
Respiratory Failure:
= Open & Maintainable , Tachypnea , Good Air Movement, Tachycardia, Pallor (pink/white cheek), Anxiety, Agitation
= Not Maintainable, Bradypnea to Apnea, Poor/Absent Air Movement, Bradycardia, Cape Cyanosis, Lethargy/Unresponsive
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
Cardiac arrest in infants & children usually from:
Respiratory failure or arrest
1 Killer 3rd trimester
Placenta Abruptio
Gestational Diabetes rx:
BGL < 70 mg/dL: Start IV NS & Admin/ 50-100 mL 50% dextrose intravenously
What 3 shunts are involved in the fetal circulation?
Ductus Venosus later lig terez
Foramen Ovale septum prinium
Ductus Arteriosus
When maternal blood volume increases, pregnant women will often receive supplemental iron to prevent anemia. This is because:
Although both red blood cells and plasma increase, there is slightly more plasma.
Jumpstart) Triaging
RPM Resp/ Pulse / Mental
Jumpstart) P of RPM
Radial pulse
Jumpstart) R of RPM
RR <15 or >45
Jumpstart) M or RPM
Mental status
hypervent/ for Child w/ brainstem herniation
hypervent/ for Infant w/ brainstem herniation
ETCO2 target:
= 30 breathes a min (>1yr)
= 35 breathes a min (1mth - 1yr)
= ETCO2 target 35 mmHg
Suction form:
= 2 x ETT
Estimate pedi weight:
(age X 3) +7=Kg <New>
(age +4) x2=Kg <Old></Old></New>
Pedi PPV BVM rate:
1 every 2-3secs ~20-30breaths /min
Pedi Resp distress:
Pedi Resp failure:
= “Huffing & Puffing Enough” to sustain life
= “failure to respirate to sustain life” >60RR
hypoglycemic with PEDIs trick:
hypoglycemia Rx for neonate:
hypoglycemia Rx for infant:
= Lots of sick kids hypoglycemic so use bone marrow for BGL
= <45BGL neonate 2mns - 1yr
= <60BGL infant 1-3yrs
What is hypoglycemia in newborns?
BG < 40 mg/dL, treated with D10 (5-10 mL/kg).
What are the steps in newborn resuscitation?
Dry, warm, position, stimulate; if HR < 100, positive pressure ventilation (PPV); if HR < 60, CPR (3:1 compressions-to-ventilation ratio)
Neonatal Hypoglycemia Treatment
Dextrose 10% (D10) at 5-10 mL/kg IV bolus
Neonatal Fever Considerations
> 100.4°F (38.0°C) is concerning; workup for sepsis if present
Pedi HypoBP form/ & starts @
<70 + (Yrs x 2) Toddler: 1-3Yrs & up
Pediatric Bradycardia Treatment
- If hypoxic → Oxygen & ventilation
- If unstable → Epinephrine 0.01 mg/kg IV/IO
- Atropine (0.02 mg/kg) if vagal cause suspected
fluid replacement for PEDI trauma PT form:
Best way to rapidly admin fluids:
= give 20 cc/kg NS/LR even if BP norm, repeat bolus if HR, LOC, CR & other signs of systemic perfusion fail to improve.
= 20mL/kG push pull push pull 3way stop cock
A surgical cricothyrotomy is contraindicated in patients less than
less than 8 years old
Infant to 1 year)ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
3.5–4.0
Uncuffed
9.5–11.0 cm
1 straight
Pedi Normal Urine output:
1-2ml/kg/Hr urine output
Pedi Polyuria
> 3ml/kg
Child BVM bag vol/
Infant BVM bag vol/
= 800mL
= 300mL
Adults vocal cords @
Pedi Vocal cords @
C4 - 5
C2 - 3
Pedi intubation indications
Bad physical signs NOT MONITORS
What is the correct tidal volume for a pediatric patient?
5-7 mL’s/kg
What is the CPR rate for a 6-month-old infant found unconscious?
At least 100/minute; ratio 15:2; depth 1/3 to 1/2 the depth of the chest
What is the pulmonary dead space volume for a pediatric patient?
3 mL/kg
Neonatal CPR Indications
HR < 60 bpm despite ventilation & oxygenation
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
Newborn’s heart rate normally be at birth?
150–180 at birth, slowing to 130–140 thereafter.
Newborn’s respiratory rate average?
40–60 breaths per minute.
