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Questions & Answers (Grade A+)
How are children different? - correct answer ✅Smaller body size, greater relative body surface area, differences in the pediatric airway, head to toe body ratio greater, a child's blood pressure may be maintained with up to 30% acute blood loss, greater capacity to compensate increasing heart rate and system vascular resistance Why are internal organs more affected in kids? - correct answer ✅Internal organs are more anterior and protected by less subcutaneous fat making liver and spleen injuries more common How does smaller body size affect kids? - correct answer ✅Greater distribution of force to a child resulting in multiple trauma What does relative body surface area cause? - correct answer ✅Greater relative body surface area makes heat loss more clinically significant What do differences in pediatric airways cause? - correct answer ✅Greater resistance and smaller more
Questions & Answers (Grade A+)
anterior airway makes airway management more difficult and the need for it more likely; Greater chance for obstruction What does a greater head to toe body ratio cause? - correct answer ✅Makes head injury more common; Blunt trauma of liver/spleen more common and perforating bowels more common if abuse What happens to pediatric vital signs in general? - correct answer ✅RR and HR go down with age and blood pressure goes up with age What is included in advanced life support? - correct answer ✅PALS (pediatric life support), ABCs, Primary and secondary survey; Children tend to have more respiratory issues and heart problems are usually secondary to pulmonary issues Pediatric Assessment Triangle - correct answer ✅
Questions & Answers (Grade A+)
What are the best pulses to check? - correct answer ✅Femoral and brachial; If missing, this identifies low blood pressure What is in the secondary survey? - correct answer ✅Head to to exam assessment in prioritized care order including skin, head, spine, chest, abdomen, pelvis, GU, extremities, and CNS What is the most common cause of serious injury in kids? - correct answer ✅Respiratory distress; Upper airway obstruction presents with stridor and is due to croup, epiglottis, foreign body, congenital malformations, or trauma; Lower airway disorders due to asthma, bronchiolitis, pneumonia, pneumothorax What is the second most common cause of serious injury in kids? - correct answer ✅Shock: Hypovolemia most commonly often due to dehydration, DKA, or blood loss;
Questions & Answers (Grade A+)
Maldistribution of fluid from septicemia or anaphylaxis; Cardiogenic due to arrhythmias or heart failure What can cause a drowsy or unconscious or seizing child? - correct answer ✅Post-ictal status epilepticus, infection, metabolic, head injury, drug/poison ingestion, intracranial hemorrhage What are goals of resuscitation? - correct answer ✅Identify abnormalities of oxygen and perfusion and restore tissue oxygenation and perfusion; Oxygen with cannula, mask, ventilator and fluids (NS, LR, D5 NS with K); It is very important to establish IV access immediately What do children with cardiopulmonary arrest usually have? - correct answer ✅Primary respiratory arrest
Questions & Answers (Grade A+)
maintain adequate gas exchange to meet metabolic demands What are causes of respiratory failure? - correct answer ✅V/Q mismatch, acute lung injury, ARDS, and status asthmaticus What are symptoms of respiratory emergencies? - correct answer ✅Tachypnea, tachycardia, low SaO2, stridor, wheeze, grunting (lower airway), retractions, changes in LOC, decreased breath sounds What are signs of respiratory failure? - correct answer ✅Decompensation results in respiratory failure which presents as bradypnea, bradycardia/arrhythmia What conditions can cause respiratory failure? - correct answer ✅Bronchiolitis, asthma, pneumonia, sepsis/ARDS, upper airway obstruction like croup, epiglottitis, foreign body
Questions & Answers (Grade A+)
What is status asthmaticus? - correct answer ✅Reversible small airway obstruction that is refractory to sympathomimetic and anti- inflammatory agents and that may progress to respiratory failure without prompt and aggressive intervention What causes status asthmaticus? - correct answer ✅Due to severe bronchospasm, excessive mucus secretions, inflammation, and edema of airways What are labs and vitals that you would use to evaluate status asthmaticus? - correct answer ✅CXR, O2 stat, BP, HR, ABG for pH and PaCO2, possible need for intubation; ABG is best and directly tells the level of distress What are goals of treatment for status asthmaticus? - correct answer ✅Attempt to improve ventilation and hypoxemia What are treatments for status asthmaticus? - correct answer ✅Humidified oxygen immediately;
Questions & Answers (Grade A+)
Other causes include near drowning, severe pneumonia, aspiration, and inhalation of noxious chemicals What are the four phases of ARDS? - correct answer ✅Early changes, onset of parenchymal changes, acute respiratory failure with progress in the 2nd to 10th days, and pulmonary fibrosis, pneumonia with progression >10 days; Secondary infections are common When does mortality occur with ARDS? - correct answer ✅Mortality in late phase >80% due to multiple organ failure and systemic hemodynamic instability What labs are drawn for ARDS? - correct answer ✅ABGs! Daily CXR, CBC for infection surveillance, monitor renal, liver, and GI function through labs What is treatment for ARDS? - correct answer ✅Fluids with goal to keep as low as possible as extra fluid will possible invade lungs, pRBC
