Typically, do patients suffering from asthma have a history of a low-grade fever?
No, unless trigger is an infection.
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 cause of sudden infant death syndrome (SIDS)?
An unknown disease process with no identifiable cause of death.
How can seizures result in death of a pediatric patient?
The principle cause is loss of airway resulting in hypoxia.
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 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.
"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.
Typical signs and symptoms of a patient suffering from epiglottitis:
Inspiratory stridor, pain on swallowing, high fever, and drooling.
Management of a child with moderate croup would include oxygen and:
nebulized saline and nebulized racemic or levo-epinephrine
A patient you would perform a surgical cricothyrotomy:
A 14 year old with an obstructed airway who does not respond to abdominal thrusts.
Likely findings in a pediatric patient with early septic shock?
Tachycardia with bounding pulses; warm, flushed skin; slow capillary refill; and irritability.