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126 Cards in this Set
- Front
- Back
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common congenital abnormalities
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diaphragmatic hernia
cleft lip/pallet |
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foramen ovale and complications
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hole between the R and L atrium, closes due to pressure changes.
blue baby syndrome, foramen ovale doesnt close completely and blood leaks |
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infant resuscitation
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IV eppie 0.1ml/kg 1:10,000 IVP
volume 10 ml/kg < 1mo naloxone (do not give to newborns) |
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premie problems
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-hypothermia
-collapsed lung -meconium staining (distressed baby) -hypoglycemia |
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hypoglycemia
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baby has depleted glucose stores
check at heel perimeter area less then 40 requires treatment |
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dextrose
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D50
25g / 50ml newborn dose 0.5 g/kg |
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febrile seizures
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-fever from upper respiratory infection
-parents bundle up baby causing overheating treatment -remove bulky clothing -transport -check cbg |
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causes of febrile seizure
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-overheating
-hypoglycemia -meningitis |
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status epilepticus and seizure types
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sustained seizure
-check CBG, administer D50 if indicated (may not require versed) grand mal = full contractions petite mal = daydreaming, common in kids |
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Newborns
Neonate Infant Toddler Preschooler School age Adolescent |
newborn = first few hours
neonate = first 30 days infant = 1-12 months toddler = 1-3 years preschooler = 3-5 years school age = 6-12 years adolescent = 13-18 years |
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pediatric assessment
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start at the feet and work towards the head
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IVs in peds
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try to avoid, especially in peds with respiratory distress
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C-spine precautions in peds
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add 1-1.5" of padding under the shoulders and body
make sure the head is inline so airway is not occluded |
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#1 cause of death in peds?
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trauma
organs are larger, bones are smaller, less protection |
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peds airway
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smaller then adults
-adenoids and tongue larger -weak neck muscles |
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3 types of airway problems in peds
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1) foreign body airway obstruction
2) trauma 3) swelling from infection |
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OPA differences in peds?
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insert with tongue blade
do not rotate 180 degrees, due to vascular soft pallet |
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Croup
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-common problem, kid wants to lay down
-fever -barking cough |
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Epiglottis
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DANGEROUS
-stridor -drooling -sitting up -no barking cough -DO NOT TOUCH MOUTH |
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peds breathing
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-20 BPM
-axilla is the best place to listen |
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peds circulation
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-20% blood loss with no S/S
-mottling of the skin -strength and regularity of pulse |
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dehydration
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kids get sick which causes them to not want to eat or drink, then they cant fight the sickness
IV may not be required, unless extremely critical Assessment -look like concentration camp victims -sunken eyes and sunken abdomen -check for skin tenting -child prefers sleep -fontanelle will sink in (bulge = infection) -low BP rapid pulse |
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choanal atresia
cleft lip cleft palate diaphragmatic hernia pierre robin |
choanal atresia = bony or membranous occlusion that blocks the passageway betwen the nose and pharynx
cleft lip = one or more fissure off-center split in the upper lip that extends to the nose cleft palate = fissure in the roof of the mouth that runs midline, may extend into the nasal cavities diaphragmatic hernia = protrusion of a part of the stomach through an opening in the diaphram pierre robin = complex of abnormalities, small mandible, cleft lip, cleft palate, other craniofacial abnormalities and defects of the eyes and ears |
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3 major physiological adaptions at birth
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1) emptying fluids from lungs and beginning ventilation
2) changing circulatory pattern 3) maintaining body temperature |
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neonate suctioning
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mouth first, bulb, no longer then 5 seconds
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neonate resusitation steps
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1. reevaluate inital steps in stabilization (provide warmth, position, clear airway, dry, stimulate, reposition)
2. provide ventilations 3. provide chest compressions 4. administer eppie |
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neonate cpr
