NSER 7210 Module 4 Peds
Appearance red flags in kiddos - -Lethargy or inadequate response to stimulation
"Blank" stare
Limp or "Rag doll" appearance
No interaction
Inconsolability
Weak or muffled cry
-Abnormal breathing red flags - -Abnormal audible breath sounds (e.g. stridor, wheezing,
or grunting)
Increased respiratory rate beyond age-related norms
Nasal flaring
Increased respiratory rate and effort
-Abnormal circulation red flags - -Pallor
Mottling
Cyanosis
Ashen or grey appearance
-Signs of increased work of breathing common to the pediatric population include - -
Accessory muscle use: supra-sternal, supraclavicular, intercostal, subcostal, and sub-
sternal
Nasal flaring
Head-bobbing
Grunting
-What are the symptoms of croup? - -High-pitched stridor on inspiration, Recent history of
cold-like symptoms, Sudden onset of SOB, Barky cough
-Which of the following are common signs and symptoms of respiratory distress in
children presenting with asthma?
Nasal flaring
Intercostal, subcostal, or suprasternal in-drawing
Tachypnea
Decreased air entry and/or wheezing
Scalene retractions
Decreased O2 saturations
Diffuse abdominal pain
Cough
Irritability. - -These are all signs or symptoms of asthma in children except bradycardia
and crackles on auscultation. You would expect an elevated heart rate as the body attempts
to compensate for reduced oxygen levels. The expected finding on auscultation would be
decreased A/E and wheezing, not crackles.
, -What is the preferred route to deliver Salbutamol and Ipratropium to pediatric patients
classified as mild or moderate respiratory distress severity using the PRAM scoring tool? -
-Metered dose inhalers (MDIs) with a spacer are the preferred route for children scoring
Mild (0-3) or Moderate (4-7) with the PRAM severity scoring scale for asthma. Only in
severe cases would you expect to give the medications via nebulizer. You may see variance
in sites with the practice for severe presentations (some will continue to use MDI/spacer
and O2 via NP initially).
-True or False? A trial of Salbutamol should be given to patients who present with a
diagnosis of bronchilotiis with respiratory distress - -False. Treatment for bronchiolitis
includes supportive care such as suctioning and oxygen if required. Ventolin is not a
recommended treatment of bronchiolitis.
-True or False? Bronchiolitis should be diagnosed by a positive RSV or parainfluenza
swab? - -False. Bronchiolitis should be diagnosed based on patient presentations, physical
exam and symptoms.
-Why are Chest x-rays are not recommended for patients who present with bronchiolitis? -
-It does not help direct the management
It is associated with increased antibiotic use
It is best to avoid radiation exposure whenever possible
It is difficult to get good x-ray views in this age group
-True or false? All pediatric patients who have a febrile seizure should get an EEG. - -The
answer is false. Children who present with simple febrile seizures and look well do not
need an EEG. EEGs should be considered in children who present with complex febrile
seizures or who have had multiple visits to rule out underlying seizure disorder.
-True or false? The administration of antipyretics decreases the risk of febrile seizures - -
False. The continuous or intermittent administration of antipyretics has not been shown to
reduce the incidence of febrile seizures and the potential side effects of these medications
may pose more of a risk (i.e. overdosing).
-True or false? A febrile seizure can be classified as simple if it has generalized neurological
signs. - -Simple febrile seizures are < 15 mins, no previous neurological history,
generalized, and only occur once in 24 hours. Complex febrile seizures are > 15 mins in
duration, have focal neurological symptoms, and may occur multiple times in 24 hours.
-True or false? Basic diagnostics such as blood work should be done on well looking
patients who present with febrile seizure. - -Children who have simple febrile seizures and
look well do not need routine diagnostics in the ED. Effective discharge teaching is crucial
for parents or caregivers with children who have had a febrile seizure.
