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25 Cards in this Set

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ABCDE of the pediatric primary survey?
Airway, Breathing, Circulation, Disability, Exposure
How do you calculate the ET tube size for a child?
4(age/4)
What should be done in the following situations:
SVT (HDS):
SVT(hemodynamically unstable):
VT (HDS)
VT (unstable):
Pulseless VT/VF:
SVT (HDS) - vagal maneuvers, adenosine, dig, esmolol, procainamide, amiodarone
SVT (unstable) - cardiovert
VT (HDS): amio, procainamide, treat hypok/mag.
VT (unstable) - cardiovert
VF/pulseless VT - non synch. cardioversion
Describe the 3 stages of shock
- Compensated - homeostatic mechanisms maintain organ perfusion. BP, Cardiac fxn, UOP all normal.
- Uncompensated - homeostatic mechanisms fail d/t ischemia, endothelial injury, toxins.
- irreversible - when uncompensated shock has progressed to cause irreparable end organ damage.
Describe the 4 types of shock
- Hypovolemic (most common)- decreased preload, stroke volume, CO, BP
- Cardiogenic - inadequate stroke volume results in decreased CO,hypotension
- Distributive - a state of relative hypovolemia due to peripheral pooling and vasomotor dysfxn leads to severe hypotension
- Septic shock
What are the etiologies of the following types of shock:
Hypovolemic, Distributive, Cardiogenic
Hypovolemic
water/lyte losses, hemorrhage, third spacing

Distributive
anaphylaxis, neuro injury, drug toxicity

Cardiogenic
congenital, ischemic, myopathy, arrhythmia, infxn
Who should be in a car seat, who should face forward and who should face backward?
All children in car seats weighing less than 40 lbs. Children > 20lbs and >1year can face forward
When should a booster seat be used in a car?
When the child outgrows the car seat and before the seat belt fits properly (usually between 8-12 years)
what is the treatment of choice for foreign body removal in kids?
rigid bronchoscopy
What are the top 3 causes of injury in children?
MVA
Drowning
Burns
What are the three degrees of burns?
1st - epidermis only is involved, no blisters
2nd -
superficial (less than half the dermis), painful, scald injuries
deep (most of the dermis but appendages intact) non painful, scarring, graft req'd
3rd - extend into subq and nontender.
What are the five greatest risk factors for SIDS?
Prone sleeping, Permature, low birth weight, IUGR, maternal smoking during pregnancy
Does 24 hour apnea monitoring decrease the risk of SIDS?
No
What are some signs of a pathologic murmur in a child?
Heaves/Thrills
Pulse delay, abnormal Splitting
S3, S4
click, snap, rubs
loud harsh or blowing murmur no change of murmur with patient positioning
When are the following functional murmurs usually seen:
Venous Hum
Stills
Pulmonary Flow murmur
Carotid bruit
PPS
--Venous Hum - 3-7 years old, continuous, soft humming murmur heard at the neck or RUSB
--Stills - 2-8 years old, II-III midsystolic musical murmur heard best at LLSB
--Pulmonary Flow murmur - 6yr-adolescence, systolic ejection murmur LUSB
--Carotid bruit - 3-8yr
--PPS - birth to 2 months, medium pitched SEM best heard at the LUSB radiating to the back
At what level of deoxygenated Hb does cyanosis become clinically evident
3g/dL
Describe the 5 cyanotic heart defects and when is cyanosis seen?
Truncus arteriosus - non specific murmur and cyanosis at birth and CHF develops in a matter of weeks as the pulmonary vascular resistance falls.

Hypoplastic left heart -

Transposition - 3:1 male predominance, parallel circuits, severe cyanosis present from birth. must give PGE immediately to keep DA patent. An ASD is also helpful.

Tricuspid Atresia - LA/LV handle the blood flow for lungs and systemic. Almost always a VSD/PFO. Cyanosis is progressive over the first two weeks of life

Tetralogy of Fallot - all patients have 22q11 microdeletion.
What is suspected when preductal sats are lower than postductal or visa versa(4things)?
Transposition, PPHN, LV outflow obstrustion (coarc, AS, LVOT obs.)
Which cyanotic heart defects are ductal independant? dependant pulmonary flow? systemic flow?
Independent - TA, TAPVR, Transposition

Dependant pulmonary flow - Tricuspid atresia, Tetralogy,
Ebstein anomaly

Dependant systemic flow - Hypoplastic left heart, Interrupted aortic arch
What defects are associated with Tetralogy of Fallot?
PS, VSD, overriding aorta, hypoplastic pulm. valve, RVH.
what is the second most common cardiac lesion presenting in the first week of life and the most common cause of death from congenital heart disease in the first month of life?
Hypoplastic Left Heart.
Which types of ASD close spontaneously?
Small secundum
What is the most common congenital heart lesion?
VSD 25%
Describe 1st degree block, what its associated with.
Results from slowing of AV conduction at the level of the AV node. It is associated with:
increased vagal tone, digoxin,
beta blocker administration, infectious etiologies
hypothermia
electrolyte(hypo/hyperkal, hypo/hypercal, hypomag)
congenital disease
rheumatic fever
cardiomyopathy
Describe the types of 2nd degree block. Also, list associations.
Mobitz I - progressive prolongation of PR until a dropped beat.
Mobitz II - abrupt failure of AV conduction below the AV node.