Pediatric Emergencies Lecture Notes

What are the primary characteristics of pediatric respiratory emergencies?

Children have smaller airways, higher metabolic demands, and limited respiratory reserves, making them vulnerable to rapid decompensation.

What does stridor indicate in a child?

Stridor is a high-pitched, musical sound during inspiration that indicates partial obstruction of the upper airway.

What is a common cause of stridor in pediatric patients?

Foreign Body Airway Obstruction (FBAO) is the most emergent cause of stridor.

What is wheezing and when does it occur?

Wheezing is a high-pitched whistling sound heard during expiration due to airflow through narrowed bronchioles.

What are some common causes of wheezing in children?

Bronchiolitis, pneumonia, asthma, and allergic reactions.

What does the absence of wheezing signify in a severely distressed child?

It may indicate silent chest, a sign of impending respiratory failure.

What are physical indicators of respiratory distress in children?

Retractions, nasal flaring, head bobbing, and grunting.

What is bronchiolitis and what primarily causes it?

Bronchiolitis is a viral respiratory infection mainly caused by respiratory syncytial virus (RSV) affecting children under 2 years.

What are key management priorities for a child with bronchiolitis?

Provide a position of comfort, supplemental oxygen, and minimize patient agitation.

What are the signs of respiratory failure to monitor in bronchiolitis?

Increasing respiratory effort, decreased oxygen saturation, and altered mental status.

What pharmacological treatment is beneficial when wheezing is present in bronchoconstriction?

Bronchodilator therapy, specifically Salbutamol (Ventolin).

What delivery methods are used for bronchodilator medication in children?

Metered dose inhaler (MDI) with spacer or nebulizer.

What is pneumonia and how does it develop in pediatric patients?

Pneumonia is caused by more virulent infections causing inflammation and fluid accumulation in the alveoli.

What is Acute Respiratory Distress Syndrome (ARDS)?

ARDS is a severe condition characterized by bilateral lung infiltrates, decreased lung compliance, and significant work of breathing.

How does asthma present in children?

Asthma presents as bronchial hyperresponsiveness, airway obstruction, and underlying airway inflammation.

What are the three simultaneous problems encountered during an asthma attack?

Bronchospasm, airway wall inflammation, and mucus hypersecretion.

What are the indicators of severe asthma?

Diminished air entry, silent chest, and symptoms of respiratory fatigue.

What is the dangerous triad in severe asthma?

Bronchospasm, edema, and mucus plugging leading to increased airway resistance.

What does the term 'silent chest' imply in an asthma context?

Severe airway obstruction with minimal or no airflow, indicating respiratory failure.

What is the management strategy for children experiencing respiratory fatigue?

Assess for decreased air entry, shallow chest rise, and prepare for possible respiratory arrest.

What do cardiovascular changes indicate in severe asthma?

Rising intrathoracic pressure decreases venous return leading to decreased cardiac output and can cause hypotension.

What factors can lead to lethargy and confusion in severely asthmatic patients?

Severe hypoxia and hypercarbia affecting brain function.

How should a provider respond to an asthmatic patient showing signs of respiratory arrest?

Administer oxygen, assist ventilation, and prepare for advanced airway management.

What are the treatment goals for pediatric asthma patients in distress?

Provide bronchodilation and reduce airway inflammation to prevent progression to respiratory failure.

Why might children with asthma experience a paradoxically quiet chest?

Significantly reduced airflow due to severe obstruction, even with respiratory distress.

What are the '4 D's' seen in epiglottitis?

Dysphagia, drooling, dysphonia, and distress.

What critical assessment is necessary in suspected epiglottitis?

Assess for drooling and difficulty breathing, as intervention is needed quickly.

How does croup typically present?

A child with a barking cough, stridor, and respiratory distress, particularly worsening at night.

What is considered successful treatment for moderate to severe croup?

Nebulized epinephrine for immediate airway edema relief and dexamethasone for longer-term inflammation control.

What is the indicative sound of croup?

Seal-like barking cough.

What defines anaphylaxis?

A severe, potentially life-threatening allergic reaction that involves multiple organ systems.

What is the primary treatment for anaphylaxis in the prehospital setting?

Administering epinephrine IM to reverse symptoms.

What are the signs of cardiovascular collapse in anaphylaxis?

Tachycardia, pale cool skin, hypotension, and altered level of alertness.

What differentiates the management of mild allergic reactions from anaphylaxis?

Mild reactions may require antihistamines while anaphylaxis requires immediate epinephrine.

What is the primary concern when managing pediatric foreign body airway obstruction?

Ensuring the child's airway remains open and managing any respiratory distress effectively.

Which object is the leading non-food cause of choking in children?

Balloons.

What are some signs of severe foreign body airway obstruction in respondable children?

Inability to speak, universal choking sign, and stridor.

What should be done if a responsive child becomes unresponsive during FBAO clearance?

Commence CPR and call for advanced medical assistance.

What are the conditions for administering epinephrine in children?

