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NMETC > Special Populations > Flashcards

Special Populations Flashcards

1
Q

Newborn age range

A

0-1 month

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2
Q

Infant age range

A

1 month- 12 months

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3
Q

Toddler age range

A

1-3 years

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4
Q

Preschool age range

A

4-5 years

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5
Q

Adolescent age range

A

13-17 years

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6
Q

Adult age range

A

18+ years

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7
Q

How does an infant respiratory system differ from adults?

A

breathe via diaphragm (belly breathers) larger tongue narrow and shorter airway obligate nose breathers

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8
Q

Infant reflexes- 4

A

Moro or startle reflex Suckle reflex Rooting reflex Palmar reflex

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9
Q

What age do the fontanels close?

A

18 months

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10
Q

School age children and the three types of reasoning

A

Preconventional-make choices to avoid punishment Conventional- decisions made via peer approval Postconventional- decisions made via own beliefs and conscience

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11
Q

Major anatomic differences with Peds

A
  • higher surface to area to volume area ratio
  • less fatty insulation
  • prone to hypothermia
  • smaller absolute circulating blood volume
  • can compensate longer than adults
  • head larger (kids lead with head with falls)
  • occiput bigger (pad shoulders if C spine maintained)
  • airway shorter and narrower
  • larger tongue
  • airway narrowest at cricoid cartilage
  • obligate nose breathers
  • higher basal metabolic rate
  • decreased functional reserve capacity
  • chest wall pliable –> organ damage more likely
  • abdominal organs less protected by rib cage
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12
Q

Respiratory distress S/S

A

Retractions nasal retractions sniffing position tripoding

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13
Q

Respiratory distress Tx

A

High flow O2 nebulized albuterol with wheezing

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14
Q

Respiratory Failure S/S

A

See saw breathing

ALOC

head bobbing

cyanosis

bradycardia

slowing respirations

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15
Q

Respiratory Arrest S/S

A

No breathing Severe bradycardia cyanosis

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16
Q

Respiratory Failure Tx

A

High flow O2 PPV

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17
Q

Respiratory Arrest Tx

A

PPV Intubation CPR for HR<60

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18
Q

Cystic fibrosis tx

A

dependent on symptoms may include bronchodilators, humidified O2, PPV

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19
Q

Bronchiolitis tx

A

albuterol or racemic epi PPV for failure or arrest

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20
Q

When do you initiate PPV in peds?

A

First sign of decreased respiratory effort or decreased LOC

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21
Q

When do we intubate peds?

A

Poor seal of mask on face

need for extended resuscitation times

cardiac arrest

respiratory arrest

head or facial injury

unable to protect airway

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22
Q

ETT equation for children under 8

A

16 + age divided by 4 for UNcuffed tubes subtract 0.5mm for cuffed tube

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23
Q

Infant ETT uncuffed size

A

3.5mm

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24
Q

Volume resuscitation Ped amount

A

20mL/kg, repeated up to 3x

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25
Q

DOPE

A

Displacement Obstruction Pneumo Equipment

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26
Q

Newborn VS

A

Pulse 100-180 SBP 50-70 RR 30-60

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27
Q

Infant VS

A

Pulse 100-160 SBP 70-90 RR 25-50

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28
Q

Toddler VS

A

Pulse 90-150 SBP 80-100 RR 20-40

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29
Q

Preschool VS

A

Pulse 80-120 SBP 80-100 RR 20-30

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30
Q

School Age VS

A

Pulse 70-120 SBP 80-110 RR 15-25

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31
Q

Adolescent VS

A

Pulse 60-100 SBP 90-120 RR 12-20

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32
Q

Adult VS

A

Pulse 60-100 SBP 100-140 RR 12-20

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33
Q

TICLS

A
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34
Q

PAT Appearance Characteristics

A

Abnormal tone

Abnormal position

Abnormal gaze

decreased interactions

unconsolable

Abnormal cry

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35
Q

PAT Work of Breathing Characteristics

A

Retractions

Grunting

Flaring

Gasps

Apnea

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36
Q

PAT Circulation

A

Temperature

pallor

cyanosis

mottling

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37
Q

Difference bw Neuro Shock and Hypovoloemic Shock Hypotension

A

Neuro= wide pulse pressure

Hypo= narrow pulse pressure

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38
Q

Difference bw Cardiogenic Shock and Hypovoloemic Shock Hypotension

A

Hypo= quiet tachypnea

Cardio= grunting, loud tachypnea with accessory muscle use

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39
Q

Indications of progression from compensated shock to hypotensive shock

A

Increased tachycardia

Diminished or absent peripheral pulses

Weakening central pulses

Narrowing pulse pressures

Cold distal extremeties with dec cap refill

ALOC

Hypotension (LATE finding)

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40
Q

PALS shock management

A

optimize O2 and SpO2

Improve volume

Correct metabolic derangements

Reduce O2 demands

-fever, px, anxiety, WOB

Positioning

Support ABCs

Fluids/IV

Monitor

Frequent reassessment

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41
Q

Peds Fluid Bolus

A

20mL/kg over 5-20mins

5-10mL/kg if compromised (cardiac)

repeat up to 2 more times

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42
Q

What vitals should we be monitoring in ped emergencies for improvement if interventions are working?

