logging in or signing up Pediatric Medical aSGuest1135 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1857 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: October 16, 2008 This Presentation is Public Favorites: 3 Presentation Description No description available. Comments Posting comment... By: abey_dude (32 month(s) ago) i want to download too.... Saving..... Post Reply Close Saving..... Edit Comment Close By: mvenki (33 month(s) ago) i want to download Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Pediatric Medical Emergencies : Pediatric Medical Emergencies Fever : Fever Not a disease, it’s a sign of disease Severity is not indication of severity of underlying disease Usually good Fever : Fever Treat child, not thermometer How do you know he has a fever? How sick does he look? How long has he been listless, weak? Will he tolerate being held on mom’s shoulder? Does he cry even when consoled? Fever : Fever Educate parents Tempra, Tylenol Avoid aspirin Sponge with water at 96 - 970F Do not say “tepid”, “lukewarm” Do not leave kid unattended Fever : Fever Educate parents Do not Use ice water “Bundle” Use alcohol rubs Use tap water enemas Fever : Fever Emergency if: >1040F in any child >1010F in infant < 3months old Septic Shock : Septic Shock Peripheral hypoperfusion due to septicemia (blood infection) Most common in young infants, debilitated children Septic Shock : Septic Shock Pathophysiology Severe peripheral vasodilation Fluid loss from vessels to interstitial space Septic Shock : Septic Shock Signs/Symptoms “Warm” shock Tachycardia, full pulses Slow capillary refill Fever Flushed skin Septic Shock : Septic Shock Signs/Symptoms “Cold” shock Tachycardia, weak pulses Slow capillary refill Cool, pale, mottled skin “Cold” shock has 90% mortality Febrile infant + Won’t tolerate being held to shoulder =Septic Shock : Febrile infant + Won’t tolerate being held to shoulder =Septic Shock Septic Shock : Septic Shock Management 100% oxygen LR in 20cc/kg boluses Fill dilated vascular space Prevent onset of “cold” shock Meningitis : Meningitis Inflammation of meninges Increased CSF production Cerebral /meningeal edema Increased intracranial pressure Meningitis : Meningitis Signs/Symptoms: Older Children Fever Headache Stiff neck (can’t touch chin to chest) Decreased LOC Seizures Meningitis : Meningitis Signs/Symptoms: Infants Difficulty feeding Irritability High-pitched cry Bulging fontanelle Classic meningeal signs possibly absent Meningitis : Meningitis Meningococcemia Petechial rash Septic shock DIC Reyes’ Syndrome : Reyes’ Syndrome Non-communicable Affects ages 2 -19 Mostly toddlers, pre-schoolers Reyes’ Syndrome : Reyes’ Syndrome Pathophysiology Dysfunction of hepatic urea cycle enzymes Increased protein breakdown leading to rise in blood ammonia levels Diffuse cerebral edema Reyes’ Syndrome : Reyes’ Syndrome History Previously healthy child Recovering from viral illness Frequently chicken pox or influenza Frequently received aspirin during illness Reyes’ Syndrome : Reyes’ Syndrome Signs/Symptoms Prolonged, violent vomiting Varying degrees of personality change Unusual behavior Irritability, drowsiness History of vomiting + Altered LOC + Recovering from virus = Reyes’ Syndrome : History of vomiting + Altered LOC + Recovering from virus = Reyes’ Syndrome Crankiness in infant + Recovering from virus = Reye’s Syndrome : Crankiness in infant + Recovering from virus = Reye’s Syndrome Reyes’ Syndrome : Reyes’ Syndrome Management Avoid overstimulation IV’s at tko Decrease ICP by controlled hyperventilation Seizures : Seizures Second most common pediatric complaint after fever Can result from same causes as adult seizures Seizures : Seizures Pedi seizures can also result from fever Most common from 6 months to 3 years Caused by rapid rise in body temperature Short-lived Does not recur during that illness Seizures : Seizures Potential dangers Aspiration Trauma Missed diagnosis Seizures : Seizures “Febrile seizure” diagnosis