Respiratory Emergencies
Shock
AHA Guideline Changes
Drug dosages
Assessment
100
Croup, Anaphylaxis, and Foreign Body Aspiration are classified by this type of respiratory illness.
What is Upper Airway Obstruction?
100
A 12 month old infant has a HR of 200 and a blood pressure of 50 systolic. This patient is considered to be in what kind of shock?
What is hypotensive or decompensated shock? <70 systolic is considered hypotensive for infants. <70 + 2(age in years) is considered hypotensive in children 1-10 years of age. Compensated shock refers to the child with signs of poor perfusion but a normal systolic blood pressure. When compensatory mechanisms fail and the systolic blood pressure drops, shock is then classified as hypotensive (previously referred to as decompensated shock).
100
To achieve effective chest compressions, rescuers should compress at least 1/3 the depth of the chest for infants and children. This corresponds to approximately _____ inches for most infants.
What is 1 1/2 ? 1/3 the depth of the chest for most children is approximately 2 inches. The compression depth for adults is at least 2 inches.
100
What percentage of the world is covered by oceans?
What is 70%.
100
Along with Work of Breathing and Circulation, this forms the Pediatric Assessment Triangle.
What is Appearance?
200
Pediatric patients suffering from Asthma, a disease that obstructs the lower airways, can be given the adult dose of albuterol if they weigh this much.
What is 20 kg? Asthma is classified as a lower airway obstruction. Lower Airway (Wheezing) • Albuterol 2.5 mg/3 ml NS in a nebulizer Pt. < 5 kg = 1 ml* Pt. 5kg - 20 kg = 2 ml* Pt. > 20 kg = 3 ml *Add 1-2 ml NS to a total volume of 3 ml. May be given continuously if severe distress • If tidal volume is decreased, administer undiluted Albuterol continuously. May be administered via inline BVM • And/or for severe distress Epinephrine (1:1000) 0.01 mg/kg SQ (repeat x 1 in 5 min, max dose 0.3 mg)
200
A 7 year old child presents with abdominal pain, vomiting, and diarrhea for two days. His lips are dry and he has a HR of 170. Blood pressure is 90 systolic. You determine that the patient is suffering from hypovolemic shock. The patient weighs 35 kg. An initial dose of NS has been given to the patient with no effect. This second dose, in mL's, is ______.
What is 700 cc's NS? Treat hypovolemic shock with 20 mL/kg NS or LR. Repeat as needed.
200
The mnemonic ABC has changed to CAB. CAB only delays ventilations for _____ seconds.
What is 18? Although most cardiac arrests in infants and children are asphyxial in nature, the AHA chose to adopt CAB for infants and children to avoid confusion and to increase the likelihood of bystander CPR.
200
List the five ocean of the world.
What is the Atlantic Ocean, the Pacific Ocean, the Arctic Ocean, the Indian Ocean, and the Southern Ocean.
200
This is what the C stands for in the mnemonic TICLS.
What is consolability? TICLS is used to help form a general impression about the acuity of a patient. Tone Interactiveness Consolability Look or Gaze Speech or Cry
300
This dosage of this drug for status epilepticus is not listed on 2005 edition of the Broselow Pediatric Emergency Tape that is carried by the SFFD.
What is Midazolam? Status epilepticus is an example of the Disordered Control of Breathing. • Cardiac monitor • IV or IO access [see PRECAUTIONS AND COMMENTS] • If rapid blood glucose test shows glucose < 60 mg/dl for child; < 40 mg/dl for newborn. [see PRECAUTIONS AND COMMENTS] • If vascular access established: • Dextrose: *Neonates < 1 month: D10W, 1-2 ml/kg IVP or IO *Child 1 month to 2 years: D25W, 2 ml/kg IVP or IO *Child > 2 years: D50W, 1 ml/kg IVP or IO • If no IV or IO access: • Glucagon: 0.1 mg/kg IM (max. dose 1 mg) • For status epilepticus: • Midazolam: Utilize length based tape measurement to determine dose. For all route of administration utilize antiseizure/sedation dosing not rapid sequence induction dosage. Maximum single dose is 2 mg IV, 4 mg IM, or 5 mg IN.