Questions & Answers (Grade A+)
and inotropes as needed to support perfusion and oxygenation, ventilator support, steroids for some, ECMO What is involved in intubation? - correct answer ✅Equipment: laryngoscope, ETT, stylet, O2, CO2 detector, suction w/catheter, sedation, ventilator; Procedure: insert laryngoscope blade in mouth with tip just past the base of the tongue (oropharynx) and lift up, tip of blade in valecula (should see epiglottis and vocal cords), pass appropriately sized ETT through vocal cords and secure; Provide ETT/bag/ventilation by hand, auscultate both sides of chest to confirm intubation and breath sounds, secure ETT at appropriate depth and obtain CXR What is the head and neck position of the child when intubating? - correct answer ✅Sniffing position to accentuate straightening of the airways
Questions & Answers (Grade A+)
When do intracellular enzymes function best? - correct answer ✅At a pH of 7.25 to 7. What do most metabolic processes produce? - correct answer ✅Acid What causes increased acid production? - correct answer ✅Lactic acid due to ischemia or anaerobic metabolism; Ketoacids from diabetes; Methanol from alcohol ingestion What can alter acid base balance? - correct answer ✅Renal, respiratory, or liver failure decrease acid removal from body; Loss of acid occurs with vomiting/NG suctioning (become alkalotic); Loss of bicarb occurs with diarrhea (become acidotic) What can cause metabolic acidosis with a normal anion gap? - correct answer ✅Renal bicarb loss, loss of bicarb from gut, decreased renal hydrogen ion secretion
Questions & Answers (Grade A+)
What causes increased anion gap in metabolic acidosis? - correct answer ✅Acid accumulation due to lactic acidosis from type A or B, ketoacidosis from insulin deficiency or starvation, or exogenous acids from salicylates What causes type A lactic acidosis? - correct answer ✅Sepsis, cardiac arrest, hypotension, methanol What causes type B lactic acidosis? - correct answer ✅Insulin deficiency, decreased hepatic metabolism What are causes of metabolic alkalosis? - correct answer ✅Hydrogen ion loss due to vomiting, renal loss, diuretics, hypokalemia, low Cl states; Bicarb gain due to sodium bicarb or citrate administration
Questions & Answers (Grade A+)
What does bicarbonate do? - correct answer ✅CO2 combines with water to form carbonic acid which dissociates into bicarb and hydrogen ion (CO2 + H20 = H2CO3 = HCO3 + H); The normal ratio of bicarb to CO2 = 20:1 as long as this ratio remains 20:1, the pH will be 7. How do we know what the main acid/base problem is?
correct answer ✅Whichever value is farthest from normal is likely the main problem; Both can be abnormal, particularly as the body attempts to compensate What are venous pH levels seen in diabetic ketoacidosis? - correct answer ✅Mild: ven pH 7.2-7.3; Moderate: ven pH 7.1-7.19; Severe: ven pH <7.1; Anion gap will be positive What is the treatment for DKA? - correct answer ✅Restoration of fluid volume, inhibition
Questions & Answers (Grade A+)
of lipolysis and return to glucose utilization, replace body salts because they're lost in urine with ketones, but cautious with potassium supplementation Correction of acidosis requires no bicarbonate because it's corrected with fluid and inhibition of lipolysis What is the target goal for blood sugar when treating DKA? - correct answer ✅Regular insulin until glucose < then add D5 and do not let glucose <200; If <120, change to D10 and adjust insulin as needed; Correcting too quickly can lead to cerebral edema What is shock? - correct answer ✅Failure of cardiovascular system to delivery oxygenated blood and substrates to tissues, and to remove toxic metabolics leads to anaerobic metabolism in cells which causes cell damage What is shock characterized by? - correct answer ✅Inadequate tissue perfusion which shows by pallor, cool skin, poor pulses, delayed capillary refill, oliguria, and abnormal mentation
Questions & Answers (Grade A+)
What happens differently with compensation in infants versus older children? - correct answer ✅Infants: increase HR but cannot adjust SVR to change CO; Older children increase SVR and HR What happens in decompensated shock? - correct answer ✅Oxygen and nutrient supply to cells deteriorates further leading to cell breakdown and release of toxic substances; HYPOtension and poor CO, metabolic acidosis and end organ failure, vasoconstriction so cool extremities and mottled appearance especially in acute HF What is the most common cause of shock in children?
correct answer ✅Hypovolemic shock; Causes include dehydration, diabetes, heat illness, burns What is hypovolemic shock? - correct answer ✅Loss of fluid from the intravascular space secondary to inadequate intake or excessive
Questions & Answers (Grade A+)
losses like vomiting, diarrhea, blood loss, capillary leak syndromes, or pathologic renal fluid losses How does hypovolemic shock present? - correct answer ✅Reduced blood volume decreases preload, SV, and CO; Increased sympatho-adrenal activity results in increased heart rate and enhanced myocardial contractility What is treatment for hypovolemic shock? - correct answer ✅Replace fluids or blood volume (pRBC if from hemorrhage); If severe enough, inotropes or vasoconstrictors to maintain BP What is distributive shock? - correct answer ✅A relative hypovolemia occurs when arterial and capillary shunting past tissue beds occurs with an increase in venous capacitance, causing blood to pool