Premature infant) ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
2.5–3.0
Uncuffed
8.0 cm
0 straight
Dextrose Pediatric Dosing
Conversion) D50 to D25:
D50 to D10:
- Neonate (<2 months): D10W, 5-10 mL/kg IV
- Infant (2Mn-2Yrs): D25W, 2-4 mL/kg IV
- Child (>2Yrs): D50W, 1-2 mL/kg IV
= Dilute by a factor of 2 (add equal Vol of fluid)
= Dilute by a factor of 5 (add 4x Vol of fluid)
Croup Med dosing:
RaceEpi) 2.25% 0.5mL + 4mLs of NS Nebulized
Epi 1:1) 1mL w/ 4mL NS Nebulized
Epi 1:10) 5-10mLs of Epi (no dilution) Nebulized
Pedi Fluid doses) Hypovolemia& Distributive:
Cardiogenic Shock:
Poisoning CCB/BB:
DKA with Compensated Shock:
= 20 mL/kg / 5-10Mins PRN
= 5-10 mL/kg / 10-20Mins PRN
= 5-10 mL/kg / 10-20Mins PRN
= 10-20 mL/kg / 60-120 Minutes
Pediatric Age Classifications
- Newborn: Birth to hours old
-Neonate: Hours to 1 month
-Infant: 1 month - 1 year
-Toddler: 1-3 years
-Preschooler: 3-5 years
-School-age: 6-12 years
-Adolescent: 13-18 years
Pediatric Vital Signs Considerations
- HR, RR higher than adults
- BP lower than adults
- Hypotension is a late shock sign
Toddler:
Preschooler:
School-age:
Adolescent:
“Kid/Child”:
=1-3 years
= 3-5 years
= 6-12 years
= 13-18 years
= 8Yrs up, 45Kg up, before puberty
hypotension threshold for an 11-month-old infant?
Less than 70 mmHg systolic
hypotension threshold for a 19-month-old pediatric patient?
Less than 70 + (2 x age in years)
hypotension threshold for a neonate?
Less than 60 mmHg systolic
hypotension threshold for a 2-month-old infant?
Less than 70 mmHg systolic
hypotension threshold for a 12-year-old pediatric patient?
Less than 90 mmHg systolic
Neonatal CPR technique?
3:1 compression-ventilation ratio, 120 bpm rate, Two-thumb technique, Depth: 1/3 AP diameter.
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
Pedi Hypovolemia& Distributive fluid Form:
= 20 mL/kg / 5-10Mins PRN
Pedi Cardiogenic Shock fluid form
= 5-10 mL/kg / 10-20Mins PRN
Pedi Poisoning CCB/BB fluid form
= 5-10 mL/kg / 10-20Mins PRN
Pedi DKA Comp Shock fluid form
= 10-20 mL/kg / 60-120 Minutes
Infant def
1 month till 1 year)
1-3 years =
3-5 years =
6-12 years =
13-18 years =
Toddler:
Preschooler:
School-age:
Adolescent:
newborn age range
Birth to the 1st couple Hrs of life
Adolescent age range
13 years and 18 years
School-aged child age range
6Yrs - 12Yrs
Toddler age range
1 year & 3 years
Neonate age range
1st few hours of life to 1 month
What are the definitions of Newborn, Neonate, and Infant?
Newborn: birth till a few hours old; Neonate: few hours till 1 month; Infant: 1 month till 1 year
What does the APGAR score assess?
Appearance (color), Pulse (HR), Grimace (reflex), Activity (muscle tone), Respiration (effort); scored at 1 & 5 minutes
Neonatal Airway Management
Position airway, suction only if obstruction present, intubate if necessary
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
How to clamp & cut the umbilical cord after delivery:
What to do immediately after the baby is delivered:
= Delay clamping 30Secs after delivery, Clamp cord 4in. (10 cm) from navel; place 2nd clamp 2in (5 cm) from 1st &
Cut cord between clamps
= Dry baby; cover w/ warm, dry blankets or towels.
Position baby on side.
Record time of birth.
Fetal Circulation) Foramen ovale:
Function:
Blood @ this time is De or oxygenated:
= hole between fetus’s atrias “fetal shunt”
= allows mixing of oxygenated blood in R-atrium, leaving the L-ventricle bound for the aorta. This serves to aid in blood flow bypassing the lungs.
