ENPC 2022 Study Guide with Complete Solution

Pediatric triangle appearance work of breathing circulation to skin General appearance considerations Tone Interactiveness: drawn to sounds or people. Wants to play Consolability Look/Gaze Speech/cry Work of breathing: Increased work of breathing evidenced by tachypnea, stridor, grunting, retractions, accessory musles, nasal flaring, head bobbing, abnormal positioning Circulation to Skin Observe palor mottling cyanosis Sick, Sicker, Sickest Sick: no disruption of any component of PAT but caregivers are concerned Sicker: one component of PAT is a concern Sickest 2+ concerns of PAT 2 leading causes of altered mental status in kids hypoxia hypoglycemia Blood pressure norms Hypotension: Less than 70 + (2 x age in years) Widening pulse pressure = increased ICP Narrowing pulse pressure = hypovolemic shock Crying child Vigorous = good weak = sick high-pitched = increased ICP "Fussiness" = red flag Respiratory distress indicated by: increased heart rate skin color changes incrased work of breathing wheezing diaphoresis abnormal airwa sounds Respiratory failure signs fatigue and become lethargic hypoxia hypercarbia General airway interventions Allow child to stay in most comfortable position Give O2 to maintain it above 92% O2 does NOT measure ventilation Croup 1-3 days of nasal congestion and fever with sudden onset of barky cough Treatment: dexamethasone and nebulized epi Discharge Teaching: oral hydration, get child to cool air or steamy bathroom Asthma interventions albuterol, duo neb and oral steroid Bronchiolitis/RSV Assessment: 1-3 days nasal congestion fever, cough, respiratory distress with wheezing and crackles. Dehydration and tachypnea interventions: nasla suctioning, fluids sever: heated, high flow nasal cannula O2 Discharge: lasts 2-3 weeks; nasal suctioning; monitor hydration treating hypoglycemia obtain glucose for anyone who is not awake and alert treat kids with 2-4ml/kg of D25W When to perform blood glucose test? When the child is not awake and alert or AMS is suspected Preventing Secondary brain injury in TBI prevent hypotension and hypoxia cuffed vs uncuffed tube uncuffed= (age in years/4) + 4 cuffed= (age in years/4) + 3.5 fluid bolus formula infant: 10ml/kg kid: 20ml/kg normal vitals pg 52 blood glucose normal ages Cardiac Assessment Trend pulse and pulse pressure palapate upper and lower extremity pulses symptoms of CHF poor feeding, irritability, fatigue easily with rapid resp rate, increased work of breathing Ass and Interventions similar to adults Myocarditis Assessment and treatment Assess: consider in anyone with recent viral infection; SOB and crackles; dysrhthmias; heart failure; syncope; elevated liver enzymes Treat: diuretics; BP support; ECMO; transplant Hypovolemic Shock Tachycardia, tacypnea; AMS; slight increaes in diastolic pressure Intervention: Stop bleed; give fluids and RBC; balanced therapy; offer pedialyte if not NPO Cardiogenic shock Intervention: expert consult; supportive care to decrease O2 and metabolism demands; slow fluids; treat hpotension while decreasing afterload; vagal maneuver; vasopressors Obstructive Shock Assessment: Cardiac tamponade- muffled heart sounds and pulsluss paradoxus; tension pneumo- asymmetrical chest rise and fall Intervention: pericardiocentesis; needle thoracentesis; antigoagulation or surgical intervention; treat ductal dependent lesion Anaphylactic Shock remove pathogen fluids epi Neurogenic spinal motion restriction vasopressors warming measures Septic Fluids antibiotics vasopressors OLD CARTS Onset