SPE2 Flashcards
1
Q
hypervent/ for Child w/ brainstem herniation
hypervent/ for Infant w/ brainstem herniation
ETCO2 target:
A
= 30 breathes a min (>1yr)
= 35 breathes a min (1mth - 1yr)
= ETCO2 target 35 mmHg
2
Q
Suction form:
A
= 2 x ETT
3
Q
Estimate pedi weight:
A
(age X 3) +7=Kg <New>
(age +4) x2=Kg <Old></Old></New>
4
Q
Pedi PPV BVM rate:
A
1 every 2-3secs ~20-30breaths /min
5
Q
Pedi Resp distress:
Pedi Resp failure:
A
= “Huffing & Puffing Enough” to sustain life
= “failure to respirate to sustain life” >60RR
6
Q
hypoglycemia Rx for neonate:
hypoglycemia Rx for infant:
A
= <45BGL infant 2mns - 1yr
= <60BGL 1-3toddler yrs
7
Q
What is hypoglycemia in newborns?
A
BG < 40 mg/dL, treated with D10 (5-10 mL/kg).
8
Q
What are the steps in newborn resuscitation?
A
Dry, warm, position, stimulate; if HR < 100, positive pressure ventilation (PPV); if HR < 60, CPR (3:1 compressions-to-ventilation ratio)
9
Q
Neonatal Hypoglycemia Treatment
A
Dextrose 10% (D10) at 5-10 mL/kg IV bolus
10
Q
Neonatal Fever Considerations
A
> 100.4°F (38.0°C) is concerning; workup for sepsis if present
11
Q
Pedi HypoBP form/ & starts @
A
<70 + (Yrs x 2) Toddler: 1-3Yrs & up
12
Q
Pediatric Bradycardia Treatment
A
- If hypoxic → Oxygen & ventilation
- If unstable → Epinephrine 0.01 mg/kg IV/IO
- Atropine (0.02 mg/kg) if vagal cause suspected
13
Q
fluid replacement for PEDI trauma PT form:
Best way to rapidly admin fluids:
A
= 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
14
Q
A surgical cricothyrotomy is contraindicated in patients less than
A
less than 8 years old
15
Q
Infant to 1 year)ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
A
3.5–4.0
Uncuffed
9.5–11.0 cm
1 straight
16
Q
Pedi Normal Urine output:
A
1-2ml/kg/Hr urine output
17
Q
Pedi Polyuria
A
> 3ml/kg
18
Q
Child BVM bag vol/
Infant BVM bag vol/
A
= 800mL
= 300mL
19
Q
Adults vocal cords @
Pedi Vocal cords @
A
C4 - 5
C2 - 3
20
Q
Pedi intubation indications
A
Bad physical signs NOT MONITORS
21
Q
What is the correct tidal volume for a pediatric patient?
A
5-7 mL’s/kg
22
Q
What is the CPR rate for a 6-month-old infant found unconscious?
A
At least 100/minute; ratio 15:2; depth 1/3 to 1/2 the depth of the chest
23
Q
What is the pulmonary dead space volume for a pediatric patient?
A
3 mL/kg
24
Q
Neonatal CPR Indications
A
HR < 60 bpm despite ventilation & oxygenation
25
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
26
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
27
Newborn’s heart rate normally be at birth?
150–180 at birth, slowing to 130–140 thereafter.
28
Newborn’s respiratory rate average?
40–60 breaths per minute.
29
Premature infant) ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
2.5–3.0
Uncuffed
8.0 cm
0 straight
30
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)
31
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
32
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
33
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
34
Pediatric Vital Signs Considerations
- HR, RR higher than adults
- BP lower than adults
- Hypotension is a late shock sign
35
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
36
hypotension threshold for an 11-month-old infant?
Less than 70 mmHg systolic
37
hypotension threshold for a 19-month-old pediatric patient?
Less than 70 + (2 x age in years)
38
hypotension threshold for a neonate?