-What is the BC Infants Act? - -The Infants Act explains the legal position of a minor
(children under 19 years of age). One of the specific topics covered in the Infants Act is
Appearance red flags in kiddos - -Lethargy or inadequate response to stimulation
"Blank" stare
Limp or "Rag doll" appearance
No interaction
Inconsolability
Weak or muffled cry
-Abnormal breathing red flags - -Abnormal audible breath sounds (e.g. stridor, wheezing,
or grunting)
Increased respiratory rate beyond age-related norms
Nasal flaring
Increased respiratory rate and effort
-Abnormal circulation red flags - -Pallor
Mottling
Cyanosis
Ashen or grey appearance
-Signs of increased work of breathing common to the pediatric population include - -
Accessory muscle use: supra-sternal, supraclavicular, intercostal, subcostal, and sub-
sternal
Nasal flaring
Head-bobbing
Grunting
-What are the symptoms of croup? - -High-pitched stridor on inspiration, Recent history of
cold-like symptoms, Sudden onset of SOB, Barky cough
-Which of the following are common signs and symptoms of respiratory distress in
children presenting with asthma?
Nasal flaring
Intercostal, subcostal, or suprasternal in-drawing
Tachypnea
Decreased air entry and/or wheezing
Scalene retractions
Decreased O2 saturations
Diffuse abdominal pain
Cough
Irritability. - -These are all signs or symptoms of asthma in children except bradycardia
and crackles on auscultation. You would expect an elevated heart rate as the body attempts
to compensate for reduced oxygen levels. The expected finding on auscultation would be
decreased A/E and wheezing, not crackles.
, -What is the preferred route to deliver Salbutamol and Ipratropium to pediatric patients
classified as mild or moderate respiratory distress severity using the PRAM scoring tool? -
-Metered dose inhalers (MDIs) with a spacer are the preferred route for children scoring
Mild (0-3) or Moderate (4-7) with the PRAM severity scoring scale for asthma. Only in
severe cases would you expect to give the medications via nebulizer. You may see variance
in sites with the practice for severe presentations (some will continue to use MDI/spacer
and O2 via NP initially).
-True or False? A trial of Salbutamol should be given to patients who present with a
diagnosis of bronchilotiis with respiratory distress - -False. Treatment for bronchiolitis
includes supportive care such as suctioning and oxygen if required. Ventolin is not a
recommended treatment of bronchiolitis.
-True or False? Bronchiolitis should be diagnosed by a positive RSV or parainfluenza
swab? - -False. Bronchiolitis should be diagnosed based on patient presentations, physical
exam and symptoms.
-Why are Chest x-rays are not recommended for patients who present with bronchiolitis? -
-It does not help direct the management
It is associated with increased antibiotic use
It is best to avoid radiation exposure whenever possible
It is difficult to get good x-ray views in this age group
-True or false? All pediatric patients who have a febrile seizure should get an EEG. - -The
answer is false. Children who present with simple febrile seizures and look well do not
need an EEG. EEGs should be considered in children who present with complex febrile
seizures or who have had multiple visits to rule out underlying seizure disorder.
-True or false? The administration of antipyretics decreases the risk of febrile seizures - -
False. The continuous or intermittent administration of antipyretics has not been shown to
reduce the incidence of febrile seizures and the potential side effects of these medications
may pose more of a risk (i.e. overdosing).
-True or false? A febrile seizure can be classified as simple if it has generalized neurological
signs. - -Simple febrile seizures are < 15 mins, no previous neurological history,
generalized, and only occur once in 24 hours. Complex febrile seizures are > 15 mins in
duration, have focal neurological symptoms, and may occur multiple times in 24 hours.
-True or false? Basic diagnostics such as blood work should be done on well looking
patients who present with febrile seizure. - -Children who have simple febrile seizures and
look well do not need routine diagnostics in the ED. Effective discharge teaching is crucial
for parents or caregivers with children who have had a febrile seizure.
-What is the BC Infants Act? - -The Infants Act explains the legal position of a minor
(children under 19 years of age). One of the specific topics covered in the Infants Act is