300
Hypotension with a wide pulse pressure and either a normal HR or bradycardia are signs of this type of shock.
What is neurogenic shock? Neurogenic, Anaphylactic, and Septic shock are all examples of Distributive Shock.
300
This type of defibrillator is preferred for infants.
What is a manual defibrillator? If a manual defibrillator is not available, an AED equipped with a pediatric dose attenuator is preferred. If neither is available, an AED without a pediatric dose attenuator may be used.
300
List the three zones of the ocean.
What is the euphotic zone, the disphoitice zone, and the aphotic zone
300
This is forced exhalation against a partially closed glottis, and may indicate progression from respiratory distress to respiratory failure.
What is grunting? Grunting is an attempt to keep open small airways and alveolar sacs. Respiratory conditions that can cause grunting include pneumonia, ARDS (noncardiogenic pulmonary edema), CHF causing pulmonary edema, and pulmonary contusion.
400
Sepsis can cause pulmonary edema because of capillary leakage in the lung tissue. Disease of the lung tissue is also called ________.
What is parenchymal? Pronunciation: /pə-ˈreŋ-kə-məl, ˌpar-ən-ˈkī-məl/ Other causes of parenchymal disease are pneumonia, CHF, non-cardiogenic pulmonary edema (ARDS), chemical pneumonitis.
400
Evidence of venous congestion such as distended neck veins, hepatomegaly, and cardiomegaly are suggestive of cardiogenic shock. Many children with cardiogenic shock have an adequate pre-load and do not need fluid therapy. If the patient's history, for example, vomiting and poor intake, suggest inadequate pre-load, a cautious fluid bolus of ____ mL/kg may be given.
What is 5-10 mL/kg NS or LR?
400
Once ROSC is achieved, titrate the oxygen administration to maintain an oxyhemoglobin saturation level of ________.
What is 94-99%? Data suggests that hyperoxemia enhances the oxidative injury observed after ischemic and reperfusion events such as cardiac arrest. The risk of oxidative injury may be reduced by titrating the inspired oxygen to reduce the PaO2.
400
Choose a specific marine animal, and locate where that animal is likely to live within the world
What is sea turtles, found mainly in warmer water in The Great Barrier Reef. (an example)
400
The GCS for an infant that has eye opening to speech, has an irritable cry, and withdraws in response to touch is ____.
What is 12?
500
The transtracheal pressure for pediatric manual jet insufflation is ____, or the least amount of pressure required to raise the chest.
What is 20 psi? Needle cricothyroidotomy is the airway of last resort. Examples of illnesses that might lead to the need of a needle cricothyroidotomy are upper airway obstructions, such as severe croup, epliglottitis, and FBAO.
500
A first responder reports that it is getting harder to ventilate the patient, a 2 year old child. You noticed earlier that the first responder was using an adult sized BVM on the patient, and appeared to be hyperinflating the lungs. LS are absent on the right side. You decide to perform a needle decompression. This is the location that you insert an 18-20 gauge needle.
What is over the top of the third rib, midclavicular line, on the affected side? Tension pneumothorax, as well as cardiac tamponade and pulmonary embolism are examples of obstructive shock.
500
This device connects an endotracheal tube to suction tubing.
What is a meconium aspirator? New guidelines state that suctioning, even bulb suctioning, immediately after birth should be reserved for babies with obvious obstruction or that require positive pressure ventilation. There is no evidence that active babies benefit from airway suctioning, even in the presence of meconium, and there is evidence of risk associated with the suctioning. The current practice of performing endotracheal suctioning of nonvigorous babies with meconium-stained amniotic fluid is unchanged.
500
Explain why there is high and low tide.
What is the tides are the rise and fall of sea levels due to the gavitational pull of the moon and the sun.
500
The PetCO2 (partial pressure of end-tidal CO2) is a good estimate of the PaCO2 (partial pressure of arterial CO2). The PaCO2 is a measure of the adequacy of ______.
What is ventilation? Hypercarbia is a sign of inadequate ventilation. When ventilating titrate to normal values of 35-45 mmHg. Remember that hyperventilation => hypocarbia hypoventialation => hypercarbia
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