jay ped. emergencies
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ObjectivesGroup reviews common pediatric illnesses and
emergencies such as fever acute gastroenteritis,hypoglycemia, hyperglycemia, diabetic
ketoacidosis, status epileptics, Septic shock,respiratory failure and pediatric surgical
emergencies.
Group identifies patient requiring emergencymanagement in relation to specific conditionsmentioned above.
Group discuss diagnosis requiring emergentevaluation and management in relation to specific
conditions mentioned above.
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A Pediatric Emergency care is the care
of children and
teens who are acutely ill or injured
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Objectives of Management of Pediatric
Emergencies
To preserve life
To promote health
To restore health
To alleviate sufferingTo prevent further complication
To decrease Mortality and Morbidity.
P
rovide Healthy citizen for nation
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Definition of Fever :
It is an elevation of body temperature abovenormal.
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Not a disease, its a sign of disease.
Severity is not indication of severity ofunderlying disease.
Fever
Emergency if:
>1040F in any child
>1010F in infant < 3months old
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Anatomical and Physiologic
Characteristics
-Increased metabolic rate
-Largebody surface
-Immature kidneys
-Rapid fluid loss
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Causes:
- Infection
- Inflammatory disease
- Dehydration
- Tumors- Disturbances in temperature
regulating center
- Extravasations of blood in tissue
- Effect of drugs or toxins
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Assessment:
1.Basic principles to be kept in mind
*Newborns temperature varies with environment*Degree of fever does not always reflect severityof the disease.
*Febrile seizures due to rapid rise in temperature
2. History
-physical examination
- laboratory test
3.Attempt to identify the pattern of fever
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Principlesof Management
- Monitor vitals
- Maintain hydration
- Prevent hypothermia
- Administration of antipyretic
- Dietary management
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Managementof fever- Use traditional cooling methods- Minimum clothing's
- Expose skin to air
- Reduce room temperature
- Increase air circulation
- Apply cool moist compress
- Tepid sponging
- -Cold sponging
Take care that temperature should not
increase more than set points.
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Diarrhea
Definition:
It is alteration in consistency and /or frequency of
stool resulting in a net loss of fluid and electrolyte
from the body.
According to W.H.O/ UNICEF :
Acute diarrhea is an attack of sudden onset ,
which lasts usually for three to seven days but
may lasts up to tento fourteen days caused byinfection of the bowel.
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Signs and Symptoms1History
- loose stool
- frequency and consistency, color ,mucus and blood
- vomiting, frequency, vomits nature
- fever
- altered sensorium
- oliguria
- tachypnea
- distention of abdomen
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2. Grades of dehydration
characteristics Mild - Gr.1 Moderate- Gr.2 Severe- Gr.3
% of loss of
fluid
Loss in
ml/kg.
General
appearance
Pulse
0.5%
50ml/kg
Thirsty
Normal
5-10%
50-100ml/kg.
Irritable/
Lethargic
Rapid /normal
>10%
>100ml/kg
Drowsy
Feeble/not
palpable
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Grades of dehydration cont
B.P. Normal decrease Unrecordable
Respiration Normal Normal /rapid Acidotic
Eyeballs Normal Soft Deeply
sunken
Anterior
fontanels
Normal Slightly
depressed
Markedly
depressed
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Grades of dehydration cont
Skin turgor Normal Normal todecrease
Completeloss
Mucous
membrane
Moist dry Very dry
Tears Present Reduced Absent
Urine
output
Normal Decreased Severe
oliguria to
anuria
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3.Investigation
stool Urine
blood
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AssessmentCollect information
- Normal body weight prior to illness
- Number and description of stool patientusually has each day, when well .
- The description of stool (fluidity ,volume,
color and the presence of blood or mucus)
- Fever, abdominal pain ,weight loss.
- Fluid intake
- Frequency of urination
- Degree of dehydration/skin turgor
- State of consciousness
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Principles of management
Correction and restoration of fluid
Useof drugs
Dieteticmanagement
Symptomatictreatment
Treatmentofcomplications
preventivemeasures
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Correction of dehydration
Grade 1-
ORS solution
Plenty oforal fluids and
Continuetobreast feed
Takethechild to health worker
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Treatment of grade 2
Hospital based treatment 100ml/kg ORS in 4hours.
Reassure the client and family members
Monitor vitals
Check skin turgorMaintain intake output
Observe the fluidity and frequency of stool
Maintain personal hygiene
Continue breast milk
Provide coconut water
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Treatment of grade 3-
I.V.Rehydration therapy (Ringer lactate )Shock
Unable to drink
Severely dehydrated
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Fluid management
Fluid till 10kg -100ml/kg/day10-20kg -50ml/kg/day
>20kg - add 20ml/kg/day
Sodium 3meq./kg/day
potassium 2meq./kg/day
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Status Epilepticus
Statusepilepticusis defined as
recurrentorcontinuousseizure
activity lasting longerthan 30minutes
in which the patient does not regain
baselinemental.
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Investigations
Specimen Investigation
Blood Complete blood count
Electrolyte, Glucose, Calcium, Magnesium,
Creatinine, Liver function test,Lactate , Arterial blood gas analysis
Anticonvulsant levels
CSF Biochemistry, Cytology, Bacteriology,viral studies
Urine Routine, microscopy, myoglobin
CT Scan/MRI Brain
EEG
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Management of Status Epilepticus
At: zero minutes
Initiategeneral systemicsupportofthe airway (insert nasal
airway orintubateif needed)Check blood pressure / Begin nasal oxygen / Monitor ECGand respiration./ Check temperature/ Obtain history.