A

O2 sats

HR

Peripheral pulses

cap refill

Skin temp/color

BP

LOC

Ongoing fluid loss (diarrhea, blood, etc)

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43
Q

Fluid bolus for peds with overdose risk (ie calcium channel or beta blocker)

A

5-10mL/kg over 10-20mins

44
Q

S/S of Septic Shock per PALS

A

ALOC- irritable or dec ALOC

Altered HR- tachycardia

Altered Temp- fever or hypothermia

Altered perfusion- long cap refill, mottling, pallor ecchymosis

Hypotension

45
Q

PALS Peds Sepsis Initial Stabilization

A

ABCs

Monitor vitals

IV/IO

BGL

Fluid bolus

Antipyretics if needed

**If symptoms persist beyond fluid boluses, consider pressor

46
Q

Pressor choices for Cold vs Warm Shock in Peds

A

Warm= norepi or epi

Cold= epi

**cold shock give epi infusion at 0.3mcg/kg/min stimulates predominantly alpha effects

47
Q

What do we give if ped is refractory to fluids and pressors?

A

Consider adrenal insufficiency and give 1-2mg/kg hydrocortisone bolus early

48
Q

PALS Anaphylaxis Tx

A

Position Pt

Maintain Airway

Epi if bad

Fluids

Albuterol for bronchospasm

Antihistamine

Solumedrol

*may need epi infusion at 10-15 min mark if severe, dose at 0.05mcg/kg/min

49
Q

PALS Neurogenic Shock Tx

A

Position pt flat to improve CO

Fluids and observe response

If refractory, give pressor trial

Provide warming or cooling as needed

50
Q

PALS Cardiogenic Shock Tx

A

Supplementary O2

May need PPV

5-10mL/kg fluid bolus

watch for pulmonary edema

consider pressors

51
Q

PALS Cardiac Tamponade Txp

A

Fluids to help compressed heart squeeze better —>better perfusion

Rapid Txp

52
Q

What are the two routes to cardiac arrest in peds?

A

hypoxia

sudden cardiac arrest (usually VF/VT)

53
Q

Signs of hypertrophic cardiomyopathy in ped EKG

A

high QRS voltage

Q wave in lateral leads

narrow QRS

sudden syncope

54
Q

Predisposing factors for Sudden cardiac arrest in peds

A

hypertrophic cardiomyopathy

anomalous coronary syndrome

long QT

Brugadas

Myocarditis

Drug intoxication

Commotio cordis

55
Q

normal QRS width in kids

A

<0.09ms

56
Q

compression depth in kids (1yo-puberty)

A

1/3 AP diameter

about 2 inches

57
Q

compression depth in infants

A

1.5 inches

about 1/3 AP diameter

58
Q

Compression to Ventilation ratio with 1 vs 2 rescuers for Child and Infants

A

15: 2 for 2
30: 2 for 1

59
Q

Unwitnessed vs witnessed arrest for when to call 911

A

Unwitnessed- 1 round of CPR

Witnessed- call 911

60
Q

Once advanced airway placed, provide ventilations at rate of

A

1:6s aka asynchronous

61
Q

If ETCO2 is 10-15 during CPR what does that indicate

A

poor CPR

change hand position or provider

62
Q

Priority Routes for Drug Admin in Ped CPR

A

IV

IO

ETT

63
Q

LEAN for Ped CPR Drugs

A

Lidocaine

Epi

Atropine

Naloxone

64
Q

Recommended ET dose for epi

A

10x normal IV/IO dose

65
Q

Recommended ET dose for other meds

A

2-3x normal IV/IO dose

66
Q

How do we give drugs down ETT?