= At this time, the blood is still oxygenated.
mLs range in uterus
= 50mLs-1.5Ls in uterus
Pediatric GCS Differences
- Modified for age
- Verbal & motor responses changed for age
Pediatric Synchronized Cardioversion Dosing
- SVT/VT w/ Pulse: Start @ 0.5-1 J/kg, increase to 2 J/kg if needed
How to estimate weight:
= (Age x 3) + 7 = Approximate weight in kg
What is the rescue breathing rate for a pediatric patient?
1 breath every 2-3 seconds
What is the correct compression to ventilation ratio for CPR on an infant?
30:2
What is the appropriate depth for chest compressions in an infant?
1 1/2 inches
Cuffed ET:
Indications:
Monometer cuff
Usually start at:
(Age /4) + 3.5
= Increased pulmonic P} Anaphylaxis, Burn, drown
= never over 30 mmHg
= 6.0 ~1st
Infant tachycardia
Children tachycardia
Note
> 220
180
get Hx, if sudden & random onset then SVT
Croup vs Epiglottitis) Temp
Usually occurs @:
Common age:
=(C)Low fever101-2 (E)High fever 102-4
=(C)Before bed (E) in Morning/middle of night
=(C)6Mns - 4Yrs (E) 3Yrs - 7Yrs
Pediatric GCS (Glasgow Coma Scale):
= Modified to assess eye opening, verbal response, motor response
Pedi Tension Pneumo decomp:
3rd rib 2nd ICS Chest wall thickness in anterior chest varies from 1.4 – 1.6 cm (0.55 - .63 inches)
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
Estimating upper limit of RR:
= Age# - 40
Age & French Suction Catheter Size) Up to 1 year:
1 to 6 years:
7 to 15 years:
16 years:
= 8
= 8-10
= 10-12
= 12
<1Yr pulse check @
Carotid
Pediatric GCS 0-24Mns changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
Pediatric GCS 2-5Yrs changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
febrile seizures result from
Most commonly between ages of
= a sudden increase in body temperature.
= 6Mns & 6Yrs often, guardians report a recent onset of fever or cold symptoms.
OG tube (French) Premature
Neonate
6 Months
1–4 Years
5 Years
5–10 Years
5
5–8
8
10
10–12
14–18
Laryngoscope blade) Premature
Neonate
6 Months
1–4 Years
5 Years
5–10 Years
0 (straight)
1 (straight)
1 (straight)
1–2 (straight)
2 (straight or curved)
2–3 (straight or curved)
What is the appropriate depth for chest compressions in a child?
2 inches
ETT) Premature (1–2.5 kg; 2.2–5.5 lb*)
Neonate (2.5–4 kg; 5.5–8.8 lb)
6 Months (6–8 kg; 13.2–17.
1–4 Years (10–14 kg; 22–30.8 lb)
5 Years (16–18 kg; 35.2–39.6 lb)
5–10 Years (24–30 kg; 52.8–66 lb)
= 2.5–3.0 (uncuffed) formula
3.0–3.5 (uncuffed) formula
3.5–4.0 formula
4.0–4.5 formula
5.0–5.5 formula
5.5–6.5 formula
French Suction/Stylet) Premature (1–2.5kg; 2.2–5.5 lb)
Neonate (2.5–4 kg; 5.5–8.8 lb)
6 Months (6–8 kg; 13.2–17.
1–4 Years (10–14 kg; 22–30.8 lb)
5 Years (16–18 kg; 35.2–39.6 lb)
5–10 Years (24–30 kg; 52.8–66 lb)
6–8/6
8/6
8–10/6
10/6
14/14
14/14
Pediatric CPR Compression Depth & Rate
- Depth: 1/3 to 1/2 of chest AP diameter
- Rate: 100-120/min
- Ratios: 30:2 (1 rescuer), 15:2 (2 rescuers), 3:1 (newborns)
Pedi Defibrillation
Initial 2 J/kg, then 4 J/kg increasing to max 10J/Kg
hypoglycemia Rx for infant:
= <60BGL infant
Ped Epi 1:10 dose:
Pedi Epi 1:1 dose
- Cardiac Arrest: 0.01 mg/kg IV/IO (1:10,000) - Anaphylaxis: 0.01 mg/kg IM (1:1,000)
Pediatric Weight Estimation Formulas
- Old: (Age + 4) × 2 = kg
- New: (Age × 3) + 7 = kg
Pedi Uncuffed ETT form:
Pedi Cuffed ETT form:
= (Age in years ÷ 4) + 4.