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3:1 compression to breath ratio
90 compressions 30 breaths per minute 2 thumb method 1/3 anterior posterior chest, recheck every 30 seconds |
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3 most common complications of postresusitation
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1) tube occlusion by mucus or meconium
2) endotracheal tube migration 3) pneumothorax S/S -decreased chest wall movement -diminished breath sounds -return of bradycardia -unilateral decrease in chest expansion -altered intensity to pitch of breath sounds -increased resistance to hand ventilation |
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primary vs secondary apnea
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primary = self limiting controlled by PCO2 levels
secondary = apnea that exceeds 20 seconds without spontaneous breathing |
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diaphragmatic hernia S/S & TX
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S/S
-little to severe distress -cyanosis unresponsive to ventilations -scaphoid abd -bowel sounds in the chest -displaced heart sounds TX -elevate the infants head and thorax to downward displace guts -o2, ventilatory, circulatory support -rapid transport -tracheal intubation BVM CONTRAINDICATED |
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bradycardia
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HR less then 100
most commonly caused by hypoxia -airway secretions -foreign body -position of the tongue or soft tissues TX -positioning -PPV O2 -intubation |
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premies
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baby born before 37 weeks of gestation
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Hypovolemia
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S/S
-mottled pale color -cool skin -tachycardia -diminished periph pulses -delayed cap refill, normal temp may be from dehydration, hemorrhage, trauma or sepsis give 10ml/kg over 5-10 minutes second 10ml/kg if no change |
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causes of neonatal seizures
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-developemental abnormalities
-drug withdrawl -hypoglycemia -hypoxic-ischemic encephalopathy -intracranial hemorrage -meningitis or encephalopathy -metabolic disturbances |
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subtle seizures
tonic seizures multifocal seizures focal clonic seizures myoclonic seizures |
subtle seizures = eve deviation, blinking, sucking, swimming movements of the arms, peddling legs. APNEA
tonic seizures = involve extension of the limbs, less often involve flexion of uppers and extension of lowers PREMIES, INTRAVENTRICULAR HEMORRHAGE Multifocal seizures = clonic activity in one extremity that migrates full term infants Focal Clonic = clonic, localized jerking full term and premature newborns myoclonic = flexion and jerking of the upper and lower extremities, singularly or repetitve jerking cycles ABCs maintain body temp, dextrose, anticonvulsants or benzos |
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fever
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rectal temps greater then 100.4 F
-acute viral or bacterial infection, causes speed up in metabolism S/S -mental status changes -hx of decreased intake -rashes and petechia -warm or hot skin DO NOT cool, take to hospital |
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hypothermia
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core temp below 93 F
-decrease in heat production -increase in heat loss -assocaited increase in metabolic demand to maintain temp can lead to metabolic acidosis, pulmomary hypertension, hypoxemia S/S -pale color -cool skin (extrem) -respiratory distress -apnea -bradycardia -central cyanosis TX -warm -dextrose -warm IV |
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hypoglycemia
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-less then 40 (less then 60 central lane)
risk factors -asphyxia -toxemia -smaller twin -CNS hemorrhage -sepsis S/S -twitching or seizure -limpness -lethargy -eye rolling -high-pitched crying -apnea -irregular respirations -cyanosis (possibly) |
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NL vomiting and diarrhea
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vomiting mucus (streaked with blood) common in the first few hours of life
5-6 stools per day NL if breastfeeding |
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vomiting
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obstrution in the upper digestive tract or increased ICP
non-bile-stained fluid is sign of anatomical or functional obstruction (duodenum) bile stained obstruction below bile duct dark blood = life threatening illness transport on side, start IV if MD order |
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diarrhea
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S/S
-loose stools -decreased urinary output -signs of dehydration TX -supportive care -IV therapy -rapid transport |
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Peds
major problems and differences from adults |
hypoxia is the major cause of cardiac arrest
peds crash extremely fast -look for intercostal muscle retractions -allow peds to lay down |
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airway problems
& big 3 |
upper airway = above neckine
lower airway = below neckline, assess lung sounds Big 3 Epiglottis, Croup = upper asthma = lower |
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croup
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seal barking cough caused by URI or cold
6 months - 4 years low grade temp transport and have ears checked |
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epiglottis
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acute high grade fever
very fast onset child will guard their airway -afraid to swallow -drooling -sore throat -not talking |
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epliglotitis treatment & aggravations
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do not touch or probe
be prepared to intubate around the swollen epiglottis crichothyrotemy is the last result aggravations -anxiety levels -IV's -Cold air transport code 1, be calm |
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Asthma
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lower airway problem