Less than 60 mmHg systolic
39
hypotension threshold for a 2-month-old infant?
Less than 70 mmHg systolic
40
hypotension threshold for a 12-year-old pediatric patient?
Less than 90 mmHg systolic
41
Neonatal CPR technique?
3:1 compression-ventilation ratio, 120 bpm rate, Two-thumb technique, Depth: 1/3 AP diameter.
42
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
43
Pedi Hypovolemia& Distributive fluid Form:
= 20 mL/kg / 5-10Mins PRN
44
Pedi Cardiogenic Shock fluid form
= 5-10 mL/kg / 10-20Mins PRN
45
Pedi Poisoning CCB/BB fluid form
= 5-10 mL/kg / 10-20Mins PRN
46
Pedi DKA Comp Shock fluid form
= 10-20 mL/kg / 60-120 Minutes
47
Infant def
1 month till 1 year)
48
1-3 years =
3-5 years =
6-12 years =
13-18 years =
Toddler:
Preschooler:
School-age:
Adolescent:
49
newborn age range
Birth to the 1st couple Hrs of life
50
Adolescent age range
13 years and 18 years
51
School-aged child age range
6Yrs - 12Yrs
52
Toddler age range
1 year & 3 years
53
Neonate age range
1st few hours of life to 1 month
54
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
55
What does the APGAR score assess?
Appearance (color), Pulse (HR), Grimace (reflex), Activity (muscle tone), Respiration (effort); scored at 1 & 5 minutes
56
Neonatal Airway Management
Position airway, suction only if obstruction present, intubate if necessary
57
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
58
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.
59
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.
60
mLs range in uterus
= 50mLs-1.5Ls in uterus
61
Pediatric GCS Differences
- Modified for age
- Verbal & motor responses changed for age
62
Pediatric Synchronized Cardioversion Dosing
- SVT/VT w/ Pulse: Start @ 0.5-1 J/kg, increase to 2 J/kg if needed
63
How to estimate weight:
= (Age x 3) + 7 = Approximate weight in kg
64
What is the rescue breathing rate for a pediatric patient?
1 breath every 2-3 seconds
65
What is the correct compression to ventilation ratio for CPR on an infant?
30:2
66
What is the appropriate depth for chest compressions in an infant?
1 1/2 inches
67
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
68
Infant tachycardia
Children tachycardia
Note
> 220
> 180
get Hx, if sudden & random onset then SVT
69
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
70
Pediatric GCS (Glasgow Coma Scale):
= Modified to assess eye opening, verbal response, motor response
71
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)
72
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
73
Estimating upper limit of RR:
= Age# - 40
74
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
75
<1Yr pulse check @
Carotid
76
Pediatric GCS 0-24Mns changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
77
Pediatric GCS 2-5Yrs changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
78
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.
79
OG tube (French) Premature
Neonate
6 Months
1–4 Years
5 Years
5–10 Years
5
5–8
8
10
10–12
14–18
80
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)
81
What is the appropriate depth for chest compressions in a child?
2 inches
82
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
83
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
84
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)
85
Pedi Defibrillation
Initial 2 J/kg, then 4 J/kg increasing to max 10J/Kg
86
hypoglycemia Rx for infant:
= <60BGL infant
87
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)
88
Pediatric Weight Estimation Formulas
- Old: (Age + 4) × 2 = kg
- New: (Age × 3) + 7 = kg
89
Pedi Uncuffed ETT form:
Pedi Cuffed ETT form:
= (Age in years ÷ 4) + 4.
= (Age in years ÷ 4) + 3.5
90
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
91
hypoglycemia for neonate:
= <45BGL neonate
92
- Dextrose Infant (2Mn-2Yrs):
D25W, 2-4 mL/kg IV
93
Dextrose Child (>2Yrs):
D50W, 1-2 mL/kg IV
94
What are the normal newborn vitals?
