ENPC 2022 Study Guide with Complete Solution

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ENPC 2022 Study Guide with Complete Solution Pediatric triangle ✔✔appearance work of breathing circulation to skin General appearance considerations ✔✔Tone Interactiveness: drawn to sounds or people. Wants to play Consolability Look/Gaze Speech/cry Work of breathing: ✔✔Increased work of breathing evidenced by tachypnea, stridor, grunting, retractions, accessory musles, nasal flaring, head bobbing, abnormal positioning Circulation to Skin ✔✔Observe palor mottling cyanosis Sick, Sicker, Sickest ✔✔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 ✔✔hypoxia hypoglycemia Blood pressure norms ✔✔Hypotension: Less than 70 + (2 x age in years) Widening pulse pressure = increased ICP Narrowing pulse pressure = hypovolemic shock Crying child ✔✔Vigorous = good weak = sick high-pitched = increased ICP "Fussiness" = red flag Respiratory distress indicated by: ✔✔increased heart rate skin color changes incrased work of breathing wheezing diaphoresis abnormal airwa sounds Respiratory failure signs ✔✔fatigue and become lethargic hypoxia hypercarbia General airway interventions ✔✔Allow child to stay in most comfortable position Give O2 to maintain it above 92% O2 does NOT measure ventilation Croup ✔✔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 ✔✔albuterol, duo neb and oral steroid Bronchiolitis/RSV ✔✔Assessment: 1-3 days nasal congestion fever, cough, respiratory distress with wheezing and crackles. Dehydration and tachypnea interventions: nasla suctioning, fluids sever: heated, high flow nasal cannula O2 Discharge: lasts 2-3 weeks; nasal suctioning; monitor hydration treating hypoglycemia ✔✔obtain glucose for anyone who is not awake and alert treat kids with 2-4ml/kg of D25W When to perform blood glucose test? ✔✔When the child is not awake and alert or AMS is suspected Preventing Secondary brain injury in TBI ✔✔prevent hypotension and hypoxia cuffed vs uncuffed tube ✔✔uncuffed= (age in years/4) + 4 cuffed= (age in years/4) + 3.5 fluid bolus formula ✔✔infant: 10ml/kg kid: 20ml/kg normal vitals ✔✔pg 52 blood glucose normal ages 5-11 ✔✔72-140 Cardiac Assessment ✔✔Trend pulse and pulse pressure palapate upper and lower extremity pulses symptoms of CHF ✔✔poor feeding, irritability, fatigue easily with rapid resp rate, increased work of breathing Ass and Interventions similar to adults Myocarditis Assessment and treatment ✔✔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 ✔✔Tachycardia, tacypnea; AMS; slight increaes in diastolic pressure Intervention: Stop bleed; give fluids and RBC; balanced therapy; offer pedialyte if not NPO Cardiogenic shock ✔✔Intervention: expert consult; supportive care to decrease O2 and metabolism demands; slow fluids; treat hpotension while decreasing afterload; vagal maneuver; vasopressors Obstructive Shock ✔✔Assessment: Cardiac tamponade- muffled heart sounds and pulsluss paradoxus; tension pneumo- asymmetrical chest rise and fall Intervention: pericardiocentesis; needle thoracentesis; antigoagulation or surgical intervention; treat ductal dependent lesion Anaphylactic Shock ✔✔remove pathogen fluids epi Neurogenic ✔✔spinal motion restriction

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