Ped Emergencies

Large occiput, floppy tongue, Larynx is more superior (C3), Larynx funnel shaped, narrowest at subglottic area, vocal cord slant anteriorly to trachea

What is different about pediatric airways?

(age + 16)/ 4 (if older than 1)

Estimation for pediatric ET tube size

Anybody under 10-12 (enlarged thymus and thyroid)

Which patient is NOT getting a crike?

A bridge for open tracheostomy (can support a 30 kg thing for 30 min), CO2 will build up

Describe needle translaryngeal ventilation

Straight blade if under 2 (Miller), uncuffed tubes if below 6-8

Tips on blade and tube choice in kids

Just enough for the chest rise, DO NOT hyperventilate (barotrauma or air in the stomach)

Tips for maintaining breathing in peds

IO is better than nothing, fluid bolus is 20 for peds, 10 for infants; If bolus (20 min max), reassess patient after each bolus

Tips for circulation

secondary to respiratory and shock (primary cardiac arrest is NOT a good sign)

In peds, cardiac arrest is usually

Airway, oxygenation, ventilation

Ped resuscitation priorities

Stridor, epiglottis, croup, FBA, peritonsillar/retropharyngeal abscess, bronchiolitis

Airway emergencies in Peds

Stridor, intercostal and suprasternal retraction, tachypnea, cyanosis (might be the baseline)

Signs of airway/breathing difficulties

Get a quick hx from the parents, keep the baby chill (try blow by oxygen), begin interventions ASAP, prepare to secure the airway

Gameplan for stridor

Dysphagia, drooling, distress

What are the 3Ds of epiglottis

Oxygen supplementation (protect the airway), IV steroids and abx; DO NOT USE A SUPRAGLOTTIC airway!!

Treatment plan for Epiglottis

Thumb sign

Xray sign for epiglottis

nasal congestion, rhinorrhea, harsh barking cough, low-grade fever; (tends to be worse at night and related to the edema)

What are the classic symptoms of Croup?

Parainfluenza

What is the most common cause of Croup (AKA viral laryngotracheobronchitis)?

corticosteroids for everybody, nebulized epi, cold air may reduce symptoms

Treatment plan for croup - depends on severity (Westley Croup score)

Level of consciousness, cyanosis, stridor, air entry, retrations

What are the parts of the Westley Croup Score?

Steeple sign

Xray sign for Croup

RSV (50-70%)

Most common cause of Bronchiolitis?

3 months - 3 y/o (most commonly less than 2)

Bronchiolitis tends to affect…

URI symptoms, wheezing, fever, apneic episodes, cyanosis, poor feeding

Symptoms of Bronchiolitis (normally worse in the 1st week)

Nebulized epi (1x trial), corticosteroids, nebulized hypertonic saline (1x trial)

Treatment plan for Bronchiolitis

valvular dysfunction, septal defects, vascular anomalies

Pediatric heart diseases are usually causes by

Punt to pediatric cardiology (NICU, or whatever), Oxygenation in a PDA or ductal dependent lesion (CoA, ToF, pulmonary atresia) will worsen condition

Gameplan for pediatric heart diseases - general

imaging

Gameplan for a limping child with a hx of trauma/overuse

imaging

Gameplan for a limping child with NO hx of trauma/overuse and NO systemic symptoms

imaging, CBC, ESR, CRP

Gameplan for a limping child with NO hx of trauma/overuse and systemic symptoms

fractures, SCFE, AVN, osteomyelitis, septic joint, cancer, deep abscess

DDX for a limping child

infections, corneal abrasion, eye FB, hair tourniquet, insect bites, burns, recent vaccines, food intolerance, otitis, abuse, anal fissure, intussusception, incarcerated hernia, testicular torsion, drug exposure/withdrawal, congenital abnormality, medication overdose

DDX for a crying child

3 hrs a day, 3 days a week, 3+ weeks

Rule of 3s for Colic

bruising in different stages of healing, fractures in different stages of healing, odd story

Red flags for child abuse