RR: 40-60 bpm,
HR birth: 150-180 bpm & after birth: 130-140 bpm
HR < 100 bpm = distress
95
Neonatal CPR Indications
HR < 60 bpm despite ventilation & oxygenation
96
Neonatal Hypovolemia Shock Signs
Pale, cool skin, poor capillary refill, weak pulses, lethargy
97
Neonatal Shock Treatment
Fluid resuscitation (10 mL/kg bolus NS or LR), treat underlying cause
98
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
99
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
100
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
101
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
102
posterior fontanelle usually closes
anterior fontanelle closes
= in 2 or 3 months
= between 9 and 18 months
103
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
104
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
105
Infants sings of comp/ shock & entering decomp/:
Hypoxica > Tachycardic > Bradycardic
106
Croup vs Epiglottitis) Virus type:
Onset:
Defining S/S:
= (C)Viral (E)Bacterial
=(C)Slow (E)Fast
=(C)Seal cough & Steeple (E)Drooling
107
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
108
What is the GCS score for a 5-year-old with Eye Opening: To verbal, Motor Response: Localizes, Verbal: Inappropriate words?
12
109
When does the posterior fontanelle of a pediatric patient generally close?
3 months
110
When does the anterior fontanelle of a pediatric patient generally close?
9-18 months
111
What is the GCS score for a 2-year-old with Eye Opening: To pain, Motor Response: Withdrawal, Verbal: Cries and Screams?
9
112
What is the GCS score for a 7-year-old with Eye Opening: To pain, Motor Response: Extension, Verbal: Incomprehensible sounds?
6
113
Infant tachycardia
Children tachycardia
Note
> 220
> 180
get Hx, if sudden & random onset then SVT
114
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
115
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
116
Cardiac arrest in infants & children usually from:
Respiratory failure or arrest
117
#1 Killer 3rd trimester
Placenta Abruptio
118
Gestational Diabetes rx:
BGL < 70 mg/dL: Start IV NS & Admin/ 50-100 mL 50% dextrose intravenously
119
What 3 shunts are involved in the fetal circulation?
Ductus Venosus later lig terez
Foramen Ovale septum prinium
Ductus Arteriosus
120
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.
121
Jumpstart) Triaging
RPM Resp/ Pulse / Mental
122
Jumpstart) P of RPM
Radial pulse
123
Jumpstart) R of RPM
RR <15 or >45
124
Jumpstart) M or RPM
Mental status
125
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
126
Suction form:
= 2 x ETT
127
Estimate pedi weight:
(age X 3) +7=Kg
(age +4) x2=Kg
128
Pedi PPV BVM rate:
1 every 2-3secs ~20-30breaths /min
129
Pedi Resp distress:
Pedi Resp failure:
= "Huffing & Puffing Enough" to sustain life
= “failure to respirate to sustain life” >60RR
130
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
131
What is hypoglycemia in newborns?
BG < 40 mg/dL, treated with D10 (5-10 mL/kg).
132
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)
133
Neonatal Hypoglycemia Treatment
Dextrose 10% (D10) at 5-10 mL/kg IV bolus
134
Neonatal Fever Considerations
>100.4°F (38.0°C) is concerning; workup for sepsis if present
135
Pedi HypoBP form/ & starts @
<70 + (Yrs x 2) Toddler: 1-3Yrs & up
136
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
137
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
138
A surgical cricothyrotomy is contraindicated in patients less than
less than 8 years old
139
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
140
Pedi Normal Urine output:
1-2ml/kg/Hr urine output
141
Pedi Polyuria
>3ml/kg
142
Child BVM bag vol/
Infant BVM bag vol/
= 800mL
= 300mL
143
Adults vocal cords @
Pedi Vocal cords @
C4 - 5
C2 - 3
144
Pedi intubation indications
Bad physical signs NOT MONITORS
145
What is the correct tidal volume for a pediatric patient?
5-7 mL's/kg
146
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
147
What is the pulmonary dead space volume for a pediatric patient?