can be exercise induced silent lung or wheezes -ask parents if they have any problems with asthma -rapid breathing dries secretions |
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asthma treatment
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albuterol/atrovent
solumedrol (swelling) MD order 1mg/kg eppie = 0.01 mg/kg 1:1000 SQ/IM |
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bacterial tracheitis
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can mimick epiglotitis
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bronchiolitis
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viral disease of lower airway
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fluid challenges
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10 ml/kg neonates
20 ml/kg older |
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status epilepticus
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check blood sugar and treat BEFORE giving versed
(try to treat the cause of the seizures) |
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child abuse duty to report
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we report any reasonable suspicion
report to the sheriff of the county where your patient ends up |
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child abuse suspicions
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-old bruising (yellow green)
-shaken baby syndrome -stories that are not adding up - SIDS |
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SIDS
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skin under diaper looks like it hasn't been treated for weeks, not necessarily neglect
drainage from nose or mouth |
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Newborn
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First few hours of life
-HR first 30 min 120-160 -RR 40-60 then 30-40 -6 to 8 lbs |
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Neonate
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first 28 days of life
-lbs may decrease 5-10% during the first few days of life because of the excretion of ECF, regain during 2nd week -sleep 16-18 hours/day -nose breathers (diaphram) problems -persistant crying -respiratory problems -jaundice -vomiting -fever -sepsis -meningitis -prematurity |
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Infant
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2-12 months
-mature nerves and standing common problems -respiratory -GI -CNS -RD -N/V/D -dehydration -seizures -sepsis -meninigits -SIDS other problems -bronchiolitis -croup -FBAO -sexual abuse -neglect -falls -MVA |
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Toddler
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1-3 years
-basic and fine motor skills -basic language -notice difference between sexes problems -RD (asthma, bronchiolitis, FBAO, Croup) -V/D/Dehydration -febrile seizures -sepsis -meningitis |
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Preschooler
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3-5 years
-fine motor skills -peer relationships problems -thermal burns -submersion / drowning -urge to explore |
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school age
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6-12 years
-puberty -moral traits problems -viral infection -increased physical activity injuries |
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adolescent
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13-18 years
-growth spurt -secondary sex characteristics -college type problems |
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blood pressure in a child over 1 EQ
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AGE X 2 + 70 = minimum systolic
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Vital Signs by age group
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Newborn 120-160 40-60 80/40
1 year 80-140 30-40 82/44 3 year 80-120 25-30 86/50 5 year 70-115 20-25 90/52 7 year 70-115 20-25 94/54 10 year 70-115 15-20 100/60 15 years 70-90 15-20 110/64 |
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infants
approach |
major fears
-separation and strangers approach strategies -consistent caretaker -reduce parent's anxiety as it is transmitted to infant -minimize separation from parent |
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toddlers
approach |
major fears
-separation and loss of control characteristics of thinking -primitive -unable to recognize views of others -little concept of body integrity approach strategy -keep explanations simple -choose words carefully -let toddler play with equipment -minimize seperation |
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preschoolers
approach |
major fears
-bodily injury and mutilation -loss of control -the unknown and the dark -being left alone characteristics of thinking -highly literal interpretation of wods -unable to abstract -primitive ideas about body (blood leaking from bandage) approach strategies -keep explanations simple and concise -choose words carefully -emphasize that a procedure will help the child be healthier -be honest |
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school age children
approach |
major fears
-loss of control -bodily injury and mutilation -failure to live up to expectations of others -death characteristics of thinking -vague or false ideas about physical illness and body structure and function -able to listen attentively without always comprehending -reluctant to ask questions about something they think they are expected to know -increased awareness of significant illness, possible hazards of treatments, lifelong injury consequences, and meaning of death approach strategies -ask children to explain what they understand -provde as many choices as possible to increase the child's sense of control -reassure the child that he or she has don't nothing wrong and that necessary procedures are not punishment -anticipate and answer questions about long term consequences (scar image and activities) |
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adolescents
approach |
major fears
-loss of control -altered body image -separation from peer group characteristics of thinking -able to think abstractly -tendency toward hyperresponsiveness to pain -little understandings of the structure and workings of the body approach strategies -allow adolescents to be a part of decision making about care -give information sensitively -express how important their compliance and cooperation are to their treatment -be honest about consequences -use or teach coping mechanisms such as relaxation, deep breathing, and self-comforting talk |
