ch. 01 emergency management
Terms
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- pediatric cardiorespiratory arrest: top 3 causes
-
1.respiratory (45%)
2.cardiac (25%)
3.CNS (20%) - airway management goals
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1.relieve obstruction
2.prevent aspiration
3.promote adequate gas exchange - blind finger sweep: bad choice b/c...
- foreign body may be further forced down oropharynx
- T/F: hyperextension of neck may result in airway obstruction
- true
- Breathing: how to check
- 1.chest wall movement
- uncuffed tube: used for what age group? why?
-
age < 8 yrs
reduce risk of subglottic edema & stenosis - narrowest part of airway in children age < 8
- cricoid ring (provides seal for uncuffed tube)
- endotracheal tube size
- 4 * (age/4)
- T/F: neonates require premedication for intubation
- false (done w/o premeds)
- infant intubation rapid-sequence
-
1.preO2 w/100% O2
2.vagolytic drug (atropine)
3.sedative/hypnotic
4.cricoid pressure
5.vecuronium - succinylcholine: what do you give before this med?
- defasciculating med (vecuronium)
- Circulation: assess by...
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1.pulses
2.cap refill
3.BP - most sensitive measure of intravascular volume status in children
- heart rate
- most sensitive measure of adequate circulation
- capillary refill
- if no pulse, then start...
- chest compressions
- secondary survey: includes...
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1.head-to-toe exam
2.Glasgow coma scale - why do children cool/lose heat quickly?
- high surface-to-body mass ratio
- 3 stages of shock
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1.compensated
2.uncompensated
3.irreversible - compensated stage of shock
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essential organ perfusion
nl BP, urine output, cardiac fxn - uncompensated stage of shock
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ischemia
endothelial injury
increase in toxic materials - most common type of shock in children
- hypovolemic shock
- distributive shock: increased / decreased resistance
- decreased resistance
-
compensated septic shock: warm / cold?
uncompensated septic shock: warm / cold? -
warm = compensated
cold = uncompensated - septic shock: must give what meds?
- abx = resuscitation med
- basic CPR: x breaths/min
- 20 breaths/min
- basic CPR: compression location for infant vs. older child
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infant: lower 1/3 sternum
older child: 1 finger below intermammary line on sternum - basic CPR (infant): compression depth, rate, method
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depth:0.5-1 inch
rate: 100/min
method: 2 fingers on sternum - basic CPR (older child): compression method, rate, depth
-
method: 1 or 2 hands on sternum
rate: 80-100/min
depth: 1-1.5 inch - supraventricular tachycardia + hemodynamically stable: tx
-
vagal maneuvers
adenosine
diagoxin
esmolol
procainamide amiodarone - SVT + hemodynamically unstable = Tx
-
synchronized cardioversion 0.5-1 J/kg
increase to 2 J/kg if unsuccessful - v-tach + hemo stable = tx
- amiodarone/procainamide (prolong QT interval)
- v-tach + hemo unstable = tx
-
synchronized cardioversion 0.5-1 J/kg
increase to 2 J/kg if unsuccessful - pulseless v-tach / v-fib = Tx
- nonsynchronized defib (2J/kg -> 4 J/kg -> epi -> lido + shock ->
- vasomotor tone abnormality = x shock
- distributive shock