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87 Cards in this Set
- Front
- Back
characteristics of 0 to 2 months
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-Spend most time sleeping or eating
-Respond mainly to physical stimuli -Have limited head control -Predisposed to hypothermia -Express themselves largely through crying -Are not able to tell difference between parents and strangers |
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characteristics of 2 to 6 months
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-Are more active and social
-Recognize caregivers -4 months of age, able to hold their heads up -May follow bright light or objects with eyes -Increased awareness of surroundings -Persistent crying, irritability, or lack of eye contact can be sign of significant illness, depressed mental status, delay in development. |
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characteristics of 6 to 12 months
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Can sit unsupported
Reach for objects Becoming more mobile More aware of surroundings Explore their own bodies Begin teething and placing things in mouth Babbling common |
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toddler
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(1- 3 years of age) may have stranger anxiety
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assessment considerations age 6 to 12 years
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Can understand difference between emotional and physical pain.
Give appropriate choices and control when possible. Respect patient’s modesty. Rewarding the school-age child after a procedure can be very helpful. |
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Anatomy of childs airway differs from adults....
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-Tongue takes up more room.
-Larynx is higher and more anterior. -Airway is narrower. -Neck and trachea are shorter. -Infants suck air in when they cry. -Gastric distention can interfere with movement of diaphragm, resulting in hypoventilation. -If infant nasal passages are blocked by secretions, they may not have intuition to open mouths to breathe. |
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Pediatric respiratory considerations
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-Tidal volume is similar to adolescents and adults, but metabolic oxygen demand is doubled.
-Infants Need to breathe faster than older child and Use diaphragm during inspiration -Infants and children are highly susceptible to hypoxia. |
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Proportionally, children have ________circulating blood volume than adults
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larger
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______________, in a child, often indicates impending cardiopulmonary arrest.
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Hypotension
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In children, Spinal cord injuries are ________ common
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less
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In child bone trauma, Injury to___________ may result in developmental abnormalities.
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epiphyseal plate
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The following should increase your index of suspicion for child abuse:
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-Conflicting information from caregivers
-Bruises or other injuries inconsistent with MOI -Injuries inconsistent with child’s age and developmental abilities -Anger or indifference about child’s injury -Child appears scared by caregiver’s presence |
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pediatric assessment triangle (PAT) .
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Appearance
(Assess adequacy of Ventilation; Oxygenation; Brain perfusion; Body homeostasis; CNS function) TICLS mnemonic Evaluate LOC using AVPU scale. Observe from distance. Work of breathing Tachypnea Abnormal airway noise Retractions of intercostal muscles or sternum Way patient positions himself or herself Circulation - skin |
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Abnormal LOC in infants/children characterized by:
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Age-inappropriate behavior or interactiveness
Poor muscle tone Poor eye contact |
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How is pulse assessed in infants and children?
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In infants, palpate brachial or femoral pulse.
In children older than 1 year, palpate carotid pulse. |
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Transport decision- If less than ______ lb, transport in car seat.
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40 lb
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Infants, toddlers, preschool-age children should be assessed starting at ______and ending at _______.
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feet
head. |
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Assessing Level of hydration in children
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-Assess skin turgor, note presence of tenting.
-In infants, note whether fontanelles are sunken or flat. -Determine whether child is producing tears when crying. -Determine if oral mucosa is moist or dry. -ask how many diapers they've gone through in last 24 hrs |
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Blood pressure is usually not assessed in children younger than _____________.
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3 years.
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best indication of circulatory status is
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Assessment of skin
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Infections causing airway obstruction.
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Croup
Epiglottitis |
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Respiratory Emergencies Pneumonia Presentation:
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-Unusual rapid breathing
-Nasal flaring -Tachypnea -Crackles -Hypothermia or fever -Unilateral diminished breath sounds Pediatric patient treatment: Primary treatment will be supportive. Monitor airway and breathing status. If warranted: Administer supplemental oxygen. Establish IV or IO access en route. |
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Bronchiolitis S&S, Tx
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Viral infection that causes inflammation of the bronchioles
Bronchioles become inflamed, swell, and fill with mucus. Look for signs of dehydration. Shortness of breath and fever may be present Treatment Maintain a calm demeanor when approaching. Allow for a position of comfort. Treat airway and breathing problems. Call early for paramedic backup. |
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Pertussis (whooping cough) S&S, Tx
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-Disease caused by a bacterium that is spread through respiratory droplets
-Not common in United States -Cold-like symptoms -Coughing becomes more severe and is characterized by distinctive whoop sound. -Keep airway patent and transport. -Communicable disease -Practice standard precautions. |
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Oxygen Delivery techniques for peds
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Blow-by technique
Nasal cannula Nonrebreathing mask Bag-mask device |
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difference in adult vs child response to hypoxia
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Adults become hypoxic, heart gets irritable, sudden cardiac death occurs from arrhythmia.
