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What does ALTE stand for?
apparent life threatening event
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What does CSHCN stand for?
children with special health care needs
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What does DUMBELS stand for?
- Diarrhea/Diaphoresis
- Urination
- Miosis
- Bradycardia/Bronchoconstriction
- Emesis
- Lacrimation
- Salivation/Swelling
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What does LANE stand for?
- Lidocaine
- Atropine
- Narcan
- Epinephrine
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What does PHAILS stand for?
- Pesticides
- Hydrocarbons
- Acid/Alkali/Alcohol
- Iron
- Lithium
- Solvents
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What does RSV stand for?
- Respiratory Syncytial Virus
- virus that usually causes bronchiolitis
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What does TICLS stand for?
- Tone
- Interactivity
- Consolability
- Look (gaze)
- Speech (cry)
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What is the Wong Baker faces scale?
Pediatric pain scale
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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
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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
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What is respiratory distress?
abnormal physiologic condition identified by increased work of breathing
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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
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What is respiratory arrest?
absence of effective breathing
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What is a unique sign/symptom of bacterial tracheitis?
A cough with pus
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What is a unique sign/symptom of croup?
Barking cough
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What are some unique signs/symptoms of epiglottitis?
- Drooling and dysphagia
- Sudden onset
- Muffled voice
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What disease is RSV often associated with?
Bronchiolitis
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What is Bronchopulmonary Dysplasia?
Chronic lung disease associated with premature birth
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How do we treat exascerbated BPD?
- PPV
- High flow O2
- Consider nebulized epinephrine
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What is the VS that differentiates between compensated and decompensated shock in children?
BP
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What percentage of TBW fluid loss compromises cardiac output and perfusion in a child?
>5% TBW
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What percentage of TBW fluid loss compromises cardiac output and perfusion in an adolescent?
5-7%
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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
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What does cardiomyopathy usually result from?
- Congenital abnormalities that affect both ventricles
- Viral infection
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What are the symptoms of cardiomyopathy?
- Fatigue
- Chest pain
- Dysrhythmias
- SXS of heart failure and cardiogenic shock
- (Crackles, JVD, Hypotension, Peripheral Edema)
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How do we manage cardiomyopathy?
- ABCs
- If decompensated, IV with antidysrhythmics, diuretics, or vasopressors
- Avoid fluid resuscitation to avoid volume overload
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What are the four major causes of pediatric dysrhythmias?
- Hypoxia
- Acidosis
- Hypotension
- Structural heart disease
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What is the first cause you should think of when observing bradycardia in a child?
Hypoxia
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What are some causes of bradycardia besides hypoxia?
- Hypoxemia
- Acidosis
- Hypotension
- Hypoglycemia
- CNS injury
- Excess vagal stimulation
- Toxic ingestion
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What is the most common nonarrest rhythm in kids?
SVT
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What is the heart rate that can distinguish SVT from sinus tach in infants?
210 bpm
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What is the heart rate that can distinguish SVT from sinus tach in kids?
180 bpm
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What are some causes of VTach with a pulse in kids?
- Congenital heart disease
- Cardiomyopathies
- Myocarditis
- Reversible causes
- Metabolic causes
- Hypothermia
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What does "DOPE" stand for?
- Dislodged
- Obstruction
- Pneumothorax
- Equipment
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What is the normal tidal volume in a pediatric patient?
8cc/kg
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What are some signs of impending cerebral herniation?
- Unequal or dilated unresponsive pupils
- Hypertension
- Bradycardia
- Respiratory irregularities or apnea
- Reduced response to stimulation
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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
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Under what age is a positive Babinski's reflex considered normal?
6 months
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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
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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
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How is epilepsy defined?
Seizure disorder involving >2 afebrile seizures
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What is considered hypoglycemia in infants and children?
<60
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What is considered hypoglycemia in newborns?
<40
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What is the level at which we consider a fever dangerous and may cause brain damage?
105 degrees
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How do we manage hyperglycemia in a child?
- ABCs
- IV fluid therapy if signs of dehydration are present
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What is a common complication of alcohol ingestion in young children?
Hypoglycemia
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What are the "One-Pill Killers"?
- Camphor
- Chloroquine
- Clonidine
- Glyburide
- Imipramine (Tricyclics)
- LIndane
- Disphenoxylate/atropine
- Propranolol
- Theophylline
- Verapamil
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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
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What are some known risk factors for SIDS?
- Maternal smoking or drugs
- Mother <20 y/o
- No prenatal care
- Social deprivation
- Premature births
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What are the hours during which SIDS usually occurs?
Midnight to 6 am
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Most SIDS deaths occur within what age group?
- Most (85%) under 6 months
- Typical age range is up to 1 year
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What complications can be seen with tracheostomy tubes?
- Obstruction
- Bleeding
- Air leakage
- Dislodgement
- Infection
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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
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What is a VAD?
- Vascular access device
- Seen in patients who need prolonged access to venous circulation for drug or fluid therapy
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What are some complications of VADs?
- Cracked line
- Air embolism
- Bleeding
- Obstruction
- Local infection
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How do we manage local infection of a VAD?
- Sterile technique
- Remove old bandages
- Cleanse the sight
- Replace clean bandages
- Transport
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How do we manage hemorrhage at the site of a VAD?
- Gentle, direct pressure with aseptic technique
- Transport
- Fluid replacement if hypovolemic
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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
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How do we manage obstruction of a VAD?
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