pedsflashcards.txt

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hollynighthawk
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71187
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pedsflashcards.txt
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2011-03-06 22:51:14
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Pediatrics
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EMS Peds Flash Cards
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  1. What does ALTE stand for?
    apparent life threatening event
  2. What does CSHCN stand for?
    children with special health care needs
  3. What does DUMBELS stand for?
    • Diarrhea/Diaphoresis
    • Urination
    • Miosis
    • Bradycardia/Bronchoconstriction
    • Emesis
    • Lacrimation
    • Salivation/Swelling
  4. What does LANE stand for?
    • Lidocaine
    • Atropine
    • Narcan
    • Epinephrine
  5. What does PHAILS stand for?
    • Pesticides
    • Hydrocarbons
    • Acid/Alkali/Alcohol
    • Iron
    • Lithium
    • Solvents
  6. What does RSV stand for?
    • Respiratory Syncytial Virus
    • virus that usually causes bronchiolitis
  7. What does TICLS stand for?
    • Tone
    • Interactivity
    • Consolability
    • Look (gaze)
    • Speech (cry)
  8. What is the Wong Baker faces scale?
    Pediatric pain scale
  9. What is the STARR program?
    • developed by the NHTSA
    • See the problems with safety
    • Talk to the family
    • Assess adverse home environment
    • Remedy situation
    • Review and monitor over time
  10. What is the EMSC program?
    • Emergency Medical Services for Children
    • national program designed to ensure that all children and adolescents, no matter where they live, attend school, or travel, receive appropriate care in a health emergency
  11. What is respiratory distress?
    abnormal physiologic condition identified by increased work of breathing
  12. What is respiratory failure?
    • the infant or child exhausts energy reserves or can no longer maintain oxygenation and ventilation
    • may occur when chest wall muscles get tired or when there is a failure of central respiratory drive from injury or toxicity
    • identified by abnormal appearance or cyanosis in a child with an increased work of breathing
    • also identified by an abnormally low respiratory rate and decreased respiratory effort usually with bradycardia
  13. What is respiratory arrest?
    absence of effective breathing
  14. What is a unique sign/symptom of bacterial tracheitis?
    A cough with pus
  15. What is a unique sign/symptom of croup?
    Barking cough
  16. What are some unique signs/symptoms of epiglottitis?
    • Drooling and dysphagia
    • Sudden onset
    • Muffled voice
  17. What disease is RSV often associated with?
    Bronchiolitis
  18. What is Bronchopulmonary Dysplasia?
    Chronic lung disease associated with premature birth
  19. How do we treat exascerbated BPD?
    • PPV
    • High flow O2
    • Consider nebulized epinephrine
  20. What is the VS that differentiates between compensated and decompensated shock in children?
    BP
  21. What percentage of TBW fluid loss compromises cardiac output and perfusion in a child?
    >5% TBW
  22. What percentage of TBW fluid loss compromises cardiac output and perfusion in an adolescent?
    5-7%
  23. What is cardiomyopathy?
    • Any disease of the heart muscle that causes a reduction in the force of heart contractions
    • Decreases the amount of blood circulated to the lungs and to the rest of the body
  24. What does cardiomyopathy usually result from?
    • Congenital abnormalities that affect both ventricles
    • Viral infection
  25. What are the symptoms of cardiomyopathy?
    • Fatigue
    • Chest pain
    • Dysrhythmias
    • SXS of heart failure and cardiogenic shock
    • (Crackles, JVD, Hypotension, Peripheral Edema)