Children become hypoxic and their hearts slow down, becoming more bradycardic. |
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Signs of shock in children include:
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Tachycardia
Poor capillary refill (> 2 seconds) Decrease in urine output Absence of tears Sunken or depressed fontanelle (infants) Changes in LOC and behavior |
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Assessing circulation, pay attention to:
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Pulse
Skin signs Capillary refill time Skin color |
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Shock Tx in children
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Ensure airway is open; prepare for artificial ventilation.
Control bleeding. Give supplemental oxygen. Continue to monitor airway and breathing. Position dictated by local protocol. Keep warm with blankets and heat. Establish vascular access and administer normal saline. Provide immediate transport. Contact paramedic backup as needed. Allow caregiver to accompany whenever possible. |
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catheter sizes for peds
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20-,22-,24-, and 26-gauge
Butterfly catheters |
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IO infusion contraindicated if
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a secure IV is available or if possible fracture exists.
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If too much fluid is administered, overload can result and cause acute ______ side heart failure and ____________.
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left
pulmonary edema. |
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Status epilepticus = Seizures that ....
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continue every few minutes without regaining consciousness or last longer than 30 minutes
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Febrile Seizures are common in children between______ (ages) and is caused by
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Common in children between 6 months and 6 years
Caused by abrupt rise in body temperature. May be sign of more serious problem. Provide cooling measures. |
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Meningitis S&S
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-Changes can range from confusion to lethargy and/or -inability to understand commands or interact appropriately.
-pain that accompanies movement. -Often results in characteristic stiff neck -In an infant, increasing irritability and a bulging fontanelle without crying. -Often leads to shock and death -Children present with small, pinpoint, cherry-red spots or larger purple/black rash. |
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An increase in body temperature
of __________or higher are abnormal and can be caused by______________ |
100.4ºF (38ºC)
Infection Status epilepticus Neoplasm |
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____________ is number one killer of children in US
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Trauma
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JumpSTART triage system
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Intended for pediatric patients younger than 8 years weighing less than 100 lb
Decision points=walking? spontaneous breathing; RR<15 or >45; appropriate response to pain Green: Minor Yellow: Delayed treatment Red: Immediate response Black: Deceased or expectant deceased |
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Leading cause of death in infants younger than 1 year
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Sudden Infant Death Syndrome
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SIDS risk factors
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Mother younger than 20 years old
Mother smoked during pregnancy Low birth weight Baby is placed on his or her stomach in crib |
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Classic ALTE is characterized by
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Cyanosis
Apnea Distinct change in muscle tone Choking or gagging |
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ages for: Infancy; Toddlers; Preschool-age ; School-age;
Adolescents |
Infancy is the first year of life.
Toddlers are 1 to 3 years of age. Preschool-age children are 3 to 6 years of age. School-age children are 6 to 12 years of age. Adolescents are 12 to 18 years of age. |
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The three keys to successful use of bag-mask device in a child are
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(1) have appropriate equipment in right size;
(2) maintain a good face-to-mask seal; and (3) ventilate at appropriate rate and volume. |
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How does a child’s anatomy differ from an adult’s anatomy?
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There are several important anatomic differences between children and adults. A child’s head—specifically the occiput—is proportionately larger. The tongue and epiglottis are also proportionately larger, and the epiglottis is floppier and more omega-shaped. The child’s airway is narrower at all levels, and the trachea is less rigid and easily collapsible.
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Febrile seizures are characterized by ______________ and last less than _________minutes;
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generalized tonic-clonic activity
15 |
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You respond to a sick child late at night. The child appears very ill, has a high fever, and is drooling. He is sitting in a tripod position, struggling to breathe. You should suspect:
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This child has all the classic signs of epiglottitis: high fever, drooling, and severe respiratory distress. Epiglottitis is a potentially life-threatening bacterial infection that causes the epiglottis to swell rapidly and potentially obstruct the airway.
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Treatment for a semiconscious child who swallowed an unknown quantity of pills includes:
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monitoring the child for vomiting, administering oxygen, and transporting.
Do not give activated charcoal to any patient who is not conscious and alert enough to swallow. Induction of vomiting is not indicated for anyone—regardless of age. |
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the mnemonic CHILD ABUSE to assess a child for signs of abuse,
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The mnemonic CHILD ABUSE stands for
-Consistency of the injury with the child’s developmental age, -History inconsistent with the injury, -Inappropriate parental concerns, -Lack of supervision, -Delay in seeking care, -Affect, -Bruises of varying stages, -Unusual injury patterns, -Suspicious circumstances, and -Environmental clues. |
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A 4-year-old girl fell from a second-story balcony and landed on her head. She is unresponsive; has slow, irregular breathing; has a large hematoma to the top of her head; and is bleeding from her nose. You should:
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manually stabilize her head, open her airway with the jaw-thrust maneuver, insert an airway adjunct, and begin assisting her ventilations with a bag-mask device.