= (Age in years ÷ 4) + 3.5
fluid replacement after perfusion rule:
4 2 1rule/ formula :
= normovolemia Used for every hr after to maintain
4ml/kg 1st 10kg
2m/Kg 2nd 10kg
1ml/kG 3rd
hypoglycemia for neonate:
= <45BGL neonate
- Dextrose Infant (2Mn-2Yrs):
D25W, 2-4 mL/kg IV
Dextrose Child (>2Yrs):
D50W, 1-2 mL/kg IV
What are the normal newborn vitals?
RR: 40-60 bpm,
HR birth: 150-180 bpm & after birth: 130-140 bpm
HR < 100 bpm = distress
Neonatal CPR Indications
HR < 60 bpm despite ventilation & oxygenation
Neonatal Hypovolemia Shock Signs
Pale, cool skin, poor capillary refill, weak pulses, lethargy
Neonatal Shock Treatment
Fluid resuscitation (10 mL/kg bolus NS or LR), treat underlying cause
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
posterior fontanelle usually closes
anterior fontanelle closes
= in 2 or 3 months
= between 9 and 18 months
Key Steps in Pediatric Primary Assessment (ABCDE)
- Airway: Position in neutral sniffing, remove obstructions
- Breathing: Assess rate, effort, SpO₂
- Circulation: HR, pulses, perfusion
- Disability: AVPU/GCS, pupil response
- Exposure: Full assessment, prevent heat loss
hypervent/ for Child w/ brainstem herniation
hypervent/ for Infant w/ brainstem herniation
ETCO2 target:
= 30 breathes a min (>1yr)
= 35 breathes a min (1mth to 1yr)
= ETCO2 target should be 35 mmHg
Infants sings of comp/ shock & entering decomp/:
Hypoxica > Tachycardic > Bradycardic
Croup vs Epiglottitis) Virus type:
Onset:
Defining S/S:
= (C)Viral (E)Bacterial
=(C)Slow (E)Fast
=(C)Seal cough & Steeple (E)Drooling
Croup vs Epiglottitis) Temp
Usually occurs @:
Common age:
=(C)Low fever101-2 (E)High fever 102-4
=(C)Before bed (E) in Morning/middle of night
=(C)6Mns - 4Yrs (E) 3Yrs - 7Yrs
What is the GCS score for a 5-year-old with Eye Opening: To verbal, Motor Response: Localizes, Verbal: Inappropriate words?
12
When does the posterior fontanelle of a pediatric patient generally close?
3 months
When does the anterior fontanelle of a pediatric patient generally close?
9-18 months
What is the GCS score for a 2-year-old with Eye Opening: To pain, Motor Response: Withdrawal, Verbal: Cries and Screams?
9
What is the GCS score for a 7-year-old with Eye Opening: To pain, Motor Response: Extension, Verbal: Incomprehensible sounds?
6
Infant tachycardia
Children tachycardia
Note
> 220
180
get Hx, if sudden & random onset then SVT
Respiratory Distress:
Respiratory Failure:
= Open & Maintainable , Tachypnea , Good Air Movement, Tachycardia, Pallor (pink/white cheek), Anxiety, Agitation
= Not Maintainable, Bradypnea to Apnea, Poor/Absent Air Movement, Bradycardia, Cape Cyanosis, Lethargy/Unresponsive
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
Cardiac arrest in infants & children usually from:
Respiratory failure or arrest
1 Killer 3rd trimester
Placenta Abruptio
Gestational Diabetes rx:
BGL < 70 mg/dL: Start IV NS & Admin/ 50-100 mL 50% dextrose intravenously
What 3 shunts are involved in the fetal circulation?
Ductus Venosus later lig terez
Foramen Ovale septum prinium
Ductus Arteriosus
When maternal blood volume increases, pregnant women will often receive supplemental iron to prevent anemia. This is because:
Although both red blood cells and plasma increase, there is slightly more plasma.
Jumpstart) Triaging
RPM Resp/ Pulse / Mental
Jumpstart) P of RPM
Radial pulse
Jumpstart) R of RPM
RR <15 or >45
Jumpstart) M or RPM
Mental status
Choanal Atresia
Congenital blockage of nasal passage, causes respiratory distress when mouth is closed
pediatric spine w/ head/neack trauma)
Positive:
Negative:
= no hard aduld discs
Positive: no intervertebral discs so more room for m-nt
Negative: More prone to invisible disc injuries (SCIWORA)
What is the breathing assistance needed for neonates?