  26. How do we manage cardiomyopathy?
    • ABCs
    • If decompensated, IV with antidysrhythmics, diuretics, or vasopressors
    • Avoid fluid resuscitation to avoid volume overload
  27. What are the four major causes of pediatric dysrhythmias?
    • Hypoxia
    • Acidosis
    • Hypotension
    • Structural heart disease
  28. What is the first cause you should think of when observing bradycardia in a child?
    Hypoxia
  29. What are some causes of bradycardia besides hypoxia?
    • Hypoxemia
    • Acidosis
    • Hypotension
    • Hypoglycemia
    • CNS injury
    • Excess vagal stimulation
    • Toxic ingestion
  30. What is the most common nonarrest rhythm in kids?
    SVT
  31. What is the heart rate that can distinguish SVT from sinus tach in infants?
    210 bpm
  32. What is the heart rate that can distinguish SVT from sinus tach in kids?
    180 bpm
  33. What are some causes of VTach with a pulse in kids?
    • Congenital heart disease
    • Cardiomyopathies
    • Myocarditis
    • Reversible causes
    • Metabolic causes
    • Hypothermia
  34. What does "DOPE" stand for?
    • Dislodged
    • Obstruction
    • Pneumothorax
    • Equipment
  35. What is the normal tidal volume in a pediatric patient?
    8cc/kg
  36. What are some signs of impending cerebral herniation?
    • Unequal or dilated unresponsive pupils
    • Hypertension
    • Bradycardia
    • Respiratory irregularities or apnea
    • Reduced response to stimulation
  37. What are some things we can consider doing if suspecting impending cerebral herniation?
    • Elevate head of bed to 30 degrees if BP is adequate
    • Keep head midline
    • Short periods of hyperventilation
  38. Under what age is a positive Babinski's reflex considered normal?
    6 months
  39. What is the Monroe-Kellie doctrine?
    • Basic principle that there is limited space in the cranium allocated to CSF/blood and brain matter
    • If the brain begins to swell, it forces CSF/blood out
    • If excessive CSF/blood is present, it forces the brain out
  40. What are some characteristics of febrile seizures?
    • No evidence of other causes
    • Usually between 6 mos and 5 years
    • Occur with rapid rise in fever
    • May be tonic-clonic or more subtle
    • Duration usually <5 mins
  41. How is epilepsy defined?
    Seizure disorder involving >2 afebrile seizures
  42. What is considered hypoglycemia in infants and children?
    <60
  43. What is considered hypoglycemia in newborns?
    <40
  44. What is the level at which we consider a fever dangerous and may cause brain damage?
    105 degrees
  45. How do we manage hyperglycemia in a child?
    • ABCs
    • IV fluid therapy if signs of dehydration are present
  46. What is a common complication of alcohol ingestion in young children?
    Hypoglycemia
  47. What are the "One-Pill Killers"?
    • Camphor
    • Chloroquine
    • Clonidine
    • Glyburide
    • Imipramine (Tricyclics)
    • LIndane
    • Disphenoxylate/atropine
    • Propranolol
    • Theophylline
    • Verapamil
  48. What is "QUEST" and what does it stand for?
    • Outlines the steps to take to evaluate pain in young children
    • Question
    • Use pain scale
    • Evaluate behavior and physiological signs
    • Seek parents' input
    • Take action and assess results
  49. What are some known risk factors for SIDS?
    • Maternal smoking or drugs
    • Mother <20 y/o
    • No prenatal care
    • Social deprivation
    • Premature births
  50. What are the hours during which SIDS usually occurs?
    Midnight to 6 am
  51. Most SIDS deaths occur within what age group?
    • Most (85%) under 6 months
    • Typical age range is up to 1 year
  52. What complications can be seen with tracheostomy tubes?
    • Obstruction
    • Bleeding
    • Air leakage
    • Dislodgement
    • Infection
  53. How do we manage a tracheostomy tube that has become blocked and cannot be cleared?
    • Replace with another tube
    • Suction first
    • Replace temporarily with ET tube if necessary
  54. What is a VAD?
    • Vascular access device
    • Seen in patients who need prolonged access to venous circulation for drug or fluid therapy