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by age ___ babies should make eye contact
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6 mo
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fontanelles close at age
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18 months
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always assess fontanelles in an infant, looking for:
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bulging=Increased ICP (menengitis, encephalitis)
sunken=dehydration |
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tracheal tugging
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child's trachea tends to draw into the neck in respirtory distress
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until age ____ infants breath through their nose,
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4-6 months
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airway management considerations in children:
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-keep the nares clear in children younger than 6 months
-avoid hyper-extension of the neck -keep airway clear of all secretions -caution using airway adjuncts as tissues are soft, use positioning whenever possible |
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respirtory tidal volume and oxygen demand in children vs adults
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same tidal volume but child has double the O2 demand.
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"belly breathers"
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refers to childs use of diaphram vs chest muscles to breathe (pressure on abdomen can restrict breathing)
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neonate: age; pulse and RR rates
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0-1 month
RR=30-60 HR=100-180 |
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Infant: age; pulse and RR rates
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1 month - 1 year
RR=25-50 HR=100 - 160 |
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Toddler: age; pulse and RR rates
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1-3 years
RR=20-30 HR=90-150 |
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Preschool: age; pulse and RR rates
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3-6 years
RR=20-25 HR=80-140 |
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School age: age; pulse and RR rates
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6-12 years
RR=15-20 HR=70-120 |
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Adolescent: age; pulse and RR rates
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12-18 years
RR=12-20 HR=60-100 |
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tachcardia vs bradycardia in children
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tachcardia = shock;
bradycardia= severe hypoxia (ominous sign) even in presence of normal blood pressure |
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children are more susceptible to hypothermia due to:
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-larger BSA/weight ration
-thinner skin -limited glycogen stores |
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Pediatric assessment: TICLS mnemonic to assess "appearance" in the PAT triangle =
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Tone-muscle movement/ resistance
Interactiveness - Alert? Aware of others? grasp objects presented? Consolability - consolable or inconsolable? Look or gaze - fix on a face or "nobody home" Speech or cry - strong & spontaneous or weak/ high-pitched, confused? |
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when assessing a childs "work of breathing" look for:
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airway sounds - snoring, stridor, grunting
posturing - sniffing , tripod, refusing to lie down Retractions - subclavicular, intercostal, head bobing Flaring - nasal flaring on inspiration Tachypnea |
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Acrocyanosis
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normal=blue hands or feet in infants < 2 months old who are cold
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cap refill time is most reliable in children younger than___ years
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6
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Pediatric Glascow Coma Scale (infants)
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Best eye response: (E)
4.Eyes opening spontaneously 3.Eye opening to speech 2.Eye opening to pain 1.No eye opening or response Best verbal response: (V) 5.Smiles, oriented to sounds, follows objects, interacts 4.Cries but consolable, inappropriate interactions. 3.Cries or screams persistently to pain. 2.grunts or moans to pain. 1.No verbal response. Best motor responses: (M) 6.Infant moves spontaneously or purposefully 5.Infant withdraws from touch 4.Infant withdraws from pain 3.Abnormal flexion to pain for an infant (decorticate response) 2.Extension to pain (decerebrate response) 1.No motor response Any combined score of less than eight represents a significant risk of mortality. |
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apical pulse
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auscultating HR over chest
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bradycardia rates in infants and newborns
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newborns<100
infants<80 |
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begin CPR in infant or child with HR < ______
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60
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infection of the childs airway above the vocal cords is likely
infection of the childs airway below the vocal cords is likely |
Epiglottis
croup (=stridor) |
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limit suctioning times to ___ seconds in infants and ___ in children
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5
10 |
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Albuterol sulfate Nebulizer dose for children
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2.5 mg/3 mL; 0.083% (unit dose)
◾ 0.05 mg/kg to 0.15 mg/kg (min: 1.25 mg; max: 2.5 mg), 3 times (20 minutes between) |
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BVM children with RR of:
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<12 or
>60 |
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NRB can't be used for blow-by O2 because of
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one-way valve (use drinking cup or other improvised device)
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when placed properly the IO needle will rest in the _________
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medullary canal
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use IO when
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unable to get IV in 3 tries or after 90 seconds in critically ill child.
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to miss the epiphyseal plate IO should be inserted
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two fingers below knee on medial side of leg
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IO complications:
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compartment syndrome
failed infusion growth plate injury osteomyelitis skin infection bony fracture |
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Volutrol
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pediatric microdrip set
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laryngotracheobronchitis
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Croup
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assessing RR in child <3 count
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abdomen rises in 30 seconds
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classic apparent life threat event is characterized by
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distinct change in muscle tone
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____ is the 2nd most common cause of cardiopulmonary arrest in children
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shock
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