Most neonates breathe spontaneously; some need assistance, few require extensive resuscitation, and meds are rarely indicated.
Heart defect categories
1 Increase pulmonary blood flow
2 Decrease pulmonary blood flow
3 Obstruct blood flow
Block Blood flow defects:
= Coarctation of the Aorta,
Pulmonary & Aortic Stenosis
Truncus Arteriosus,
Hypoplastic Left Heart Syndrome
Decrease pulmonic defects:
= Tetralogy of Fallot (TOF),
dextro-Transposition of the Great Arteries (d-TGA), Levo-Transposition of the Great Arteries (l-TGA)
Heart defect categories
=Block blood flow, Decreased & Increased Pulmonic Flow,
Moro reflex/“startle reflex,” reflex
When startled, babies throw their arms wide, spreading their fingers and then grabbing instinctively with the arms and fingers. The reflex should be brisk and symmetrical. An asymmetric Moro reflex (in which one arm does not respond exactly like the other) can imply a paralysis or weakness on one side of the body.
Pediatric Airway Management Positioning
- Neutral sniffing position prevents airway collapse - Padding under shoulders for younger children
Broselow Tape Purpose
Rapid pediatric weight & dose estimation based on height.
Pediatric Thermoregulation Considerations
- Higher surface area-to-mass ratio → heat loss easier
-Brown fat for thermogenesis
-Increased risk of hypothermia
Key Steps in Pediatric Primary Assessment (ABCDE)
- Airway: Position in neutral sniffing, remove obstructions
- Breathing: Assess rate, effort, SpO₂
- Circulation: HR, pulses, perfusion
- Disability: AVPU/GCS, pupil response
- Exposure: Full assessment, prevent heat loss
Signs of Pediatric Respiratory Failure
- Early: Tachypnea, retractions, nasal flaring, grunting
- Late: Bradypnea, cyanosis, altered LOC
Pediatric Shock Types & Causes
- Hypovolemic: diarrhea, Vomiting, hemorrhage
- Distributive: Sepsis, anaphylaxis
- Cardiogenic: Congenital heart defects, myocarditis
- Obstructive: Tension pneumothorax, tamponade
Pediatric Bradycardia Treatment
- If hypoxic → Oxygen & ventilation
- If unstable → Epinephrine 0.01 mg/kg IV/IO
- Atropine (0.02 mg/kg) if vagal cause suspected
Pediatric CPR Compression Depth & Rate
- Depth: 1/3 to 1/2 of chest AP diameter
- Rate: 100-120/min
- Ratios: 30:2 (1 rescuer), 15:2 (2 rescuers), 3:1 (newborns)
Pediatric Cervical Spine Injury Considerations
- SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) is more common
- Use pediatric C-collars & padding under shoulders
Pedi Polyuria
> 3ml/kg
Infants sings of comp/ shock & entering decomp/:
Hypoxica > Tachycardic > Bradycardic
What is the appropriate depth for chest compressions in an infant?
1 1/2 inches
Croup vs Epiglottitis) Virus type:
Onset:
Defining S/S:
= (C)Viral (E)Bacterial
=(C)Slow (E)Fast
=(C)Seal cough & Steeple (E)Drooling
Croup vs Epiglottitis) Temp
Usually occurs @:
Common age:
=(C)Low fever101-2 (E)High fever 102-4
=(C)Before bed (E) in Morning/middle of night
=(C)6Mns - 4Yrs (E) 3Yrs - 7Yrs
Pediatric Chain of Survival
- Prevention
- Early CPR
- Early 911
- Rapid ALS
- Post-Arrest Care
Pediatric Airway Differences
- Larger tongue, floppy epiglottis - Narrowest airway @ cricoid, not vocal cords - More anterior airway
Pediatric Cardiovascular System Considerations
- Stroke volume is fixed, CO dependent on HR
-Hypotension is a late sign of shock - Bradycardia often secondary to hypoxia
Key Differences in Pediatric Airway Anatomy
- Larger tongue relative to mouth
- Floppy, U-shaped epiglottis
- More anterior & superior larynx
- Narrowest airway @ cricoid cartilage
Pediatric Assessment Triangle (PAT) Components
- Appearance: LOC, interactiveness, muscle tone (TICLS: Tone, Interactiveness, Consolability, Look/gaze, Speech/cry)
- Work of Breathing: Visible effort, abnormal sounds
- Circulation to Skin: Color, capillary refill, mottling
Stridor
(2/3 occlusion) Is abnormal, musical, high-pitched sound, more commonly heard on inspiration