  55. What are some complications of VADs?
    • Cracked line
    • Air embolism
    • Bleeding
    • Obstruction
    • Local infection
  56. How do we manage local infection of a VAD?
    • Sterile technique
    • Remove old bandages
    • Cleanse the sight
    • Replace clean bandages
    • Transport
  57. How do we manage hemorrhage at the site of a VAD?
    • Gentle, direct pressure with aseptic technique
    • Transport
    • Fluid replacement if hypovolemic
  58. How do we manage a suspected air embolus from a VAD?
    • Stop the infusion
    • Left side head down position
    • High flow O2
    • MCEP
    • Rapid transport
  59. How do we manage obstruction of a VAD?
    • Irrigation
    • Anticoagulants
  60. What is the neonate/pediatric dose and concentration for epinephrine for cardiac use?
    • 0.01 mg/kg 1:10,000 IV/IO q 3-5 mins
    • 0.1 mg/kg 1:1000 ETT
  61. What is the NS bolus amount for a neonate?
    10 cc/kg
  62. What is the dose and concentration for dextrose for a neonate?
    D10 0.2g/kg SIVP
  63. What is the neonate/pediatric dose for Narcan?
    0.1 mg/kg SIVP
  64. What is the neonate/pediatric dose for sodium bicarbonate?
    1 mEq/kg SIVP
  65. What is the neonate/pediatric dose for IV valium?
    0.1 - 0.2 mg/kg SIVP
  66. What is the neonate/pediatric dose for dopamine?
    1 mcg/kg/min IVD
  67. What is the pediatric dose for rectal valium?
    0.5 mg/kg
  68. What is the pediatric dose for APAP?
    10-15 mg/kg PO
  69. What is the pediatric dose for activated charcoal?
    1 g/kg PO
  70. What is the pediatric dose for adenosine?
    • 0.1 mg/kg RIVP max 6 mg 1st dose
    • 0.2 mg/kg RIVP max 12 mg 2nd and 3rd doses
    • All followed by 5-10cc flush
  71. What is the pediatric dose of albuterol?
    • 2.5 mg via nebulizer max 5 mg
    • Must be on the monitor at 5 mg
  72. What is the pediatric dose for amiodarone in VTac with a pulse?
    5 mg/kg IV/IO over 20 minutes
  73. What is the pediatric dose for amiodarone in pulseless VTac/VFib?
    5 mg/kg IV/IO max 15 mg/kg IV/IO
  74. What is the minimum age of a child to give atropine for bradycardia?
    1 y/o preferably 2 y/o
  75. What is the dose of atropine for symptomatic bradycardia in a child?
    0.02 mg/kg IV/IO max 0.5 mg single dose max 1.0 mg total dose
  76. What is the dose of atropine for symptomatic bradycardia in an adolescent?
    0.02 mg/kg IV/IO max 1 mg single dose max 2.0 mg total dose
  77. What is the ETT dose for atropine in a pediatric?
    0.04 - 0.06 mg/kg
  78. What is the pediatric dose for atropoine in an organophosphate OD?
    0.05 mg/kg IV/IO
  79. What is the pediatric joule setting for synchronized cardioversion?
    1 J/k first dose, 2 J/k subsequent doses
  80. What is the pediatric joule setting for defibrillation?
    2 or 4 J/k first dose, 4 J/k subsequent doses
  81. What is the pediatric dose and concentration for dextrose?
    0.5 - 1 g/kg SIVP
  82. What is the pediatric dose for diphenhydramine?
    1-2 mg/kg
  83. What is the pediatric dose for fentanyl?
    1-2 mcg/kg SIVP
  84. What is the pediatric dose for glucagon?
    0.1 mg/kg IM max 1 mg
  85. What is the pediatric dose for a lidocaine bolus?
    1 mg/kg IV/IO
  86. What is the pediatric dose for a lidocaine drip?
    20-50 mcg/kg/min IVD
  87. What is the pediatric dose for lidocaine down the tube?
    2-3 mg/kg ETT
  88. What is the pediatric dose for magnesium sulfate?
    25-50 mg max 2 g SIVP
  89. What is the pediatric dose for morphine?
    0.1 mg/kg max 10 mg SIVP
  90. What is the NS bolus amount for a pediatric?
    20 cc/kg
  91. What is the Parkland Burn Formula?
    • 4cc X kgs X BSA = Total CC/ 24 hrs
    • Divide by 2 = First 8 hours
    • Divide by 8 = CC/hr
  92. Break down the BSA burn % approximations for an infant by body area and percentage.
    • Head = 18%
    • Trunk = 18%
    • Arms = 9% each
    • Legs = 13.5% each
    • Genetalia = 1%
  93. Break down the BSA burn % approximations for a child by body area and percentage.