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ped head characteristics
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proportionally larger
-high percentage of blunt trauma in children involves the face and the head and face -under 3 pad shoulders -over 3 pad occiput |
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fontanelle
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remains open for 9-18 months after birth
anterior fontanelle is usually level or slightly below surface of the skull -tight bulging fontanelle = increased ICP (seen in meningitis) -sunken fontanelle = dehydration assess upright and not crying |
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ped airway
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-cricoid ring is the narrowest part
-floppy epiglottis -uncuffed for children under 8 ET -assess nares b/c obligate breathing |
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ped chest and lungs
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-higher metabolic and O2 consumption rates (susceptible to lactic acid build up)
-ribs are pliable and positioned horizontally and pliable offering less protection -mediastinum is more mobile (tension pnuemo) -fragile lung tissue -diaphragmatic breathers |
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ped abdomen
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-liver and spleen larger
-less protection, injured more easily |
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ped extremities
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-bones are soft
-all strains ad sprains considered a fx -be wary of injuries to the growth plate that may disrupt bone growth |
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ped skin and body surface area
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-less sub Q fat
-larger surface area to body mass -dehydration, hypo/hyperthermia, |
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ped respiratory
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-muscles are main support, tire easily
-double metabolic o2 requirements |
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ped CV system
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-CO is rate dependent
-loss of small volumes of fluid and blood can cause shock -child may be in shock despite normal blood pressure -bradycardia is a response to hypoxia -compensation and then fast crashing, hypotension is a late sign shock assessment -tissue perfusion -LOC -skin color -cap refill -tachy |
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ped nervous
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-greater potential for head injuries due to weak skull bones
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ped metabolic differences
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-small glucose and glycogen stores
-easily crash out afrer infection -significant dehydration loss from V/D |
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Ped assessment triangle
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Appearance
-mental status -muscle tone Work of Breathing -respiratory rate -respiratory effort Circulation -skin signs -skin color |
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pediatric gcs
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Eye
-SAA Verbal (birth to 2 years) 5 cries appopriately 4 cries 3 inappropriate crying/screaming 2 grunts 1 no response 2-5 years 5 appropriate words and phrases 4 inappropriate words 3 cries/screams 2 grunts 1 no response Motor 5 localizes pain 4 flexion withdrawl 3 flexion decorticate 2 flexion extnesion 1 none |
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upper vs lower respiratory distress in peds
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upper airway
1) croup 2) epiglotis 3) bacterial tracheitis lower airway 1) asthma 2) pnuemonia 3) bronchiolitis |
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respiratory distress, failure, and arrest
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distress
-change in mental statues from normal to irritable or anxious -trachypnea -retractions -nasal flaring -poor muscle tone -tachycardia -head bobbing -grunting -cyanosis improving with supplemental O2 Respiratory failure -irritability to lethargy -marked tachypnea to bradypnea -mared retractions to agonal -marked tachycardia to bradycardia respiratory arrest -cessation of breathing -unresponsiveness -apnea -absent chest wall movement -limp muscle tone -bradycardia deteriorating to asystole -cuanosis |
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airway obstruction S/S
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acute respiratory compromise
-anxiety -inspiratory stridor -muffled/hoarse voice -drooling -pain in the throat -decrease breath sounds -rales -rhonchi -wheezing do not mess with partial obstruction |
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CROUP!
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laryngotracheobronchitis
-common viral infection -6 months to 4 years -late fall early winter S/S -recent URI -low grade fever -barking cough -wheezing if lower airways present TX -humidified nebulized O2 -cool air |
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Epiglotitis
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BACTERIAL INFECTION
3-7 years of age -edema and occlusion from swelling of the epiglottis and supraglottic structures -VERY ACUTE (wake up in night) S/S -fever over 104 -sore throat, pn on swallowing -muffled voice -drooling from pooled saliva that occurs because of difficult and painful swallowing -no barking cough -upright patient TX -do not lay ped down -do not visualize airway -100% humidified O2 -do not attempt IV -prep for ET |
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Bacterial Tracheitis
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bacterial infection of the upper airway and subglottic trachea
1-5 years S/S -agitation -cough producing pus or mucus -high-grade fever -hoarseness -inhale/exhale stridor -throat pain |
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Asthma
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LOWER
