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Birth to 28 days
Define an infant
28 days to 1 Y/O
1 Y/O - 10 Y/O
Which do you suction first mouth or nose?
Mouth then nose (alphabetical)
Is Meconium dangerous?
No it is sterile but it signifies stress
Is deep suction (below vocal chords) used after delivery?
No. Unless neonate is not vigorous and meconium is present.
What affect does meconium have on surfactant?
Surfactant is inactivated by meconium.
What does an isolette (incubator) do?
- Maintains heat
- Provides supplemental O2
- Protects from environment
What are indications that an isolette is needed?
- < 5 Lbs
- Distressed neonate
What are the top 3 killers of neonates in the first 24 hours?
- Respiratory Complications
- Cardiac Problems
Rupture of Membrane =
Prepare for delivery
What are sign and symptoms of infant seizures?
- Lip smacking
- Tongue thrusting
- Eyes fluttering
- Lowered O2 Sats
Subtle Seizures are also known as what?
Complex Partial Seizures
What are common causes of subtle seizures?
- Opiod withdrawal
If you see Choanal Atresia what should I think?
How long are infants obligate nasal breathers?
What is another term for Respiratory Distress Syndrome (RDS)?
Hyaline Membrane Disease (HMD)
What is the #1 killer of premature infants born < 38 weeks?
Respiratory Distress Syndrome (RDS)
When transporting preterm infants what should you consider using?
Surfactant (given via ETT)
Persistent Pulmonary Hypertension of the Newborn (PPHN) will likely have what?
- Patent foramen ovale
- patent ductus arteriosus
What is Omphalocele? How is it treated?
- "O" Abdominal ring, protrusion viscera (missing abdominal wall)
- Attached to the umbilical chord
- Treatment: (Like abdominal evisceration)
- Maintain body temperature
- Cover with moist, sterile dressing
- Keep NPO
- Requires surgical repair
What is Gastroschesis? What is the treatment?
- Abdominal contents are coming out of the body on one side of the umbilical cord.
- Treatment: (Like abdominal evisceration)Maintain body temperatureCover with moist, sterile dressingKeep NPORequires surgical repair
What is used for increased CSF in congenital hydrocephalus?
What treatment for a build up of ICP for congenital hydrocephalus?
- Raise head of bed 30 degrees (semi-fowlers)
What is a tell tale sign of Shaken Baby Syndrome?
In a newborn with a HR ≤ 60 and D-stick ≤ 60:
- Administer Epi 1st (1:10000) 0.1 - 0.3 ml/kg by IV or ETT
- Administer Glucose next 2cc/kg D10
Cardiomegaly + Hepatomegaly =
- Stop all IV fluids
- Administer Digitalis
What is the most common cardiac defect in children?
- Ventricle Septal Defect (VSD)
- A hole between the ventricles
PGE1 (prostaglandin E1) keeps what open? What can it cause?
- Patent Ductus Arteriosis (PDA)
How are patent Ductus arteriosis found?
- Physical exam
- Checking for femoral pulses
What is a "tet spell"?
How are they characterized?
- Tetralogy of Fallot
- Sudden cyanosis and syncope
How do we treat a "tet spell"?
- Knees to chest
- If unsuccessful:
- 100% O2
How many veins and arteries does and umbilical cord normally have? what is it caused when it is different?
- 2 arteries, 1 vein
- 1 artery, 1 vein is called "single artery cord" (Renal system is likely affected)
What is the ETT Diameter formula?
What is the 2/3/4/ rule?
- 2 X ETT Size = Suction/NG Foley diameter
- 3 X ETT Size = ETT Insertion depth
- 4 X ETT Size = Chest Tube Size
When do you use an uncuffed vs cuffed ETT?
- ≥ 5.5 Cuffed ETT
- < 5.5 Uncuffed
At what age would you consider a cricothyroidotomy?
What is the Normal Systolic B/P formula?
90 + (2 X Age)
What is the hypotensive Systolic B/P formula?
70 + (2 X Age)
What is the Pediatric Fluid Resuscitation Formula?
- Neonate/Infant 10cc/kg
- Child 20cc/kg
- *Never give more than 2 bolus infusions
What is the Pediatric Maintenance Fluid Formula? (4, 2, 1)
1 - 10 → 4cc/kg/hr
10 - 20 → 2cc/kg/hr
> 20 → 1cc/kg/hr
What is the Pediatric Glucose Management formula?
- Neonate 2cc/kg D10
- Infant 2cc/kg D25
- Child 2cc/kg D50
When do we think about giving glucose?
D-stick < 60mg/dL
Stridor is a/an ___________ problem and involves the __________ airway.
Wheezing is a/an ____________ problem and involves the _____________ airway.
What is Bronchiolitis?
What is it often caused by?
- Swelling of the bronchiole walls
- Respiratory Syncytial Virus (RSV)
Is RSV contagious?
- Isolation is required
- Watch for apnea!
Is Croup life threatening?
What is Croup?
What are the S&S?
How is it treated?
- Swelling around the vocal chords
- Gradual onset with URI, no drooling, Seal like bark
- Steeple Sign on x-ray (the crow lives in the steeple) Crow = Croup
- Racemic Epinephrine and steroids (Decadron)
What is Epiglottitis?
What are the S&S?
How is it treated?
- Swelling of the epiglottis
- Sudden onset, Drooling, "Tripod position"
- Thumb sign on x-ray
- DO NOT DISTURB CHILD!
- Antibiotics, humidified o2
When falling what part of the body does the child hit first?
What is the most common cause of traumatic death in pediatrics?
What is the most commonly injured organ?
At what point of blood lose do children show signs of compensation?
How do they compensate?
- >25% blood loss
With an altered LOC pediatric of unknown cause what is the treatment?
- Flumazenil (top choice)
What is a child's primary emotion?