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EM: Critical Infant and Metabolic Emergencies
Terms in this set (37)
What age is a neonate?
Less than 28 days old
Clinical features of the critical infant
"What's wrong with my baby!?!"
Depressed or altered mentation
Decreased PO intake
Increased work of breathing
Poor muscle tone and or suck reflex
Decreased pulses and prolonged cap refill
Considered Fever at what temp?
>38 or 100.4
Hypothermia caused by what bacteria?
Usually Gram Negative infections, poorer prognosis than fever
Normal infant sleep
16.2 hours per day
which signs and responses are normal in infants?
multiple periods of crying per day, no social smile, clonus and babinski positive, myoclonic jerks, startle response
Baby's should regain their birth weight by what time frame?
abnormal infant behaviors in infants
sleeping through multiple feedings, Bilous vomiting, sweating or choking with feeds, abdominal distension
infant respiratory rate
30-60 breaths per minute, periodic breathing, pulse ox should be normal by 24 hours
Normal infant heart rate
acrocyanosis normal for first few days, as well as heart murmur (as PDA is closing)
signs of abnormal infant heart funcrtion
central cyanosis, cap refill > 3 sec, hepatosplenomegaly, sustained tachycardia, pulmonary congestion
Cardiac output formula
CO = HR X SV (stroke volume)
**Children dont raise stroke volume like adults, so their HR is what increases cardiac output
In infants, tachycardia is an early indicator of what?
Hypotension in infants
**Late sign of shock! Catch up!
Term neonates (0-28 days) <60 mm Hg
Infants (1 month to 12 months) <70mm Hg
Children (1 yr - 10 yr) <70 + (2 x age in years) mm Hg
Children and adults (10 yr and older) <90 mm Hg
Early or compensated
Warm and flush extremities
Normal systolic BP
Depressed mental state
Decreased urine output
Weak central pulses
Can be woken up, but immediately goes back to sleep
GSC cutoffs for action
less than 12 moderate brain injury
Less than 8 intubate
First thing to think of in critical infants
Sepsis, Sepsis, Sepsis
Correct position for airway for child
Slight extension (not like adult)
What type of blade do you need to use on children when intubating
miller straight blade. They have a floppy epiglottis
Length-based color coded system
Provides quick estimated weight to use in resuscitation
Provides medication dosages, equipment sizes, defibrillation settings
Used in conjunction with Broslow cart or bag
Mnemonic for sudden deterioration with intubated patient
D - Displacement of tube
O - Obstruction of tube
P - Pneumothorax - over aggressive baggers
E - Equipment failure
IO on infants
1-2 attempts for the peripheral IV, then you go to the IO
Medial aspect of the tibial tuberosity
Bolus for infants during recessitation
20ml/kg - consider inotropes if no improvement after multiple bolus
Declaration of Death in infants
No cardiac function on EKG or US or obvious signs
Different from brain death
No set time frame to run code
Cardiac arrest in the field generally not a good outcome
Consider DNR/DNI for chronic kids
Contact organ donation team
Contact Medical Examiner
Risk Factors for Acute life threatening event
Prematurity (<37 weeks gestation)
Age (<30 days)
Suspicion for non-accidental trauma, seizures
Osmolality that causes mental status change
Most Common causes of Glucose Emergencies
INFARCTION - acute coronary syndrome/AMI, TIA or stroke
IUP - pregnancy
INFECTION - recent or current infection i.e.: pneumonia, UTI, gastroenteritis, pancreatitis, GI bleed, sepsis, hidden appendicitis, cholecystitis
INJURY - head trauma, multisystem trauma
INDISCRETION - non-compliance: consider psychosocial and psychological reasons
INTOXICATION - ETOH or drug abuse, medications (corticosteroids, thiazides), toxic ingestion (salicylates, methanol, barbiturates)
Mainstay treatement of DKA is?
Fluids! Severely Dehydrated (5-9 Liters behind)
DKA is NOT excluded by what test?
A negative Acetone
What electrolyte imbalance in DKA?
SERUM POTASSIUM. Take before insulin, then treat. May go from hyper to hypokalemia in the serum. If it is low or just normal before insulin give 40mEq
In DKA, add 1.6 to the NA+ for every 100 above normal sugar ***NEVER correct a sodium deficit rapidly. The increasing osmolality may precipitate cerebral edema, especially in children
Glucose usuall above what in HHS
mental status in HHS
Gradual change, as opposed to rapid in DKA
Always check a blood sugar finger stick on who?
a mentally altered patient
hallmark of pheocromocytoma
THIS SET IS OFTEN IN FOLDERS WITH...
Head and Neck Trauma
Emergency Medicine: Dermatology
Trauma: Vertebrae and Spinal Cord
Emergency Medicine: Derm and Tox
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