ENPC
Pediatric triangle - ANS appearance
work of breathing
circulation to skin
General appearance considerations - ANS Tone
Interactiveness: drawn to sounds or people. Wants to play
Consolability
Look/Gaze
Speech/cry
Work of breathing: - ANS Increased work of breathing e...
Pediatric triangle - ANS appearance
work of breathing
circulation to skin
General appearance considerations - ANS Tone
Interactiveness: drawn to sounds or people. Wants to play
Consolability
Look/Gaze
Speech/cry
Work of breathing: - ANS Increased work of breathing evidenced by tachypnea, stridor,
grunting, retractions, accessory musles, nasal flaring, head bobbing, abnormal positioning
Circulation to Skin - ANS Observe palor
mottling
cyanosis
Sick, Sicker, Sickest - ANS 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 - ANS hypoxia
hypoglycemia
Blood pressure norms - ANS Hypotension: Less than 70 + (2 x age in years)
Widening pulse pressure = increased ICP
Narrowing pulse pressure = hypovolemic shock
Crying child - ANS Vigorous = good
weak = sick
high-pitched = increased ICP
"Fussiness" = red flag
Respiratory distress indicated by: - ANS increased heart rate
,skin color changes
incrased work of breathing
wheezing
diaphoresis
abnormal airwa sounds
Respiratory failure signs - ANS fatigue and become lethargic
hypoxia
hypercarbia
General airway interventions - ANS Allow child to stay in most comfortable position
Give O2 to maintain it above 92%
O2 does NOT measure ventilation
Croup - ANS 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 - ANS albuterol, duo neb and oral steroid
Bronchiolitis/RSV - ANS Assessment: 1-3 days nasal congestion fever, cough, respiratory
distress with wheezing and crackles. Dehydration and tachypnea
treating hypoglycemia - ANS obtain glucose for anyone who is not awake and alert
treat kids with 2-4ml/kg of D25W
When to perform blood glucose test? - ANS When the child is not awake and alert or AMS is
suspected
Preventing Secondary brain injury in TBI - ANS prevent hypotension and hypoxia
cuffed vs uncuffed tube - ANS uncuffed= (age in years/4) + 4
cuffed= (age in years/4) + 3.5
fluid bolus formula - ANS infant: 10ml/kg
kid: 20ml/kg
, normal vitals - ANS pg 52
blood glucose normal ages 5-11 - ANS 72-140
Cardiac Assessment - ANS Trend pulse and pulse pressure
palapate upper and lower extremity pulses
symptoms of CHF - ANS poor feeding, irritability, fatigue easily with rapid resp rate, increased
work of breathing
Ass and Interventions similar to adults
Myocarditis Assessment and treatment - ANS 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 - ANS Tachycardia, tacypnea; AMS; slight increaes in diastolic pressure
Intervention: Stop bleed; give fluids and RBC; balanced therapy; offer pedialyte if not NPO
Cardiogenic shock - ANS Intervention: expert consult; supportive care to decrease O2 and
metabolism demands; slow fluids; treat hpotension while decreasing afterload; vagal maneuver;
vasopressors
Obstructive Shock - ANS Assessment: Cardiac tamponade- muffled heart sounds and
pulsluss paradoxus; tension pneumo- asymmetrical chest rise and fall
Anaphylactic Shock - ANS remove pathogen
fluids
epi
Neurogenic - ANS spinal motion restriction
vasopressors
warming measures
Septic - ANS Fluids
antibiotics
vasopressors
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