Ped_resp_emergencies

Ped_resp_emergencies - Respiratory Emergencies in the...

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Respiratory Emergencies in the Pediatric Population
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16 month old boy with wheeze Initial Vitals: HR 160 RR 60 BP 88/50 Temp 38 O2sat on RA 89% CASE 1
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You do your pediatric assessment triangle: Appearance Crying, distressed, looking around, moving all 4 limbs Breathing (work of) Laboured, chest caving in, +++indrawing Circulation Colour OK, N cap refill
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What would you like to do now? Oxygen by mask applied, IV attempt started and pt now on cardiac monitor Airway No stridor audible, no obvious secretions Breathing +++ wheeze with little air entry bilat (inspiratory AND expiratory) Circulation Warm extrem, PPP, cap refill 2 secs
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What would you like to do now? Oxygen Ventolin Atrovent IV Access established – orders? CXR done / pending Blood work Doctor? Venous Gas pH 7.35 pCO2 38 pO2 125
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History : Has had a “cold” for almost 2 days now (mild fever, decreased energy / appetite with cough and runny nose) Started getting wheezy this morning No history of exposure to allergens, inhalants or FB aspiration Family History of Asthma / no smokers / no pets Otherwise healthy with no known allergies
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Continuous Ventolin for 15 mins has little effect Still indrawing RR 65 Still alert and looking around, crying Additional treatment? IV steroids Solucortef 1 mg/kg IV / IM Continue Ventolin Consider racemic Epinephrine (0.5 mls)
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Repeat Venous Gas about 30 mins later pH 7.15 pCO2 55 pO2 120 Eyes rolling back, little crying now … What do you want to do? Drugs? Tube Size? Ketamine 1-2 mg/kg IV Atropine 0.01 mg/kg IV (min 0.1 mg) Succinyl 1 mg/kg IV 4 – 4.5 tube
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Other Options IV Magnesium 25 mg/kg (max 2 gm) IV Epinephrine IV Ventolin Inhalational Anesthetics Methylxanthines Heli - Ox
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Differential Diagnosis of Wheezing H + N Vocal cord dysfunction Chest Asthma Bronchiolitis Foreign Body Aspiration CVS Congestive Heart Failure Vascular Rings
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CAEP Pediatric Asthma Guidelines MILD Nocturnal cough Exertional SOB Increased Ventolin use Good response to Ventolin O2 sat > 95% PEF > 75% (predicted / personal best) ± O2 Ventolin Consider po Steroids Symptoms Pre - Treat Treatment
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MODERATE Normal mental status Abbreviated speech SOB at rest Partial relief with Ventolin and required > than q 4h O2 sat 92%-95% PEF 50-75% (predicted / personal best) O2 100% Ventolin Systemic corticosteroids Consider anticholinergic Symptoms Pre - Treat Treatment CAEP Pediatric Asthma Guidelines
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Ped_resp_emergencies - Respiratory Emergencies in the...

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