3 mL/kg
148
Neonatal CPR Indications
HR < 60 bpm despite ventilation & oxygenation
149
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
150
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
151
Newborn’s heart rate normally be at birth?
150–180 at birth, slowing to 130–140 thereafter.
152
Newborn’s respiratory rate average?
40–60 breaths per minute.
153
Premature infant) ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
2.5–3.0
Uncuffed
8.0 cm
0 straight
154
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)
155
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
156
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
157
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
158
Pediatric Vital Signs Considerations
- HR, RR higher than adults
- BP lower than adults
- Hypotension is a late shock sign
159
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
160
hypotension threshold for an 11-month-old infant?
Less than 70 mmHg systolic
161
hypotension threshold for a 19-month-old pediatric patient?
Less than 70 + (2 x age in years)
162
hypotension threshold for a neonate?
Less than 60 mmHg systolic
163
hypotension threshold for a 2-month-old infant?
Less than 70 mmHg systolic
164
hypotension threshold for a 12-year-old pediatric patient?
Less than 90 mmHg systolic
165
Neonatal CPR technique?
3:1 compression-ventilation ratio, 120 bpm rate, Two-thumb technique, Depth: 1/3 AP diameter.
166
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
167
Pedi Hypovolemia& Distributive fluid Form:
= 20 mL/kg / 5-10Mins PRN
168
Pedi Cardiogenic Shock fluid form
= 5-10 mL/kg / 10-20Mins PRN
169
Pedi Poisoning CCB/BB fluid form
= 5-10 mL/kg / 10-20Mins PRN
170
Pedi DKA Comp Shock fluid form
= 10-20 mL/kg / 60-120 Minutes
171
Infant def
1 month till 1 year)
172
1-3 years =
3-5 years =
6-12 years =
13-18 years =
Toddler:
Preschooler:
School-age:
Adolescent:
173
newborn age range
Birth to the 1st couple Hrs of life
174
Adolescent age range
13 years and 18 years
175
School-aged child age range
6Yrs - 12Yrs
176
Toddler age range
1 year & 3 years
177
Neonate age range
1st few hours of life to 1 month
178
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
179
What does the APGAR score assess?
Appearance (color), Pulse (HR), Grimace (reflex), Activity (muscle tone), Respiration (effort); scored at 1 & 5 minutes
180
Neonatal Airway Management
Position airway, suction only if obstruction present, intubate if necessary
181
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
182
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.
183
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.
184
mLs range in uterus
= 50mLs-1.5Ls in uterus
185
Pediatric GCS Differences
- Modified for age
- Verbal & motor responses changed for age
186
Pediatric Synchronized Cardioversion Dosing
- SVT/VT w/ Pulse: Start @ 0.5-1 J/kg, increase to 2 J/kg if needed
187
How to estimate weight:
= (Age x 3) + 7 = Approximate weight in kg
188
What is the rescue breathing rate for a pediatric patient?
1 breath every 2-3 seconds
189
What is the correct compression to ventilation ratio for CPR on an infant?
30:2
190
What is the appropriate depth for chest compressions in an infant?
1 1/2 inches
191
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
192
Infant tachycardia
Children tachycardia
Note
> 220
> 180
get Hx, if sudden & random onset then SVT
193
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
194
Pediatric GCS (Glasgow Coma Scale):
= Modified to assess eye opening, verbal response, motor response
195
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)
196
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
197
Estimating upper limit of RR:
= Age# - 40
198
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
199
<1Yr pulse check @
Carotid
200
Pediatric GCS 0-24Mns changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
201
Pediatric GCS 2-5Yrs changes:
(E) Alert, shout, pain, none
(M) same but follows commands now spontaneous
(S) Coos, Consolable ,Crys, Crazy, none
202
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.
203
OG tube (French) Premature
Neonate
6 Months
1–4 Years
5 Years
5–10 Years
5
5–8
8
10
10–12
14–18
204
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)
205
What is the appropriate depth for chest compressions in a child?