risky in field Seizures : Seizures History Previous seizures? Previous febrile seizures? Number of seizures this episode? What did seizure look like? Seizures : Seizures History Remote, recent head trauma? Diabetes? Headache, stiff neck? Petechial rash? Seizures : Seizures History Possible ingestion? Medications? Seizures : Seizures Physical exam ABC’s Neurological exam Signs of injury? Signs of dehydration? Rash, stiff neck? Bulging, depressed anterior fontanelle? Seizures : Seizures Management--if actively seizing: Place on floor away from furniture Position on side Prevent injury Do not restrain Do not force anything between teeth Seizures : Seizures Management--following seizure Check ABC’s, suction prn Assure good oxygenation, ventilation Vascular access Check blood glucose, if < 70, give D25W If febrile, remove excess clothing, sponge with water to cool patient. Status Epilepticus : Status Epilepticus Diazepam: 0.3 mg/kg to 5mg if < 5 years old 0.3 mg/kg to 10mg if > 5 years old Status Epilepticus : Status Epilepticus Administer diazepam slowly Anticipate respiratory arrest, hypotension Rectal route is alternative when vascular access cannot be obtained Most Common Cause of Seizure Deaths = Anoxia : Most Common Cause of Seizure Deaths = Anoxia Hypoglycemia : Hypoglycemia More common than in adults, especially in newborns Signs/symptoms may mimic hypoxia Hypoglycemia : Hypoglycemia Check blood glucose in any child with: Seizures Decreased LOC Severe dehydration Known hypoglycemia or diabetes Pallor, sweating, tachycardia, tremors Hypoglycemia : Hypoglycemia Management Oral sugar if tolerated 2cc/kg D25W, if oral sugar not possible ? Glucagon 1 mg IV or IM Reassess every 20 - 30 minutes Diabetes Mellitus : Diabetes Mellitus Typically insulin-dependent Complications Hypoglycemia Hyperglycemia, DKA Diabetes Mellitus : Diabetes Mellitus DKA therapy same as for severe dehydration Not every diabetic is known diabetic Every diabetic must have first hyperglycemic episode Coma : Coma Disturbance in consciousness; patient unresponsive to stimuli Causes Metabolic Structural Coma : Coma Metabolic causes: Anoxia Drug Toxicity Hypoglycemia Epilepsy DKA Reyes’ Syndrome Infections Increased ICP (Edema) Coma : Coma Structural causes: Trauma Tumor CVA Coma Control ABC’s before worrying about cause!! : Coma Control ABC’s before worrying about cause!! Coma : Coma Airway/Breathing All patients with decreased LOC receive oxygen!! Evaluate for ineffective breathing patterns Controlled hyperventilation if increased ICP suspected Coma : Coma Circulation Control bleeding Give fluid boluses for hypovolemia Disability AVPU, pupils Check blood glucose Coma : Coma Management Support ABC’s 2 cc/kg D25W glucose < 70 mg% Narcan 0.1 mg/kg IV/IM/SQ/ET Elevate head 300 if C-spine injury not suspected and patient not in shock Rapid transport Reassess, Reassess, Reassess Poisoning : Poisoning Incidence Accidental: 75% children < 5 years old Overdose: School-age, adolescents Poisoning : Poisoning Assessment Remove to safe environment Control airway Support breathing: 100% O2 Circulation - vasodilation, decreasing myocardial tone, hypoxia Blood glucose Poisoning : Poisoning History What? When? How much? Vomiting? Coughing? Seizures? Altered LOC? Ipecac? Poisoning : Poisoning Management Support ABC’s Consider D25W, Narcan Ipecac?/Charcoal? Transport samples Consult poison control Treat patient, not poison!! Near-Drowning : Near-Drowning A leading cause of childhood death Two major groups Toddlers Adolescents Near-Drowning : Near-Drowning Pathophysiology Hypoxia Acidosis Hypothermia Aspiration, pulmonary edema, atelectasis Near-Drowning : Near-Drowning Management Protect rescuers Assume C-spine injury 100% oxygen Decompress stomach early with gastric tube Near-Drowning : Near-Drowning Management Remember mammalian diving reflex!! Think about underlying causes-- ? Child abuse All near-drownings are transported regardless of how good they