ENPC 5th edition

ENPC 5th edition Neonate characteristics: - ANS Birth to 4 weeks If preterm neonate until original due date plus 28 days Loses 5-10% weight by 3-4th day of life Flexion normal posture Limited glycogen store Nose breathers Infant characteristics: - ANS Nose breather until 6months And muscle to breathe Metabolic rate 2x adult (increased need for oxygen and glucose) Toddler characteristics: - ANS Babinski réflex normal until walking Plantar réflex at 2 years And muscles to breathe Most common cause of bradycardia in peds - ANS hypoxia When to begin chest compressions in peds - ANS when HR is below 60bpm Suctioning the neonate - ANS increases the risk for decreased cerebral blood flow decreased pulmonary oxygenation bradycardia suction mouth then nose Neonate first minute emphasis - ANS ventilation not intubation Lower glucose levels in Neonate - ANS associated with potential for brain injury stress of respiratory and circulatory efforts metabolize existing glucose D10 IV for glucose 40mg/dL normal heel stick at birth 30 mg/dL normal heel stick at 24h 45 mg/dL Neonatal CHD - ANS compare pulse ox from right hand to either foot (difference 3% suggest dx) considered in infant presenting with respiratory distress or shock (with absence of fever) s/s include shock, cyanosis, tachypnea, or pulmonary edema Neonatal cyanosis - ANS look inside the mouth at gum line for purple/blue color of tongue and gums - central look for hands and feet to change color - peripheral Respiratory Distress in peds patient - ANS characterized by increased respiratory rate increased heart rate skin color changes increased WOB (grunting, nasal flaring, head bobbing, accessory muscle use) wheezing diaphoresis abnormal upper airway (sounds such as stridor) change in mentation (irritable or agitated) Laryngotracheobronchitis (Croup) - ANS viral illness that account 90% peds stridor inflammation, exudates and edema of larynx l/d narrowing of upper airway tx with dexamethasone and racemic epi (nebulized epinephrine) tx with antipyretics for fever Pertussis (whooping cough) - ANS acute bacterial infection of the respiratory tract that is highly contagious characterized by spasmodic, hacking cough followed by whooping noise upon breath intake tx with erythromycin, azithromycin, clarithromycin or trimethoprim-sulfamethoxazole cystic fibrosis (CF) - ANS genetic condition r/t exocrine dysfunction result in thick mucous production persistent productive cough, hyperinflated lungs, diminished pulmonary function and increased susceptibility to ch. bacterial resp infections tx with abx, steroids for asthma-like s/s, brochodilator followed by nebulized hypertonic saline and dornase alfa Pneumothorax - ANS simple - when air enters pleural space (monitor) large - s/s hypotension, distended neck veins, pale and diaphoretic skin, decreased or absence BS on affected side, hyper-resonance to percussion (Chest tube) spontaneous - no known trauma or injury (most cases is ruptured bleb) Heart Failure in peds - ANS inadequate CO r/t ventricle unable to either fill with blood or eject blood can be result of sepsis, renal dx, inflammatory conditions, dysrythmias, muscular dystrophy, chemotherapy or blunt chest traumas tx by position of comfort, record weight daily, BB, avoid vasodilators and caution of diuretics Cardiomyopathy in peds - ANS left ventricular hypertrophy (thickened muscle wall) dilated cardiomyopathy (left ventricular enlarged and weakened) cause include coronary artery dx, HTN, obesity, drug tox and kawasaki dx tx by position of comfort, record weight daily, BB, avoid vasodilators and caution of diuretics Myocarditis - ANS inflammation of the heart muscle that has significant mortality and morbidity in peds viral, bacterial, toxic and autoimmune etiologies s/s include fever, malaise (general unwell) and myalgia (soreness/achiness in muscles); SHOB at rest and crackles on auscultation; dysrhytmias; HF; elevated enxymes; syncope Percarditis - ANS inflammation of pericardial sac of heart infectious (viral/bacterial) or dug (PCN, phenytoin), post cardiac surg, metabolic or immune mediated tx NSAIDS and possible pericardiocentesis Marfan Syndrome - ANS inherited autosomal dominant dx connective tissue dx s/s - thin, tall with long extremities, flat feet, pectus excavatum (caved-in chest) or pectus carinatum (protruding "pigeon" chest) tx with BB or angiotensin-receptor blocker Kawaski Disease - ANS vasculitis of unknown cause may be r/t infection (viral/bacterial) L/T coronary artery aneurysms, progressive stenosis, ischemic heart disease, myocardial infarction, HG or sudden cardiac death Reversible causes of peds cardiac arrest - ANS Hypovolemia hypoxia hydrogen ion (acid-base illness) hypokalemia/hyperkalemia (glucose also) hypothermia tension pneumothorax tamponade (cardiac) toxins/tablets thrombosis (PE, MI) hypovolemic shock - ANS decreased intravascular volume fluid volume loss - n/v/d, UO, hemorrhage, burns, and fluid shift into third space most common shock in children distributive shock - ANS characterized by vasodilation and maldistribution of blood volume anaphylactic - allergen exposure and histamine release cause vasodilation septic - endotoxin release cause increased vascular permebility and vasodilation neurogenic - SCI, spinal anesthesia or nervous system damage cause loss of sympathetic tone and vasodilation obstructive shock - ANS obstruction that decreases the heart's ability to pump blood or venous return of the heart cause include pericardial tamponade, tension pneumothorax, CHD and PE cadiogenic shock - ANS characterized by decreased cardiac contractility and output secondary to abnormal pump function or pump failure cause by myocardial injury (myocarditis or trauma), CHD or dysrhythmias Compensated shock (Stage I) - ANS tachycardia, mild tachypnea, slightly delayed cap refil, and subtle changes ******