Transcript Pediatric review

“Anyone who does anything to help a
child in his life is a hero to me. ”
― Fred Rogers
• Describe general pediatric emergencies, review pediatric
congenital abnormalities
• Explain pathophysiology and possible presentations
• Predict possible patient outcomes and treatment needs
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Obstruction/Difficult Airway
Apnea, Increased or Decreased RR
No Pulse, Poor Perfusion, Hypotension, Bradycardia
Unresponsive, Decreased LOC
Hypothermia, Significant Bleeding, Purpura
• From the Door
• CBC
• Conscious
• Breathing
• Color
• Primary=ABCDE
• Secondary=SAMPLE
• What does it have?
• What does it not have?
• Not as weight/mg but as a volume.
• Considers Age and Length
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“The Handtevy Method is taught by first associating five ages with their corresponding weights in
kilograms via a finger counting method on your hand. To obtain the corresponding weight for each
age, assign each finger a chronological odd number starting with 1: 1, 3, 5, 7, 9. Each finger
represents an age in years. Then, using the same fingers, count up in 5s starting with 10: 10, 15, 20,
25 and 30 to obtain the corresponding ideal body weight in kilograms. For example, a 1-year-old
ideally weighs 10 kg, a 3-year-old 15 kg, etc.”
• http://vimeo.com/76185292
• https://www.youtube.com/watch?v=JuZ7GdEV-n8
• Upper
• Anaphylaxis
• Croup
• Epiglottitis
• Lower
• Asthma
• Pneumonia
• Disorder Control of Breathing
• Overdose
• Head injury
• 8 y/o with sudden onset of difficulty breathing and stridor
• 9 y/o at school with difficulty breathing after playing football
• 6 y/o seizure patient has already received Dystatin, RR 6 per
minute
• Hypovolemic
• Minimum systolic BP <10 y/o
• 70 + 2x(age in years)
• >10 y/o min. 90 sys.
• Cardiac-Pump problem
• Congenital
• Infectious
• Distributive
• Anaphylaxis
• Sepsis
• Obstructive
• DOPE mnemonic
• 12 y/o with 3 days of N/V and diarrhea
• CBC
• Type of Shock
• Tx?
• 3 y/o vent patient sudden onset of diff breathing
• CBC
• Type of Shock
• Tx?
• 9 y/o with Hx of fever and vomiting
• CBC
• Type of Shock
• Tx?
• 2 y/o with Difficulty Breathing poor oral intake
• CBC
• Type of Shock
• What are we Worried about?
• Too Fast
• Too Slow
• Not at All
• Rhythm review
• Sinus Tach
• Causes
• Fever
• Pain
• Rhythm Review
• SVT
• The Numbers: HR >180/ min Children
• <220/ min Infants
• Signs of Poor Perfusion
• Treatment
• Vagal
• Adencoard
• Syncardioversion-.5-1 Joules/KG
• Rhythm Review
• Sinus Brady
• Causes?
• Treatment
• 02 (bagging), IV, Monitor
• CPR
• Epi
Normal rhythm on monitor but no Pulse, What is the
Rhythm?
PEA
Tx?
EPI
H’s and T’s
• Rhythm review
V-Tach
With Pulse
No pulse
V-Fib
• Rhythm review
Asystole
Tx?
Epi
CPR
H and T
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Muscular Dystrophy
Cystic Fibrosis
Marfans Syndrome
Down Syndrome
Congenitial Heart Disease
• Most common Duchenne
• Dystrophin
• Sacrolemma
• Connective tissue-Pseudo hypertrophy
• Gowers sign-Rapid progression
• Severe scoliosis-Lung Function
• Cardiac-Cardiomegaly, CHF, Dysrhythmias
• Fixed Cardiac output
• RSI-Succinylcholine
• NaCl and H20 transport problems
• Most common for our current population
• Increase viscosity
• Blockage problems
• Airway, Liver, Pancreas
• Triad of problems
• Increase Cl- concentration in sweat
• Pancreatic insufficiency
• Pulmonary disease
• Often missed
• Affects the body’s connective tissue
• Pneumothorax
• Aortic rupture (unusual cases)
• Type A
• Type B
• Beta-Blocker
• Pregnancy
• Less severe problems
• Most Common chromosomal cause
• Delayed axonal myelination
• Repair
• System delays
• Language and Behavior
• Increase Spinal cord injuries
• Heart defects
• MVP
• Vent/Septal defects
• PDA
• 12 lead!!!!!!!
• Most common congenital disorder in newborns
• Varying degrees of cardiorespiratory compromise
• May be diagnosed in utero
• Examples include:
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Hypoplastic left heart syndrome (HLHS)
Tricuspid atresia
Transposition of the great arteries (TGA)
Tetralogy of Fallot (TOF)
Total anomalous pulmonary vasculary return (TAPVR)
Truncus arteriosus
• Typically presents in neonatal period with:
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Increasing respiratory distress
Poor perfusion
Cyanosis
Cardiovascular collapse if unrecognized
• Initial management includes cardiorespiratory support and
monitoring.
• 4 anatomic malformations:
-Right Ventricular
Hypertrophy
-Pulmonary Valve
Stenosis
-Transposition of
the aorta
-Ventricular Septal
Defect
• Clinical presentation is directly related to the degree of
pulmonary stenosis.
• Severe stenosis results in immediate cyanosis following birth.
Mild stenosis will not present until later.
• Growth is retarded – insufficient oxygen and nutrients
• Shortness of breath on exertion
• What’s the condition
• Different How?
• Extra Equipment
• Parents
• Modified treatments?