2 inches
206
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
207
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
208
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)
209
Pedi Defibrillation
Initial 2 J/kg, then 4 J/kg increasing to max 10J/Kg
210
hypoglycemia Rx for infant:
= <60BGL infant
211
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)
212
Pediatric Weight Estimation Formulas
- Old: (Age + 4) × 2 = kg
- New: (Age × 3) + 7 = kg
213
Pedi Uncuffed ETT form:
Pedi Cuffed ETT form:
= (Age in years ÷ 4) + 4.
= (Age in years ÷ 4) + 3.5
214
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
215
hypoglycemia for neonate:
= <45BGL neonate
216
- Dextrose Infant (2Mn-2Yrs):
D25W, 2-4 mL/kg IV
217
Dextrose Child (>2Yrs):
D50W, 1-2 mL/kg IV
218
What are the normal newborn vitals?
RR: 40-60 bpm,
HR birth: 150-180 bpm & after birth: 130-140 bpm
HR < 100 bpm = distress
219
Neonatal CPR Indications
HR < 60 bpm despite ventilation & oxygenation
220
Neonatal Hypovolemia Shock Signs
Pale, cool skin, poor capillary refill, weak pulses, lethargy
221
Neonatal Shock Treatment
Fluid resuscitation (10 mL/kg bolus NS or LR), treat underlying cause
222
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
223
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
224
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
225
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
226
posterior fontanelle usually closes
anterior fontanelle closes
= in 2 or 3 months
= between 9 and 18 months
227
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
228
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
229
Infants sings of comp/ shock & entering decomp/:
Hypoxica > Tachycardic > Bradycardic
230
Croup vs Epiglottitis) Virus type:
Onset:
Defining S/S:
= (C)Viral (E)Bacterial
=(C)Slow (E)Fast
=(C)Seal cough & Steeple (E)Drooling
231
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
232
What is the GCS score for a 5-year-old with Eye Opening: To verbal, Motor Response: Localizes, Verbal: Inappropriate words?
12
233
When does the posterior fontanelle of a pediatric patient generally close?
3 months
234
When does the anterior fontanelle of a pediatric patient generally close?
9-18 months
235
What is the GCS score for a 2-year-old with Eye Opening: To pain, Motor Response: Withdrawal, Verbal: Cries and Screams?
9
236
What is the GCS score for a 7-year-old with Eye Opening: To pain, Motor Response: Extension, Verbal: Incomprehensible sounds?
6
237
Infant tachycardia
Children tachycardia
Note
> 220
> 180
get Hx, if sudden & random onset then SVT
238
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
239
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
240
Cardiac arrest in infants & children usually from:
Respiratory failure or arrest
241
#1 Killer 3rd trimester
Placenta Abruptio
242
Gestational Diabetes rx:
BGL < 70 mg/dL: Start IV NS & Admin/ 50-100 mL 50% dextrose intravenously
243
What 3 shunts are involved in the fetal circulation?
Ductus Venosus later lig terez
Foramen Ovale septum prinium
Ductus Arteriosus
244
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.
245
Jumpstart) Triaging
RPM Resp/ Pulse / Mental
246
Jumpstart) P of RPM
Radial pulse
247
Jumpstart) R of RPM
RR <15 or >45
248
Jumpstart) M or RPM
Mental status
249
Choanal Atresia
Congenital blockage of nasal passage, causes respiratory distress when mouth is closed
250
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)
251
What is the breathing assistance needed for neonates?
Most neonates breathe spontaneously; some need assistance, few require extensive resuscitation, and meds are rarely indicated.
252
Heart defect categories
1 Increase pulmonary blood flow
2 Decrease pulmonary blood flow
3 Obstruct blood flow
253
Block Blood flow defects:
= Coarctation of the Aorta,
Pulmonary & Aortic Stenosis
Truncus Arteriosus,
Hypoplastic Left Heart Syndrome
254
Decrease pulmonic defects:
= Tetralogy of Fallot (TOF),
dextro-Transposition of the Great Arteries (d-TGA), Levo-Transposition of the Great Arteries (l-TGA)
255
Heart defect categories
=Block blood flow, Decreased & Increased Pulmonic Flow,
256
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.
