AIRWAY
A simple way to maintain the airway.
What are Position, head lift-chin tilt, suction, and adjunct airway?
Identify one sign of an infant or young child in respiratory distress.
Nasal flaring, grunting, fast/slow/irregular breathing, and retractions.
The most common reversible cause of bradycardia in kids.
What is Hypoxia?
The acronym AVPU stand for…
What is Alert, Voice, Pain, Unresponsive?
The Dose of Epinephrine used for pediatric patients during CPR.
What is 0.01mg/kg
Three things to do when checking airway patency.
What are look, listen, and feel?
Goal SpO2 for a pediatric patient.
What is >/=94%?
A way to assess circulation in a child if vitals have not yet been obtained.
What is Capillary refill or skin color/temp?
What should always be check when a pediatric patient is altered?
Blood glucose
In a hospital setting (multiple team members present) what is the compression to ventilation ratio prior to obtaining an advanced airway on a three year old patient?
15:2
Identify this breath sound and the medication used to intervene.
What is stridor and racemic epinephrine, with Croup for example?
This sound signifies lung tissue disease resulting from small airway collapse, alveolar collapse, or both.
Grunting
Amount of isotonic crystalloid given as a bolus every 5-20 minutes in shock patients.
10-20mL/kg
Blood glucose levels considered hypoglycemic in an infant and a child.
What are <40 for an infant and and <60 for a child?
The defibrillation energy level for the first shock on a pediatric patient
2J/kg (subsequent shock 4J/kg up to max of 10J/kg)
After Albuterol, Magnesium sulfate can be used for refractory status asthmaticus--Why?
Slow IV infusion of mag sulfate antagonized Ca2+ influx and inhibits the release of excitatory mediators like acetylcholine and histamine preventing further constriction.
A sign of impending arrest related to breathing.
What is Bradypnea?
This, when present on a pediatric patient's skin, indicates possible septic shock.
What is Petechia or purpura?
Second line medications used and their doses for refractory Vfib/pVT.
Amiodarone: 5mg/kg (may repeat up to three doses)
Lidocaine: 1mg/kg
This specific airway emergency requires the child to remain calm to avoid laryngospasm and loss of airway.
What is Epiglottitis?
What is a key take away when assessing temperature (by touch) in the pediatric population?
Noting difference between core temp and peripheral temp on the skin.
FINAL JEOPARDY! The effects of Epinephrine on multiple receptor sites please explain as best you can down to a cellular level.
Stimulates B1 receptors: ultimately resulting in an influx of Ca2+ causing increased contraction, influx of Ca2+ affects pacemaker cells by speeding up rate of depolarization
Alpha 1 receptors: ultimately resulting in an influx of Ca2+ and constriction of the vascular smooth muscle (think peripheral vasoconstriction and what leads to those dusky extremities and increased risk for skin breakdown!)
Stimulates B2 receptors: Ca2+ influx dilates blood vessels in bronchioles (and uterus, bladder, GI tract) opens airway, also dilates coronary arteries.
*Pearls:
High dose epinephrine will also cause glucose and potassium shifts. Glycogenolysis will allow for more glucose to be readily available--Think you may need to start an MDN
High dose epinephrine can enhance platelet aggregation while limiting other procoagulant platelet function. Keep DIC in the back of your mind with these super sick patients.Affinity for receptors:
Low dose: Higher affinity for B2
High dose: Higher affinity for Alpha