Chapter 37- Pediatrics

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55 terms · Chapter 37- Pediatrics

Typically, do patients suffering from asthma have a history of allergies?

Yes.

Typically, do patients suffering from bronchiolitis have a history of allergies?

No.

Typically, do patients suffering from asthma have a history of a low-grade fever?

No, unless trigger is an infection.

Typically, do patients suffering from bronchiolitis have a history of a low-grade fever?

Yes.

Etiology of croup?

Viral

Etiology of epiglottitis?

Bacterial

Croup typically affects this age group.

6 months to 6 years old

Epiglottitis typically affects this age group.

3 to 7 years old

Speed of onset of croup.

Gradual, typically several days.

Speed of onset of epiglottits.

Rapid, typically hours.

Pain level of patient suffering from croup?

None or very mild.

Pain level of patient suffering from epiglottitis?

Severe, cannot swallow.

Does a patient suffering from croup present with drooling?

No.

Does a patient suffering from epiglottitis present with drooling?

Yes.

Does a patient suffering from croup present with a fever?

Typically low-grade.

Does a patient suffering from epiglottitis present with a fever?

Typically high-grade.

What are the most common causes of shock in pediatric patients?

Hypovplemic and sepsis.

What is a fontanelle?

The soft spots in the infants skull that allow for rapid growth of the brain during the first year of life.

What change occurs in the fontanelles of a dehydrated infant?

They become sunken below the surrounding skull.

What is status asthmaticus?

A severe asthma attack that will not respond to treatment with beta2-adrenergic agonists.

What is a treatment plan for status asthmaticus is the pediatric patient?

Managed with oxygen, continued administration of nebulized beta2-adrenergic agonists, assisted ventilations, correction of dehydration and acidosis, possible subcutaneous administration of beta2-adrenergic agonists, and possible endotracheal intubation. Medical direction may include aminophylline, magnesium sulfate, and terbutaline by continous infusion.

Why should skin turgor be checked on any pediatric patient who is experiencing an asthma attack?

Patients will have increased respiratory water loss and decreased fluid intake. Dehydration will worsen the attack by thickening mucus in lower airways, causing plug formation.

Why is it important to determine the medications taken by an asthmatic patient before beginning any therapy?

Patients may have abused their MDIs and may be suffering from an overdose of beta2 agonists. Some patients who overuse their MDIs develop a resistance to the effects of their usual bronchodilator. Trying a different agent may be useful.

Why should oxygen be humidified when administering to a pediatric patient experiencing an asthma attack?

It will reduce the chance of mucus drying up in the lower airways and causing a plug formation.

What is the prehospital treatment for croup?

Humidified oxygen and nebulized racemic epinephrine.

What is the principle danger facing a patient with epiglottitis?

Complete airway obstruction.

What is the cause of sudden infant death syndrome (SIDS)?

An unknown disease process with no identifiable cause of death.

What are the most common causes of cardiac arrest in children?

respiratory failure

How can seizures result in death of a pediatric patient?

The principle cause is loss of airway resulting in hypoxia.

What is status epilepticus?

A patient has two or more seizures without regaining consciousness.

What class of medications are used for managing status epilepticus in the prehospital setting?

Benzodiazepines. Diazepam (Valium) or lorazepam (Ativan) are the drugs most commonly used.

How is hypovolemic shock corrected in pediatric patients?

It is treated using boluses of IV fluid.

How would you determine the appropriate size endotrachial tube to use when intubating a pediatric patient?

(Age of the child + 4) / 4. If the age is unknown, use the an endotracheal tube closest in size to the child's little finger.

What are your considerations when deciding to use a cuffed or uncuffed endotracheal tube in patients younger than 8 years old?

When an endotrachela tube of proper size is inserted, the cricoid cartilage (narrowest point of the airway in children under 8) forms a functional cuff, sealing the airway, making a cuff unnecessary. Placing a cuff on a pediatric endotracheal tube would decrease the lumen of the tube to a point where it would be difficult to adequately ventilate.

What is the suggested initial setting for defibrillation of pediatric patients? What energy is used on subsequent shocks?

2 J/kg then 4J/kg

What is the minimum dose of atropine for pediatric patients? Why?

0.02 mg/kg. The minimum dose must be 0.1 mg. Anything less will result in slowing of the heart rate (paradoxical bradycardia).

What routes are available for drug administration to children during cardiopulmonary arrest?

IV, IO and endotracheal tube.

What drug is always used first in the management of symptomatic bradycardia in pediatric patients?

Oxygen. Second line drug is epinephrine.

What is the IV dose of epinephrine in pediatric cardiac arrest?

0.01 mg/kg (0.1 mL/kg) of the 1:10,000 solution.

Why are children and infants suffering from burn injuries more likely to have more significant fluid loss than adults?

The body surface area is larger in proportion to the body volume.

In which age group does the majority of SIDS deaths occur?

Birth to 6 months.

"Jitteriness" and trembling in a pediatric patient with hypoglycemia are caused by the body's activation of the:

sympathetic nervous system, resulting in the liver releasing additional glucose.

You are dispatched to an elementary school for a 5-year-old, 42-lb male with a history of diabetes. He is confused, diaphoretic, and tachycardic. When you attempt to get a BGL, the glucometer malfunctions. The next appropriate therapy following management of ABCs and IV access is:

Give D50W at a dose of 2 mL/kg.

What is cardiac output most dependent upon in pediatric patients?

heart rate

The first-line medication for all pediatric resuscitations?

oxygen

Typical signs and symptoms of a patient suffering from epiglottitis:

Inspiratory stridor, pain on swallowing, high fever, and drooling.

Common nontraumatic causes of shock in the pediatric patient include:

sepsis and hypovolemia

Late signs of shock in the pediatric patient include:

hypotension and bradycardia

Which dysrhythmia is a normal compensatory response in pediatric patients?

sinus tachycardia

Management of a child with moderate croup would include oxygen and:

nebulized saline and nebulized racemic or levo-epinephrine

What would be a likely initial skin color finding in a child with compensated shock?

pallor

A patient you would perform a surgical cricothyrotomy:

A 14 year old with an obstructed airway who does not respond to abdominal thrusts.

In which age group is fever the most common cause of seizures?

3 months to 5 years old

Likely findings in a pediatric patient with early septic shock?

Tachycardia with bounding pulses; warm, flushed skin; slow capillary refill; and irritability.

Observations of a child from across the room before initial contact should include:

muscle tone, interaction, skin color, respiratory effort and rate

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