257
Pediatric Airway Management Positioning
- Neutral sniffing position prevents airway collapse - Padding under shoulders for younger children
258
Broselow Tape Purpose
Rapid pediatric weight & dose estimation based on height.
259
Pediatric Thermoregulation Considerations
- Higher surface area-to-mass ratio → heat loss easier
-Brown fat for thermogenesis
-Increased risk of hypothermia
260
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
261
Signs of Pediatric Respiratory Failure
- Early: Tachypnea, retractions, nasal flaring, grunting
- Late: Bradypnea, cyanosis, altered LOC
262
Pediatric Shock Types & Causes
- Hypovolemic: diarrhea, Vomiting, hemorrhage
- Distributive: Sepsis, anaphylaxis
- Cardiogenic: Congenital heart defects, myocarditis
- Obstructive: Tension pneumothorax, tamponade
263
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
264
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)
265
Pediatric Cervical Spine Injury Considerations
- SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) is more common
- Use pediatric C-collars & padding under shoulders
266
Pedi Polyuria
>3ml/kg
267
Infants sings of comp/ shock & entering decomp/:
Hypoxica > Tachycardic > Bradycardic
268
What is the appropriate depth for chest compressions in an infant?
1 1/2 inches
269
Croup vs Epiglottitis) Virus type:
Onset:
Defining S/S:
= (C)Viral (E)Bacterial
=(C)Slow (E)Fast
=(C)Seal cough & Steeple (E)Drooling
270
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
271
Pediatric Chain of Survival
1. Prevention
2. Early CPR
3. Early 911
4. Rapid ALS
5. Post-Arrest Care
272
Pediatric Airway Differences
- Larger tongue, floppy epiglottis - Narrowest airway @ cricoid, not vocal cords - More anterior airway
273
Pediatric Cardiovascular System Considerations
- Stroke volume is fixed, CO dependent on HR
-Hypotension is a late sign of shock
- Bradycardia often secondary to hypoxia
274
Key Differences in Pediatric Airway Anatomy
- Larger tongue relative to mouth
- Floppy, U-shaped epiglottis
- More anterior & superior larynx
- Narrowest airway @ cricoid cartilage
275
Pediatric Assessment Triangle (PAT) Components
1. Appearance: LOC, interactiveness, muscle tone (TICLS: Tone, Interactiveness, Consolability, Look/gaze, Speech/cry)
2. Work of Breathing: Visible effort, abnormal sounds
3. Circulation to Skin: Color, capillary refill, mottling
276
Stridor
(2/3 occlusion) Is abnormal, musical, high-pitched sound, more commonly heard on inspiration
277
Appendicitis:
= Common GI emergencies
= If untreated, can lead to peritonitis or shock
= Rebound Tenderness Pain at McBurning's Point (2/3 from umbilicus)
278
dif/ from a PEDI vs adult airway) PEDI:
Adult:
= Large tongue, Floppy omega epiglottis, cricoid narrowest point
= glottis narrowest point, firm epiglottis
279
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
280
A surgical cricothyrotomy is contraindicated in patients less than
less than 8 years old
281
Common issue/injury w/ PPV on Pedis
= Barotrauma; Too much squeeze & too slow
282
Pedi PPV BVM rate:
1 every 2-3secs ~20-30breaths /min
283
Auscultation technique w/ Pedis
Using Bell & Armpit to Armpit
284
Upper airway in Pedis:
= Anything above carina
285
Adults vocal cords @
Pedi Vocal cords @
C4 - 5
C2 - 3
286
Pedi 1st most & 2nd most common arrest rhythm
#1 Asystole #2 PEA
287
Pedi Resp distress:
Pedi Resp failure:
= "Huffing & Puffing Enough" to sustain life
= “failure to respirate to sustain life” >60RR
288
Mottling
"Blonching Blues" seen in sick pedis
289
Transitional Phase
- "Talking Phase of building rapport w/ Pedi (GOOD PATs)
-Toe to head exam & @ eye Lvl
290
Pedi intubation indications
Bad physical signs NOT MONITORS
291
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
292
Pedi Vocal cords differences
more anterior & superficial
293
What are the 3 parts of the Primary Assessment Triangle (PAT)?