Appendicitis:
= Common GI emergencies
= If untreated, can lead to peritonitis or shock
= Rebound Tenderness Pain at McBurning’s Point (2/3 from umbilicus)
dif/ from a PEDI vs adult airway) PEDI:
Adult:
= Large tongue, Floppy omega epiglottis, cricoid narrowest point
= glottis narrowest point, firm epiglottis
fluid replacement after perfusion rule:
4 2 1rule/ formula :
=back to normovolemia Used for every hr after to maintain
= [A] 4ml/kg 1st 10kg
[B]2m/Kg 2nd 10kg
[C]1ml/kG after per hour Used for every Hr after to maintain
A surgical cricothyrotomy is contraindicated in patients less than
less than 8 years old
Common issue/injury w/ PPV on Pedis
= Barotrauma; Too much squeeze & too slow
Pedi PPV BVM rate:
1 every 2-3secs ~20-30breaths /min
Auscultation technique w/ Pedis
Using Bell & Armpit to Armpit
Upper airway in Pedis:
= Anything above carina
Adults vocal cords @
Pedi Vocal cords @
C4 - 5
C2 - 3
Pedi 1st most & 2nd most common arrest rhythm
1 Asystole #2 PEA
Pedi Resp distress:
Pedi Resp failure:
= “Huffing & Puffing Enough” to sustain life
= “failure to respirate to sustain life” >60RR
Mottling
“Blonching Blues” seen in sick pedis
Transitional Phase
- “Talking Phase of building rapport w/ Pedi (GOOD PATs)
-Toe to head exam & @ eye Lvl
Pedi intubation indications
Bad physical signs NOT MONITORS
Croup is characterized by
S/S:
Rx:
Notes:
= subglottic edema} laryngotracheobronchitis
= Bark Stridor, ~6Mns-4Yrs, No drooling,
= SVN Epi, Albuterol, RaceEpi
= decrease truck temp b/c cool air helps subglottic edema
Pedi Vocal cords differences
more anterior & superficial
What are the 3 parts of the Primary Assessment Triangle (PAT)?
Appearance, Work of breathing, Skin color
What is the correct compression to ventilation ratio for CPR on an infant?
30:2
What is the CPR rate for a 6-month-old infant found unconscious?
At least 100/minute; ratio 15:2; depth 1/3 to 1/2 the depth of the chest
Infant possible SVT rate
Children possible SVT rate
SVT vs TC
> 220
180
get Hx, if sudden & random onset then SVT
Cardiac arrest common etiologies
1st most common Cardiac myopathy from sick)
Prolonged QT syndrome
Commotion cordis
Bacterial tracheitis:
seen w/:
S/S:
= bacterial infection of subglottic region
= after Croup, 1-5Yrs
= High fever, phlem, horse if talking, Stridor
Bronchiolitis:
= viral infection of bronchioles, most commonly respiratory syncytial virus (RSV) affecting lining of the bronchioles
Bronchiolitis sound:
Occurs commonly:
AKA:
= expiratory wheezing
= in winter <2Yrs
= “Baby asthma”
Pertussis AKA:
Absolute sign:
S/S:
= “Whooping cough” bacterial infection (<6Yrs)
= “whoop” sound after a coughing attack
= Low grade fever, Rhonchi, can be dehydrated
AEIOU-TIPPS reflects major causes of AMS
Alcohol
Epilepsy
Insulin
Opiates
Uremia (Kidney Failure)
Trauma, Temp
Infection
Poisoning
Psychogenic
Shock, Stroke, Seizure
Bacterial Meningitis
Viral Meningitis
Most Lethal
Most common/viral
Brudzinkis sign:
+ sign indicates:
= Supine & flex head feet kick up
= Meningitis
Kirinick’s sign:
+ sign indicates:
= bend knee to chest but cant outflex legs
= Meningitis
BRUE)
ALTE)
= Brief resolved unexplained event
= Apparent Life threatening event
Infants who are not breathing, cyanotic, and unresponsive sometimes resume breathing and color with stimulation
Classic presentation is characterized by: Distinct change in muscle tone, Change in color, Choking or gagging/apnea , 50% underlying cardiac
Pedi Tension Pneumo decomp:
3rd rib 2nd ICS Chest wall thickness in anterior chest varies from 1.4 – 1.6 cm (0.55 - .63 inches)
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
Nasal flaring
Occurs from widening of the nostrils; seen primarily on inspiration
Cardiac arrest in infants & children usually from:
Respiratory failure or arrest
What is the appropriate depth for chest compressions in a child?
