Systematic Approach to the Seriously Ill or Injured Child Flashcards
Most cardiac arrests in infants and children result from
1) Progressive respiratory failure 2) Shock 3) Both
In the out-of-hospital setting, only ___% of children who experience cardiac arrest survive to hospital discharge
4-13%
If cardiac arrest occurred at the hospital, ___% survive to hospital discharge
33%
Parameters to assess to make an initial impression
1) Consciousness 2) Breathing 3) Color
Start CPR even if there is a pulse if the rate is ___
Less than 60/min with poor perfusion despite oxygenation and ventilation
Components of primary assessment
ABCDE: Airway, breathing, circulation, disability,
Components of secondary assessment
Focused medical history and focused PE
Measures to open and maintain a patent upper airway
1) Allow child to assume position of comfort 2) Head tilt-chin lift or jaw thrust 3) Foreign body airway obstruction relief techniques 4) Airway adjuncts
Measure of choice in opening and maintaining upper airway in a patient with suspected cervical spine injury
Jaw thrust
Technique to relieve foreign body obstruction in children less than 1 y/o
5 back slaps, 5 chest thrusts
Technique to relieve foreign body obstruction in children 1 y/o or older
Abdominal thrusts
Normal RR: Less than 1 year
30-60
Normal RR: Toddler (1-3 years)
24-40
Normal RR: Preschooler (4-5 years)
22-34
Normal RR: School age (6-12 years)
18-30
Normal RR: Adolescent (13-18 years)
12-16
Often the first sign of respiratory distress in infants
Tachypnea
Define apnea
Cessation of breathing for at least 20 seconds or less than 20 seconds if accompanied by 1) bradycardia 2) cyanosis 3) pallor
Classifications of apnea
1) Central 2) Obstructive 3) Mixed
Refers to inspiratory effort without airflow
Obstructive apnea
Coarse, high-pitched sound typically heard on inspiration
Stridor
Short, low-pitched sound typically heard during expiration
Grunting
Normal HR: NB to 3 months
85-205
Normal HR: 3 months to 2 years
100-190
Normal HR: 2-10 years
60-140
Normal HR: >10 years
60-100
MCC of bradycardia in children
Hypoxia
Cyanosis is not apparent until at least ___ of hen are desaturated
5 g/dL
When measuring BP, the cuff bladder should cover about ___% of the MUAC
40
When measure BP, the cuff should extend at least ___% to ___% of the length of the upper arm
50-75
Hypotension in neonates (0-28 days)
Less than 60mmHg
Hypotension in infants (1-12 months)
Less than 70mmHg
Hypotension in children (1 year to 10 years)
5th percentile BP; Less than 70+(age in years x 2)
Hypotension in children >10 years
Less than 90
Standard evaluations of disability in pediatric patients
1) AVPU 2) GCS 3) Pupil response to light
AVPU
Alert, responsive to voice, responsive to pain, unresponsive
3 levels of head injury as defined by the GCS
Mild - GCS 13-15; Moderate - GCS 9-12; Severe GCS 3-8
Triad consistent with poor myocardial contractility or extrinsic cardiac compression
Low arterial BP, high CVP, tachycardia
O2 consumption in infants
6-8 mL/kg/min
O2 consumption in adults
3-4 mL/kg/min
When airflow is laminar, what is the relationship of resistance to airway radius
Inversely proportional to 4th power of radius
When airflow is laminar, what is the relationship of resistance to airway radius
Inversely proportional to 4th power of radius
Mechanisms involved in breathing
1) Brainstem 2) Central and peripheral chemoreceptors 3) Voluntary control
Central chemoreceptors for control of breathing respond to
Hydrogen ion concentration
Peripheral chemoreceptors for control of breathing respond to
Arterial O2
Clinical state characterized by abnormal RR
Respiratory distress
Clinical state of inadequate O2, ventilation, or both
Respiratory failure
Classifications of respiratory distress or failure
1) Upper airway obstruction 2) Lower airway obstruction 3) Lung tissue disease 4) Disordered control of breathing
Intervention for mild croup
Consider Dexamethasone
Intervention for moderate to severe croup
1) Humidified O2 2) Nebulized epi (then observe for 2 hours for recurrence of stridor) 3) Dexamethasone 4) Consider heliox
Intervention for impending respiratory failure in croup
1) High O2 concentration (nonrebreathing mask) 2) IV/IM Dexa 3) Intubate if indicated using ET half a size smaller than predicted for age 4) Prepare for surgical airway if needed
Intervention for anaphylaxis
1) IM epi q10-15min prn 2) If wheezing, salb neb or MDI; continuous neb if w/ severe bronchospasm 3) Prepare for intubation 4) Diphen and H2 blocker (ranitidine) IV 5) Methylpred or equivalent corticosteroid IV
Intervention for hypotension in anaphylaxis
1) Trendelenburg position 2) Isotonic crystalloid @ 20cc/kg 3) If unresponsive to fluids, IM epi; if still unresponsive, epi infusion titrated to achieve adequate BP for age