Appearance, Work of breathing, Skin color
294
What is the correct compression to ventilation ratio for CPR on an infant?
30:2
295
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
296
Infant possible SVT rate
Children possible SVT rate
SVT vs TC
> 220
> 180
get Hx, if sudden & random onset then SVT
297
Cardiac arrest common etiologies
1st most common Cardiac myopathy from sick)
Prolonged QT syndrome
Commotion cordis
298
Bacterial tracheitis:
seen w/:
S/S:
= bacterial infection of subglottic region
= after Croup, 1-5Yrs
= High fever, phlem, horse if talking, Stridor
299
Bronchiolitis:
= viral infection of bronchioles, most commonly respiratory syncytial virus (RSV) affecting lining of the bronchioles
300
Bronchiolitis sound:
Occurs commonly:
AKA:
= expiratory wheezing
= in winter <2Yrs
= "Baby asthma"
301
Pertussis AKA:
Absolute sign:
S/S:
= "Whooping cough" bacterial infection (<6Yrs)
= “whoop” sound after a coughing attack
= Low grade fever, Rhonchi, can be dehydrated
302
AEIOU-TIPPS reflects major causes of AMS
Alcohol
Epilepsy
Insulin
Opiates
Uremia (Kidney Failure)
Trauma, Temp
Infection
Poisoning
Psychogenic
Shock, Stroke, Seizure
303
Bacterial Meningitis
Viral Meningitis
Most Lethal
Most common/viral
304
Brudzinkis sign:
+ sign indicates:
= Supine & flex head feet kick up
= Meningitis
305
Kirinick’s sign:
+ sign indicates:
= bend knee to chest but cant outflex legs
= Meningitis
306
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
307
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)
308
Pedi Hypotension criteria cheat
Start @ 90 neonates w/ 60SBP w/ chidlren (1-10Yrs) for foumula
309
Nasal flaring
Occurs from widening of the nostrils; seen primarily on inspiration
310
Cardiac arrest in infants & children usually from:
Respiratory failure or arrest
311
What is the appropriate depth for chest compressions in a child?
2 inches
312
Steeple sign:
= w/ xray has church steeple from epiglottitis
313
Bronchiolitis) Mild Treatment:
Moderate:
Severe:
= Nebulized Albuterol & Atrovent, & Steroids: Dexamethasone & Solu Medrol
= CPAP/ SVN Epi & Mag Sulfate
= Epi 1:1 IM & ET Intubation
314
Croup/(Laryngotracheobronchitis) Rx
SVN Albuterol (or Epis) & Steroids: Dexamethasone & Solu Medrol, CPAP
315
Abortion:
Expulsion of fetus prior to 20 weeks' gestation
Most common cause of bleeding in 1st & 2nd trimesters
316
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
317
Abnormal Delivery Situations
Breech Presentation, Prolapsed Cord, Limb Presentation, Occiput Posterior Position, Multiple Births, Cephalopelvic Disproportion, Precipitous Delivery, Shoulder Dystocia, Meconium Staining
318
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
319
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
320
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
321
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)
322
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
323
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)
324
Acrocyanosis
= extremities remain dusky after delivering & drying healthy baby (Very common in 1st Hrs of life
325
What 3 shunts are involved in the fetal circulation?
Ductus Venosus later lig terez
Foramen Ovale septum prinium
Ductus Arteriosus