2 inches
Steeple sign:
= w/ xray has church steeple from epiglottitis
Bronchiolitis) Mild Treatment:
Moderate:
Severe:
= Nebulized Albuterol & Atrovent, & Steroids: Dexamethasone & Solu Medrol
= CPAP/ SVN Epi & Mag Sulfate
= Epi 1:1 IM & ET Intubation
Croup/(Laryngotracheobronchitis) Rx
SVN Albuterol (or Epis) & Steroids: Dexamethasone & Solu Medrol, CPAP
Abortion:
Expulsion of fetus prior to 20 weeks’ gestation
Most common cause of bleeding in 1st & 2nd trimesters
APGAR Scoring) Scoring
A
P
G
A
R
5 parameters; Scored bad 0 to 2 Normal/healthy
Appearance (skin color)
Pulse rate) Normal 100-180
Grimace (irritability)
Activity (muscle tone)
Respiratory effort) Normal 30-60
Abnormal Delivery Situations
Breech Presentation, Prolapsed Cord, Limb Presentation, Occiput Posterior Position, Multiple Births, Cephalopelvic Disproportion, Precipitous Delivery, Shoulder Dystocia, Meconium Staining
Breech Presentation:
Risks:
Increased potential for:
Delivering:
If head does not deliver:
= Buttocks or both feet present first
= Increased risk for delivery trauma to mother,
= cord prolapse, cord compression, anoxic insult for infant
= Hold her legs flexed, As infant delivers, DONT PULL LEGS,
Allow entire body to be delivered w/ contractions
= place gloved hand in vagina w/ palm toward infant’s face
Limb Presentation:
Possible causes:
Absolute:
= a Limb protruding from the vagina
Preterm birth, multiple gestation.
= Cesarean section necessary &NEVER EVER should you attempt field delivery
Cephalopelvic Disproportion:
Causes:
Delivering:
What can occur:
= Infant’s head too big to pass through maternal pelvis easily; oversized fetus.
= Diabetes, multiparity, postmaturity.
= Fetal abnormalities may make vaginal delivery impossible
=Fetal demise or uterine rupture may occur
Shoulder Dystocia:
Causes:
Baby presentation:
Delivering:
= Infant’s shoulders larger than head
= Diabetic & obese mothers; post-term pregnancies.
= Head retracts back into perineum; shoulders trapped between pubic symphysis & sacrum
= Have mother drop butt off end of bed; flex thighs upward to facilitate delivery & Apply firm pressure w/ open hand immediately above pubic symphysis (McRobert’s Maneuver)
Fetal Circulation) 1 umbilical vein connects directly to:
2 Blood then travels through:
3 Blood enters R-atrium & passes through & into:
4 Blood exits R-ventricle & travels through & into:
5 The foramen ovale allows:
6 Once in pulmonic artery, blood enters & connects w/:
7 The ductus arteriosus causes blood to:
8 Once in the aorta, blood flow is:
9 Deoxygenated blood w/ waste products exits fetus:
1= Inferior Vena-Cava by ductus venosus
2= the inferior vena cava to the heart
3= the tricuspid valve into the R-ventricle
4= the pulmonic valve into the pulmonary artery
5= mixing oxygenated blood in the R-atrium, leaving the L-ventricle bound for aorta bypassing the lungs &
At this time, the blood is still oxygenated
6= Ductus arteriosus, which connects the pulmonary artery with the aorta.
7= bypass the uninflated lungs.
8= basically the same as in extrauterine life
9= after passage through the liver via the umbilical arteries
Fetal Circulation) As soon as a baby takes its 1st breath:
Ductus arteriosus:
Ductus venosus:
Forman Ovale:
= lungs inflate, greatly decreasing pulmonic vascular resistance to blood flow
= closes, diverting blood to the lungs
= closes, stopping blood flow from placenta
= closes stopping blood flow through atriums (now fossis ovalis)
Acrocyanosis
= extremities remain dusky after delivering & drying healthy baby (Very common in 1st Hrs of life
What 3 shunts are involved in the fetal circulation?
Ductus Venosus later lig terez
Foramen Ovale septum prinium
Ductus Arteriosus