inflammation, bronchoconstriction and mucus production S/S asthma exacerbation -anxiety -dyspnea -tachypnea -expiratory wheezes, prolonged exhalation triggered by -infection -change in temp -exercise -emotional response TX -assist ventilations -duo neb -eppie 0.01 ml/kg 1:1000 -solumedrol LOW TIDAL VOLUMES 5-8 to redue the potential for barotrauma |
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Bronchiolitis
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LOWER
viral disease caused by respiratory synctial virus children under 2 S/S -tachypnea & wheezing TX -ventilatory support with humidified O2 -albuterol |
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pneumonia
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acute infection of the lower aiway and lungs. involves the alveolar walls or the alveoli
-bacterial or viral S/S -HX of recent airway infection -decreased breath sounds -fever -pain in the chest -rales -rhonchi -tachypnea TX -severe cases, bronchodilators -assist ventilations |
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compensated vs decompensated shock S/S
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compensated (reversible)
-cool, pale extremities -decreased urinary output -delayed cap refill -irritability or anxiety -normal systo -tachycardia -tachypnea -weak periph pulses/full central pulses Decompensated (often irreversible) -absent perip pulses/weak central pulses -cool, pale, dusky, mottled extremities -hypotension, -lethargy or coma -marked tachycardia or bradypnea -significantly decreased urinary output -significantly delayed cap refill |
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systolic blood pressures characterizing hypotension in peds
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term neonates (0-28 days) < 60
infants (1 - 12 months) < 70 children (1 - 10 years) < 70 over 10 years < 90 |
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ped cardiac reserve
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less cardiac reserve then adults
-reduce energy and oxygen requirements of a child in shock |
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nine ped assessment components
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1. LOC
2. Skin 3. Mucus membranes 4. nail beds 5. Peripheral circulation 6. cardiac 7. Respiration 8. blood pressure (over 3 years) 9. body temp |
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Hypovolemia
dehydration |
-V/D
-poor fluid intake -fever -burns 5% or more of total body weight 5-7% for adolescent TX -fluid replacement with isotonic crystalloids -20ml/kg in less then 20 min -PRN as needed |
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Hypovolemia
blood loss |
-ABC's
-bolus 20ml/kg child may show little response to bolus (slight improvement in color and cap refill and a decreased HR may be evident give second bolus |
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Mild Dehydration
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infant 5% (50ml/kg) body weight loss
slightly decreased turgor flat or depressed fontanelle dry mucus mmbranes warm normal color skin mildly tachy normal periph pulses normal BP normal or irritable sensorium |
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Moderate Dehydration
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10% (100ml/kg) body weight loss
moderately decreased turgor depressed fontanelle very dry membranes cool extremities, pale skin moderately tachy diminished periph pulses normal BP irritable or lethargic |
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Severe dehydration
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15% (150 ml/kg)
greatly decreased skin turgor significantly depressed fontanelle parched membranes cold grey or mottled extremities extremely tachy absent periph pulses reduced BP unresponsive |
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distributive shock
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septic, nuerogenic, anaphylactic shock
spectic shock -caused by systemic bacterial infection, meningitis and pneumonia |
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cardiomyopathy
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disease resulting in the reduction in the force of heart contractions
-viral infection or congenital abnormalities affecting both ventricles of the heart S/S -fatigue -CX PN -dysrhythmias -crackles -hypotension -JVD -periph edema -tachycardia -tachypnea |
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cardiac disturbances
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-most result from hypoxia, acidosis, hypotension, or structural heart defects
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Febrile Seizure
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60% have family HX
last less then 5 minutes, uncomplicated short postictal period associated with -underlying viral infection of the URI -GI -reosela -otis media TX -ABC's -rapid transport |
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status epilepticus
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seizure lasting 30 min or longer
1. Provide ABCs, intubation seldomly needed 2. IV access - D50/D25/D10 if less then 60, if no change diazepam, lorazepam, midazolam rectally 3. attach cardiac monitor, observe for rhythm or conduction abnormalities that suggest hypoxia |
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Diazepam
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75-90% effective
15 minutes effective , prn to max 3 doses -respirtory depression and hypotension possible can be given rectally 1. carefully restrain the child knee chest position 2. draw the dose into the syringe 0.5mg/kg 3. lubed 1-ml syringe into spincter aimed to ward rectal wall 4. inject and flush with 1ml NS 5. squeeze butt 6. transport |
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Lorazepam
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IM, IV, IO, rectally
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hypoglycemia
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S/S
MILD -hunger -weakness -tachypnea -tachycardia Moderate -sweating -tremors -irritability -vomiting -mood disorders -blurred vision -stomachage, H/A dizziness Severe -decreased LOC -seizure TX -oral glucose -D50 |
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Hyperglycemia
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Early