look!! You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Pediatric Medical aSGuest1135 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1857 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: October 16, 2008 This Presentation is Public Favorites: 3 Presentation Description No description available. Comments Posting comment... By: abey_dude (32 month(s) ago) i want to download too.... Saving..... Post Reply Close Saving..... Edit Comment Close By: mvenki (33 month(s) ago) i want to download Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Pediatric Medical Emergencies : Pediatric Medical Emergencies Fever : Fever Not a disease, it’s a sign of disease Severity is not indication of severity of underlying disease Usually good Fever : Fever Treat child, not thermometer How do you know he has a fever? How sick does he look? How long has he been listless, weak? Will he tolerate being held on mom’s shoulder? Does he cry even when consoled? Fever : Fever Educate parents Tempra, Tylenol Avoid aspirin Sponge with water at 96 - 970F Do not say “tepid”, “lukewarm” Do not leave kid unattended Fever : Fever Educate parents Do not Use ice water “Bundle” Use alcohol rubs Use tap water enemas Fever : Fever Emergency if: >1040F in any child >1010F in infant < 3months old Septic Shock : Septic Shock Peripheral hypoperfusion due to septicemia (blood infection) Most common in young infants, debilitated children Septic Shock : Septic Shock Pathophysiology Severe peripheral vasodilation Fluid loss from vessels to interstitial space Septic Shock : Septic Shock Signs/Symptoms “Warm” shock Tachycardia, full pulses Slow capillary refill Fever Flushed skin Septic Shock : Septic Shock Signs/Symptoms “Cold” shock Tachycardia, weak pulses Slow capillary refill Cool, pale, mottled skin “Cold” shock has 90% mortality Febrile infant + Won’t tolerate being held to shoulder =Septic Shock : Febrile infant + Won’t tolerate being held to shoulder =Septic Shock Septic Shock : Septic Shock Management 100% oxygen LR in 20cc/kg boluses Fill dilated vascular space Prevent onset of “cold” shock Meningitis : Meningitis Inflammation of meninges Increased CSF production Cerebral /meningeal edema Increased intracranial pressure Meningitis : Meningitis Signs/Symptoms: Older Children Fever Headache Stiff neck (can’t touch chin to chest) Decreased LOC Seizures Meningitis : Meningitis Signs/Symptoms: Infants Difficulty feeding Irritability High-pitched cry Bulging fontanelle Classic meningeal signs possibly absent Meningitis : Meningitis Meningococcemia Petechial rash Septic shock DIC Reyes’ Syndrome : Reyes’ Syndrome Non-communicable Affects ages 2 -19 Mostly toddlers, pre-schoolers Reyes’ Syndrome : Reyes’ Syndrome Pathophysiology Dysfunction of hepatic urea cycle enzymes Increased protein breakdown leading to rise in blood ammonia levels Diffuse cerebral edema Reyes’ Syndrome : Reyes’ Syndrome History Previously healthy child Recovering from viral illness Frequently chicken pox or influenza Frequently received aspirin during illness Reyes’ Syndrome : Reyes’ Syndrome Signs/Symptoms Prolonged, violent vomiting Varying degrees of personality change Unusual behavior Irritability, drowsiness History of vomiting + Altered LOC + Recovering from virus = Reyes’ Syndrome : History of vomiting + Altered LOC + Recovering from virus = Reyes’ Syndrome Crankiness in infant + Recovering from virus = Reye’s Syndrome : Crankiness in infant + Recovering from virus = Reye’s Syndrome Reyes’ Syndrome : Reyes’ Syndrome Management Avoid overstimulation IV’s at tko Decrease ICP by controlled hyperventilation Seizures : Seizures Second most common pediatric complaint after fever Can result from same causes as adult seizures Seizures : Seizures Pedi seizures can also result from fever Most common from 6 months to 3 years Caused by rapid rise in body temperature Short-lived Does not recur during that illness Seizures : Seizures Potential dangers Aspiration Trauma Missed diagnosis Seizures : Seizures “Febrile