Requires history of asthma and presence of significant bronchospasm.

What is the dosing protocol for Salbutamol in pediatric patients?

600 mcg via metered dose inhaler every 5 minutes as needed.

What should be documented in the case of administering systemic steroids in pediatric patients?

All doses, times, and patient responses to treatment.

What is pediatric hypoglycemia commonly defined as?

A blood glucose level less than 4 mmol/L for patients older than 2 years.

What is the treatment for a child with hypoglycemia presenting altered level of awareness?

Administer Dextrose (D10W) or Glucagon as per medical directive.

What is the relationship between pediatric hyperglycemia and fluid loss?

Osmotic diuresis causes massive fluid loss leading to dehydration and electrolyte depletion.

What are the clinical signs of Type 1 diabetes-related ketoacidosis?

Fruity breath odor, Kussmaul respirations, nausea/vomiting, and altered mental status.

What action should be taken for pediatric patients with signs of increased intracranial pressure?

Hyperventilation during PPV-BVM management.

What are the symptoms of increased ICP in children?

Decreased LOC, widened pulse pressure, ipsilateral pupil dilation, and bradycardia.

How is treatment modified for pediatric patients experiencing shock?

Use ABCDE methodology and administer fluids or medications as required.

What is the significance of understanding systemic steroid contraindications in acute care?

To prevent adverse effects and manage patient safety regarding recent steroid use.

What factors contribute to respiratory distress in pediatric patients?

Increased work of breathing, altered mental status from hypoxia, and use of accessory muscles.

Why are infants particularly vulnerable to respiratory distress?

Their smaller airway diameters and immature respiratory systems.

How can dexamethasone help in the management of croup and bronchitis?

By reducing inflammation and preventing rebound symptoms post-treatment.

How does the presentation of pneumonia differ between viral and bacterial causes in children?

Bacterial pneumonia typically results in higher fevers and more significant distress compared to viral.

What monitoring is necessary for children receiving bronchodilator therapy?

Assessing respiratory effort, oxygen saturation, and mental status.

What is the role of environmental considerations in managing pediatric respiratory cases?

Ensure treatments are administered in well-ventilated areas and protective equipment is used.

What are signs that a child's airway may be obstructed?

Sudden respiratory distress, stridor, and inability to speak or cry.

What critical step should be taken before airway suctioning in pediatric patients?

Verify tube placement and pre-oxygenate the patient before the procedure.

Why is fever a concern in pediatric seizures?

It can lead to increased metabolic demand and potential hypoxia.

How should a child in a respiratory distress position be managed?

Allow positioning for comfort, assess breathing ability, and monitor vital signs.

What are the primary goals in treating pediatric seizures?

Prevent injury, establish airway protection, and manage contributing factors.

Why is drawing blood glucose necessary in active seizure management?

To rule out hypoglycemia and determine appropriate treatment.

What is the procedure for managing suspected opioid overdose in pediatric patients?

Immediate airway management, administer naloxone, and monitor closely.

What is the importance of the Wong-Baker FACES Pain Scale in pediatric patients?

It allows for self-reporting of pain intensity through facial expressions.

What considerations should be taken for infants under one year with pain?

Utilize appropriate dosing and safety precautions due to their age and weight.

How is complex burn injury in children characterized?

Involvement of face, hands, perineum, or respiratory tract, and critical TBSA percentages.

What is CO poisoning treatment protocol?

Administer high concentration oxygen through non-rebreather mask or BVM as the first-line treatment.

What precautions should be taken when administering medications via nebulizer?

Use appropriate PPE to prevent exposure to airborne pathogens.

What are critical considerations for managing a child with an adrenal crisis?

Consider administering hydrocortisone and monitor vital signs closely.

What management strategies apply to pediatric patients experiencing shock?

Oxygen support, fluid resuscitation, and addressing the underlying cause.

How does the body's response to hypoperfusion manifest in children?

Increased heart rate, cool extremities, anxiety, and delayed capillary refill.

What is the goal of actively managing a child in severe asthma or respiratory failure?

To prevent further deterioration by addressing airway obstruction and administering supportive care.

How can parental involvement impact pediatric patients during emergency care?

It provides comfort and reassurance, aiding in the management of stress and anxiety.

What is the appropriate response for a child with suspected croup?

Continuous respiratory assessment and provide nebulized treatments as required.

What potential complications arise from untreated severe asthma?

Respiratory arrest, cardiac arrest, and severe hypoxia.

What is the significance of monitoring vital signs in pediatric patients experiencing allergic reactions?

To identify and respond to any signs of anaphylaxis or other severe reactions.

How is the pediatric pain management protocol adjusted for age and developmental level?

By utilizing specific age-appropriate medication dosing and assessment scales.

What are the initial steps taken in the management of anaphylaxis?

Administer epinephrine, provide oxygen, and position the patient appropriately.

What are the distinguishing characteristics of pediatric versus adult injuries in trauma?

Children's smaller stature creates different injury patterns and requires tailored assessment and management.