A

Prep drug amount

instill drug down ETT, briefly pausing compressions to do so

follow with 5mL flush

rapidly give 5 PPV after

67
Q

Defib joules for peds CPR

A

1st- 2J/kg

2nd- 4J/kg

3rd- >4J, usually 6J, 8J

Max of 10J/kg

68
Q

Epinephrine dose for peds in CPR

A

0.01 mg/kg q 3-5 mins

69
Q

Amiodarone peds dose for CPR

A

5mg/kg repeated 2 more times

70
Q

Lidocaine dose for peds CPR Initial

A

1mg/kg loading dose

71
Q

Lidocaine dose for peds CPR Infusion

A

20-50mcg/kg/min

*repeat bolus initial dose if infusion >15mins after initial bolus therapy

72
Q

Max Amiodarone dose

A

15mg/kg aka 3 doses

73
Q

Traumatic Arrest Causes for Peds

A

hypoxia via FBAO, resp arrest, traumatic injury

injury to vital structures

severe brain injury causing cardio collapse

upper cervical spinal cord injury

tension pneumo

cardiac tamponade

massive hemorrhage

74
Q

Steps to Cardiac arrest for Trauma Peds

A

CPR

ABCs

Anticipate airway obstruction via teeth, blood, etc

Minimize C spine motion

Control bleeding

Txp to adequate facility

Establish IV IO

75
Q

Early s/s of hypoxia with peds

A

anger irritable

nasal flaring

retractions

tachypnea

tachycardia

mottling

pallor

cyanosis

76
Q

Late s/s of hypoxia in peds

A

ALOC

bradycardia

tachypnea

grunting

positioning

head bobbing

severe retractions

pallor

cyanosis

mottling

77
Q

Signs of U Airway Obstruction

A

Increased rate, effort of breathing

Increased inspiratory effort

stridor

hoarsness

barking cough

drooling

snoring

gurgling

poor chest rise

poor auscultation

78
Q

Signs of L Airway Obstruction

A

Increased rate and effort

Increased expiration effort

wheezing

cough

79
Q

Causes of Mobitz Type I in peds

A

drugs- Ca and B blockers

conditions that stimulate vagal tone

MI

80
Q

Causes of Mobitz Type II in Peds

A

Intrinsic conduction issue

cardiac surgery

MI

81
Q

Causes of Third Degree Block in Peds

A

Extensive conduction issues

cardiac surgery

Congenital

MI

Toxic drugs

acidosis

severe hypoxia

82
Q

2 most common reversible causes of bradycardia

A

hypoxia

increased vagal tone

83
Q

Atropine dose in peds

A

0.02 mg/kg may repeat 1x

84
Q

Atropine minimum and maximum dose

A
  1. 1mg/kg minimum
  2. 5mg single max dose
85
Q

S/S of Advanced tacharrythmias in Peds/Infants

(s/s of cardiac compromise)

A

irritability

s/s of pulmonary edema

poor feeding

tachypnea- loud

“sudden” collapse

s/s of shock

JVD

86
Q

Narrow Tachycardias in Peds

A

sinus tach

SVT

Atrial flutter

87
Q

Wide Tachycardia in Peds

A

>.09ms

VT

SVT with aberrancy

88
Q

Sinus Tach HR for Peds and Infants

A
89
Q

SVT vs Sinus tach PALS

A
90
Q

Synchronized Cardioversion Initial Joules

A

0.5-1 J/kg

91
Q

Synchronized Cardioversion Subsequent Doses

A

2J/kg

92
Q

PALS Tachycardia with Pulse

A
93
Q

If pt is in SVT or VT with Pulse AND is hemodynamically stable and refractory to meds…

A

consider expert consult before SCV

94
Q

If wide complex tachycardia is refractory to SCV…

A

consider expert consult before administration of amiodarone or procainamide (give slow!)

95
Q

ROSC Care for Peds

A
96
Q

EPI infusion dose Peds

A

0.1-1mcg/kg/min

lower doses have beta effects

higher doses (0.3mcg) have alpha effects

97
Q

Norepi Infusion dose in Peds

A

0.1-0.2 mcg/kg/min

98
Q

Tx of Mild Croup

A

Consider decadron

blow by O2

99
Q

Moderate to Severe Croup Tx

A

Nebulized epi

decadron

blow by O2

100
Q

Impending respiratory failure for Croup Tx

A

NRB or BVM if sats below 90

decadron IV or IM

Consider ETT or Cric

go with a size smaller tube

101
Q

Moderate to Severe Anaphylaxis Tx

A

IM epi

Albuterol for wheezing

Decadron or Solumedrol

Fluids for hypotension

Benadryl

102
Q

FBAO in peds Tx

A

If kid can cough forcefully and make noise, all them to continue to clear airway

if they can’t, abdominal thrusts

if they become unresponsive, CPR with airway clearing before ventilations

103
Q

Complications of Hyperventilation

A

Gastric distention- aspiration

Pneumo

Severe air trapping- decreases preload

104
Q
A
105
Q

What is hypoglycemia in infants vs peds?

A

45 infants

60 peds

NMETC (11 decks)

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