seizure” diagnosis risky in field Seizures : Seizures History Previous seizures? Previous febrile seizures? Number of seizures this episode? What did seizure look like? Seizures : Seizures History Remote, recent head trauma? Diabetes? Headache, stiff neck? Petechial rash? Seizures : Seizures History Possible ingestion? Medications? Seizures : Seizures Physical exam ABC’s Neurological exam Signs of injury? Signs of dehydration? Rash, stiff neck? Bulging, depressed anterior fontanelle? Seizures : Seizures Management--if actively seizing: Place on floor away from furniture Position on side Prevent injury Do not restrain Do not force anything between teeth Seizures : Seizures Management--following seizure Check ABC’s, suction prn Assure good oxygenation, ventilation Vascular access Check blood glucose, if < 70, give D25W If febrile, remove excess clothing, sponge with water to cool patient. Status Epilepticus : Status Epilepticus Diazepam: 0.3 mg/kg to 5mg if < 5 years old 0.3 mg/kg to 10mg if > 5 years old Status Epilepticus : Status Epilepticus Administer diazepam slowly Anticipate respiratory arrest, hypotension Rectal route is alternative when vascular access cannot be obtained Most Common Cause of Seizure Deaths = Anoxia : Most Common Cause of Seizure Deaths = Anoxia Hypoglycemia : Hypoglycemia More common than in adults, especially in newborns Signs/symptoms may mimic hypoxia Hypoglycemia : Hypoglycemia Check blood glucose in any child with: Seizures Decreased LOC Severe dehydration Known hypoglycemia or diabetes Pallor, sweating, tachycardia, tremors Hypoglycemia : Hypoglycemia Management Oral sugar if tolerated 2cc/kg D25W, if oral sugar not possible ? Glucagon 1 mg IV or IM Reassess every 20 - 30 minutes Diabetes Mellitus : Diabetes Mellitus Typically insulin-dependent Complications Hypoglycemia Hyperglycemia, DKA Diabetes Mellitus : Diabetes Mellitus DKA therapy same as for severe dehydration Not every diabetic is known diabetic Every diabetic must have first hyperglycemic episode Coma : Coma Disturbance in consciousness; patient unresponsive to stimuli Causes Metabolic Structural Coma : Coma Metabolic causes: Anoxia Drug Toxicity Hypoglycemia Epilepsy DKA Reyes’ Syndrome Infections Increased ICP (Edema) Coma : Coma Structural causes: Trauma Tumor CVA Coma Control ABC’s before worrying about cause!! : Coma Control ABC’s before worrying about cause!! Coma : Coma Airway/Breathing All patients with decreased LOC receive oxygen!! Evaluate for ineffective breathing patterns Controlled hyperventilation if increased ICP suspected Coma : Coma Circulation Control bleeding Give fluid boluses for hypovolemia Disability AVPU, pupils Check blood glucose Coma : Coma Management Support ABC’s 2 cc/kg D25W glucose < 70 mg% Narcan 0.1 mg/kg IV/IM/SQ/ET Elevate head 300 if C-spine injury not suspected and patient not in shock Rapid transport Reassess, Reassess, Reassess Poisoning : Poisoning Incidence Accidental: 75% children < 5 years old Overdose: School-age, adolescents Poisoning : Poisoning Assessment Remove to safe environment Control airway Support breathing: 100% O2 Circulation - vasodilation, decreasing myocardial tone, hypoxia Blood glucose Poisoning : Poisoning History What? When? How much? Vomiting? Coughing? Seizures? Altered LOC? Ipecac? Poisoning : Poisoning Management Support ABC’s Consider D25W, Narcan Ipecac?/Charcoal? Transport samples Consult poison control Treat patient, not poison!! Near-Drowning : Near-Drowning A leading cause of childhood death Two major groups Toddlers Adolescents Near-Drowning : Near-Drowning Pathophysiology Hypoxia Acidosis Hypothermia Aspiration, pulmonary edema, atelectasis Near-Drowning : Near-Drowning Management Protect rescuers Assume C-spine injury 100% oxygen Decompress stomach early with gastric tube Near-Drowning : Near-Drowning Management Remember mammalian diving reflex!! Think about underlying causes-- ? Child abuse All near-drownings are transported regardless of how good they look!!