Peds Er

Front 1

First Impression Inital Pediatric Assessment consists of?

Back 1

Appearance
Breathing
Circulation

Front 2

Appearance assessment consists of?

Back 2

Appearance (TICLS)
T= Tone (Muscle tone)
I= Interactivity/ Mental Status
C= Consolability
L= Look or gaze
S= Speech or cry

Front 3

Breathing assessment consists of?

Back 3

Work of Breathing
Body position
Visible movement (chest/ abdomen)
Respiratory Rate
Respiratory Effort
Audible airway sounds

Front 4

Circulation assessment consists of?

Back 4

Skin Color

Front 5

Why is assessment of appearance of the pediatric pt important?

Back 5

Appearance reflects the adequacy of oxygenation, ventilation, brain perfusion, homeostasis and central nervous system function.

Front 6

Why is assessment of breathing of the pediatric pt important?

Back 6

Breathing reflects the adequacy of airway, oxygenation and ventilation.

Front 7

Why is assessment of appearance of the pediatric pt important?

Back 7

Circulation reflects adequacy of cardiac and perfusion of vital organs

Front 8

Why is assessment of appearance of the pediatric pt important?

Back 8

Appearance reflects the adequacy of oxygenation, ventilation, brain perfusion, homeostasis and central nervous system function.

Front 9

Why is assessment of breathing of the pediatric pt important?

Back 9

Breathing reflects the adequacy of airway, oxygenation and ventilation.

Front 10

Why is assessment of appearance of the pediatric pt important?

Back 10

Circulation reflects adequacy of cardiac and perfusion of vital organs

Front 11

SBP norm for child 1-10 yrs?

Back 11

>70= (2 x age in yrs)

Front 12

When should the SBP be over 90 mm Hg?

Back 12

child over 10 yrs old

Front 13

If pt is acutely ill, what should be checked/ monitored/ tx'ed?

Back 13

Glucose
Electrolytes
Temperature
CO2

Front 14

Treatment for hypoxemia?

Back 14

give O2

Front 15

Treatment for hypovolemia?

Back 15

replace volume

Front 16

Treatment for hypothermia?

Back 16

use simple warming techniques

Front 17

Treatment for hyper/ hypokalemia?

Back 17

correct metabolic electrolyte and acid base disturbances

Front 18

Treatment for tamponade?

Back 18

pericardiocentesis

Front 19

Treatment for tension pneumothorax?

Back 19

needle decompression

Front 20

Treatment for toxins/ poisions/ drugs?

Back 20

antidote/ specific therapy

Front 21

Treatment for thromboembolism?

Back 21

anticoagulation

Front 22

Ventilation rate for an infant?

Back 22

Under 1 y
1 breath q 3 to 5 sec (10 - 20 bpm)

Front 23

Ventilation rate for an adult?

Back 23

more than 12 - 14 y
1 sec (10 to 12 breaths/ min)

Front 24

Ventilation rate for a child?

Back 24

1 to 12-14 y
1 breath q 3 to 5 sec (10 - 20 bpm)

Front 25

Where do you assess the pulse for an
1. Infant
2. Child
3. Adult

Back 25

1. Infant- Brachial / femoral
2. Child-Carotid
3. Adult- Carotid

Front 26

For an infant, you compress with?

Back 26

2 fingers (one rescuer) or 2 thumbs encircling chest (2 rescuers)

Front 27

For a child, you compress with?

Back 27

heel of 1 hand, heels of 2 hands (adult technique acceptable)

Front 28

For an adult, you compress with?

Back 28

heels of 2 hands

Front 29

Compression depth for a child?

Back 29

1/3 -1/2 depth of chest
(1-1 1/2 inches)

Front 30

Compression depth for an infant?

Back 30

1/3 -1/2 depth of chest
(1-1 1/2 inches)

Front 31

Compression depth for an adult?

Back 31

1 1/2 to 2 inches

Front 32

Compression to ventilation ratio for adult?

Back 32

1 or 2 rescuer =30:2

Front 33

Compression to ventilation ratio for infant?

Back 33

1 rescuer =30:2
2 rescuer = 15:2

Front 34

Compression to ventilatio ratio for child?

Back 34

1 rescuer =30:2
2 rescuer = 15:2

Front 35

For pediatric shock, what do you do?

Back 35

Perform an initial assessment
ABCDE

Front 36

After ABCDE what do you do?

Back 36

1. Give a bolus of 20 ml/kg of isotonic crystalloid soln (NS or LR) IV/IO rapidly (<20 min) to maintain circulating blood vol.
2 Check glucose. Treat if <60 mg/dl
3 Maintain normal body temp
4 Correct elec and acid base disturbances

Front 37

After bolus, glucose check, norm body temp and elec. and acid base disturb check, what do you do?

Back 37

Assess response
1. Mental Status
2. Capillary Refill
3. HR
4. Resp effort
5. BP

Front 38

If response is inadequate, check for the type of shock ?

Back 38

1 hypovolemic,
2 cardiogenic,
3 distributive or
4 obstructive shock

Front 39

Types of hypovolemic shock?

Back 39

1 Hypovolemic/ Nontraumatic Shock
2 Hemorrhagic shock

Front 40

Types of Distributive shock?

Back 40

1 Anaphylaxis
2 Septic
3 Neurogenic

Front 41

What do you do for Hypovolemic Shock?

Back 41

Administer 1 or 2 additional fluid boluses as indicated. Reassess. Consider vasopressors if poor perfusion persists despite adequate ventilation, oxygenationa and volume expansion.

Front 42

What do you do for Hemorrhagic Shock?

Back 42

Administer 1 to 2 additional fluid boluses as indicated and reassess; administer packed RBC if avail at 10 ml/kg. Type and cross emergently if the child has severe trauma and life threatening blood loss. Consider giving O neg blood w/o crossmatch. Order a consult w/ Trauma Service as soon as possible.

Front 43

What do you do for Cardiogenic Shock?

Back 43

1 Consider giving a small IV/IO fluid bolus of isotonic crystalloid sol'n (5 to 10 ml/kg of LR or NS).
2 Repeat the primary survey after each fluid bolus. The fluid bolus may be repeated based on the child's response. If the child fails to imprve, consider giving an inotrope (ex dopamine, dobutamine, or epinephrine) to improve myocardial contractility and increase cardiac output.
3 Treat dysrhythmias if present and contributing to shock. Consult cardiologist for additional orders.

Front 44

How do you treat anaphylaxis?

Back 44

Remove/ discontiue the causative agent.
Give epinephrine 0.01 mg/kg (0.01ml,kg) 1:1000 soln IM
Give 1 or 2 additional fluid boluses as indicated. Reassess. Consider inhaled bronchodialator (albuterol), diphenhydramine 1.0 mg/kg IM or IV, methyprednisolone 1-2 mg/kg IV
Give epinepherine IV infusion for signs of decompensated shock

Front 45

What do you do for Septic Shock?

Back 45

Administer 1 or 2 additional fluid boluses as indicated. Reassess
Administer a vasopressor by IV infusion for signs of decompensated shock
Give IV antibiotics

Front 46

What do you do for Obstructive Shock?

Back 46

Tension pneumothorax
1Perform needle decompression followed by chest tube insertion. Reassess.
Cardiac tamponade
1 Administer 1 o2 additional fluid boluses as indicated. Reassess.
2 Pericardiocentesis is the definitive treatment for cardiac tamponade.