-excessive thirst polydipsia -excessive hunger polyphagia -increased urination polyuria Late -weakness -abd pain -aches -N/V -dehydration -fruity breath -tachypnea -hyperventilations -tachycardia -kussmaul and coma |
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poisoning & toxic
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S/S
-cardiac/respiratory depression -CNS stim or depress -GI irrittiation -behavioral changes TX -ABCs -call poison control -all pills, substances and containers should be brought |
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ped cocaine
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S/S
-tachycardia (VF/VT) -tremor -diaphoresis -mydriasis -mood elevation -movement disorders -hypertension -ACS TX -cool to prevent hypothermia -O2 admin vent support -continous EKG -Benzies for anticonvulsant -Nitro -Sodium bicarb/lido -eppie as a vasopressor -no beta blockers |
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ped tricyclic antidepressents
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effects result from inhibition of fast sodium channels in the brain and myocardium
S/S -cardiac rhythm disturbances, preterminal sinus brady, heart block with junctional or ventricular wide complex escape beats TX -O2 admin -continuous EKG -do not give amio, sotalol, procanimide, quinidi -sodium bicarb and lido -NS bolus to manage hypotension -vasopressors |
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ped calcium channel blockers
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effects result from inhibiting the influx of calcium into cells leading to bradydys and hypotension
S/S -bradycardia, hypotension, AMS, cerebral hypoprofusion TX -O2 -EKG -NS to manage hypotension -calcium chloride -vasopressor -insulin glucose therapy |
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ped beta adrenergic
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competition at beta adrenergic receptors resulting in bradycardia and decreased cardiac contractility
S/S -hypotension with brady, varying degrees of block, AMS TX -O2 ABC -EKG -Shock tx -eppie -insulin/glucose -calcium chloride |
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ped opiods
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CNS depression
S/S -ALOC, hypoventilation, apnea and respiratory failure TX -O2 vent -EKG -narcan |
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SIDS risk factors
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-maternal smoking
-maternal youth (20) -poor or no prenatal care -social deprivation -pemies and low birth weight -cocaine, methadone, heroin use -stomach sleeping |
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pain assessment in kids
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Q - Question child about pain (boo-boo, owie etc)
U - use pain rating scale faces or pain scale E - evaluate the child's behavior facial grimace, rigidity, crying, anxious behavior S - secure the parent or caregiver's involvement in assessing the child's pain (any subtle changes?) T - take cause of the pain into account (type of injury expected intensity of pain) T - take action to provide comfort and to relieve pain (narcotic, non-narcotic drugs, comfort measures cold, elevation, distraction technique) |
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child abuse trends and precipitating events
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-under 5
-boys -illigitimacy events -financial stress -loss of employment -eviction -marital stress |
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15 indicators for child abuse
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1. obvious or suspected FX in a child under 2
2. injuries in various stages of healing, burns and bruises 3. more injuries than are usually seen in other children of the same age 4. injuries scattered on many areas of the body 5. bruises or burns in patterns that suggest intentional infliction 6. suspected increased ICP in infant 7. suspected intraABD trauma in young children 8. injury that does not fit description of cause 9. long-standing skin infections 10. an accusation that the child injured himself intentionally 11. extreme malnutrition 12. extreme lack of cleanliness 13. inappropriate clothing for the situation 14. child who withdraws from parent 15. inappropriate child response to incident |
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bruises guidelines
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butt = punishment
genital area, inner thigh = toilet misphaps facial bruises or earlobes = slapping upper lip and labial frenulum = forced feeding or pacifier human hand marks bite marks shaken baby syndrome = subdural hematoma |
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abdominal injury & bone injury
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ABD = second most common cause death in battered kids
bone injury = 20% positive for broken bones |
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sexual abuse
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-mostly girls
S/S -pregnancy & VD in a child younger then 12 -painful urination and defacation -tenderness or lacerations to the perineal area -bleeding from the rectum or vagina -presence of dried blood, semen, or pubic hair in the genital area of child |
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tracheostomy tube management
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tube can become block o dislodged
-clear tube with sterile water or saline or remove and reinsert -temporary ET tube -suction 10-15 secs, high flow O2 after |
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central venous line TX
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-stop the infusion
-clamp cath between tear and patient IF PE (ALOC) -position on left side -lower head -O2 -IV -Rapid transport |
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gastric tube patient positioning
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lay on right side with head elevated
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shunts
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from brain ventricles into R atrium and peritoneal cavity (overflow)
-can obstruct or displace = increased ICP -H/A -N/V -visual distrubances -cushings TX -ABCs -MD may order ET and hyperventilation to lower ICP -respiratory arrest common -elevate head |