    • Head = 12%
    • Trunk = 18%
    • Arms = 9% each
    • Legs = 16.5% each
    • Genetalia = 1%
  94. Break down the BSA burn % approximations for an adolescent by body area and percentage.
    • Head = 9%
    • Trunk = 18%
    • Arms = 9% each
    • Legs = 18% each
    • Genetalia = 1%
  95. What is the Moro reflex and when is it appropriate?
    • In infants
    • Make a loud noise near the infant, and the legs will flex, the arms will make an embracing gesture, and the infant will usually give a brief cry
  96. If the Moro and/or Babinski reflexes are found in an older child, what might it indicate?
    Spinal cord damage
  97. What is the formula for typical systolic BP in children 1-10 years?
    90 + age x2 = mmHg
  98. What is the lower range of normal systolic BP in children over 10 years?
    90 mmHg
  99. What is the formula for the lower limit of systolic BP in children 1-10 years?
    70 + age x2 = mmHg
  100. What is cystic fibrosis?
    • AKA mucoviscidosis
    • Inherited metabolic disease of the lungs and digestive system
    • Manifests in childhood
    • Causes the glands in the lining of the bronchi to produce excess thick mucus
    • Predisposes the patient to chronic lung infections
    • Pancreas also fails to produce enzymes required for breakdown of fats and absorb them
  101. What are the SXS of cystic fibrosis?
    • Persistent cough and breathlessness
    • Pneumonia, bronchiectasis, bronchitis
    • Stunted growth
    • Abnormally salty sweat
    • Pale, greasy-looking, fowl-smelling stool
  102. What is cerebral palsy?
    • Nonprogressive disorders of movement and posture
    • Results from damage to the fetal brain
    • Most common cause is cerebral dysgenesis
    • No cure exists
    • Widely varying range of functionality and disability
  103. What is muscular dystrophy?
    • Inherited muscle disorder that results in slow but progressive deterioration of muscle fibers
    • Incurable
    • Respiratory failure/congestive heart failure are our main concerns
  104. What is spina bifida?
    • Congenital defect which leaves a portion of the spinal cord exposed
    • Wide range in severity
  105. What is Trisomy 21?
    • AKA Down's syndrome
    • Three of the 21st chromosome instead of a pair
    • Mental disability, heart defects, hearing defects, and other illnesses are very common with it
  106. What is Trisomy 18?
    • AKA Edward's syndrome
    • Three of the 18th chromosome instead of a pair
    • Congenital heart disease
    • Airway issues/GI issues
  107. What is the AHA Chain of Survival for Pediatric Cardiac Arrest?
    • Prevention
    • Early CPR
    • Early Access to the Emergency Response System
    • Rapid PALS
    • Integrated Post-Arrest Care
  108. What are the major types of acyanotic congenital heart defects?
    • PDA
    • ASD
    • VSD
    • Aortic stenosis
    • Pulmonary stenosis
    • Coarctation of aorta
    • AV canal defect
  109. What are the major types of cyanotic congenital heart defects?
    • Tetralogy of Fallot
    • Tricuspid atresia
    • Pulmonary atresia
    • TAPVR
    • Truncus arteriosis
    • Hypoplastic left heart syndrome
    • Transposition of the great vessels (D and L types)
  110. What type of medication is commonly prescribed to help close a PDA?
    NSAIDs
  111. What type of medication is commonly prescribed to help keep a PDA open?
    Prostaglandin therapy
  112. What defect do the Fontan and Hemi-Fontan procedures treat?
    Single ventricle defects
  113. What has been discussed as a possible cause for SIDS in new research?
    Low serotonin levels in the brain
  114. What are some risk factors associated with SIDS?
    • Maternal smoking/smoking in house = 3x more likely
    • Narcotic use during pregnancy = 10x more likely
    • Sleep position
    • Temperature
    • Apnea hypothesis
    • Asphyxiation
    • Immune system disorders

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