Perform neurologicexamination.
Send sampleserum forevaluation ofelectrolytes,blood ureanitrogen,glucose level,completeblood cell count,toxic drugscreen, and anticonvulsant levels;check arterial blood gasvalues
.
StartIV linecontainingisotonicsaline at a low infusion rate.
Inject 50mLof 50 percentglucoseIV and 100mgofthiamineIV orIM.
Administer lorazepam (Ativan) at0.1to0.15 mg per kgIV (2
mg perminute);ifseizures persist, administer phenytoin at18mg per kgIV (150mg perminute, with an additional 7 mg
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Nursing Diagnosis
1.Risk for injury related to type of seizure
2.Risk for injury related to impaired
consciousness.
3.Interrupted family process related to
child with a chronic illness
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Status Asthmaticus
Severe attack of bronchial asthma with extensive
bronchial obstruction from the beginning or during the
course of episode
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Causes
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Signs and symptoms
Severe persistent dysponea
Respiratory rate over 30per/minute
Prolonged expiration [wheezing]
Hyperactivity of accessory muscles
Inability to speak without pauseCyanosis
Altered consciousness
Respiratory muscle fatigue
Pneumothorax
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MANAGEMENT
Humidified oxygen
Hydration
Correction of metabolic acidosis
Maintain electrolyte
Antibiotics
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Nursing management
Emotional support
Positioning
Assessment of respiratory status
Administration of oxygenAerosol therapy
Postural drainage
I.V. Medication
Restrict overeating
Provide rest
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Aspiration of foreign bodies
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Aspiration of foreign bodies occurs in infants and toddlers
between the of 6 months to 3years of age
Laryngeal
hoarseness of voice,
cough,
aphonia
hemoptysisdyspnea ,
wheezing &
inflammation
Tracheal
Cough ,
hoarseness, dyspnea
Bronchial
Cough, wheeze, blood streaked sputum
atelectasis ,
gagging cough
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Management
Removal of foreign body
Bronchoscopy
AntibioticsAbdominal thrust
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Poisoning
Definition:It is an ingestion or inhalation
of toxic substances which ,when taken into
the body or exposed to the body produce
serious and harmful effect on the body.
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Types of poisoning
- Corrosive poisoning
Acid and Alkali
Hydrocarbons
keroseneLamp oil
Turpentine
Paintthinner and remover
Over doseofmedicinee.g. aspirin,syrups
cleaning agents (phenol/Lysol)
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CONT.
Eyes should be flushed with water
Skin should be cleaned
Induce vomiting
Prevent aspiration
Hospital approach
- Removal of poison
- Observe for symptoms of complications- Emotional support to child & parents
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Non corrosive substance
Decreased amount or activity of substance in G.I.T.
- Gastric lavage
- Administration of charcoal
- Administration of cathartics
- Forced diuresis for excretion of waste
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Corrosive substances- NOT to remove by lavage / emesis
- Neutralization is not advised- Provide patent airway- Analgesics
Hydrocarbon- induce vomiting- assess vitals- symptomatic management
- observation
- emotional support- counselling
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EndocrineDisorders
-DKA
-Hypoglycemia
-Hyperglycemia
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Hypoglycemia
Causes : (in older children)
Poisonings/drugs
Liver diseaseAmino acid & organic acid disorders
Systemic disease
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Hypoglycemia
CNS and cardiopulmonary
disturbances.
Hypotonia
Lethargy, apathy
Poor feedingJitteriness,seizures
Congestive heart failure
Cyanosis
ApneaHypothermia
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Hypoglycemi
Clinical manifestations associatedwith activation of theautonomic
nervous system
Anxiety,tremulousness
DiaphoresisTachycardia
Pallor
Hunger, nausea, and vomiting
n ca man es a ons o ypog ycorr ac a or
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n ca man es a ons o ypog ycorr ac a or
neuroglycopenia
Headache
Mental confusion, staring, behavioralchanges, difficulty concentrating
Visual disturbances (eg, decreased
acuity, diplopia)
DysarthriaSeizures
Ataxia, somnolence, coma
Stroke (hemiplegia, aphasia),
paresthesias, dizziness, amnesia,decerebrate or decorticate posturing
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Treatment of hypoglycemia
Anti hypoglycemic agent:
Dextrose
DiazoxideOctreotide
Glucagon
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Signs and symptoms DKA
Abdominal Pain
Nausea/vomitingDehydration
LOC
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DKA Treatment
Fluids
InsulinElectrolyteimbalances
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Septic Shock
Peripheral hypoperfusion dueto
septicemia (blood infection)
Mostcommon in younginfants,
debilitated children
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PATHOPHYSIOLOGY
Severe peripheral vasodilation
Fluid loss fromvesselstointerstitial
space
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Signs/Symptoms
Warm shock
Tachycardia, full pulses
Slow capillary refill
Fever
Flushed skin
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Signs/Symptoms
Cold shock
Tachycardia, weak pulses
Slow capillary refill
Cool, pale,mottled skin
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Management
100%oxygen
RLin 20cc/kgboluses
Fill dilated vascularspace
Preventonsetof cold shock
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Respiratory failure
Clinical manifestations
Cardinal signs:
Restlessness
TachypneaTachycardia
Flaring nares
Chest wall retractions
Expiratory gruntWheezingor prolonged expiration
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Clinical manifestations
More SeverHypoxiaHypotension or hypertension
Dimnessofvision
StuporComa
Dyspnea
Depressed respirations
Bradycardia
Cyanosis (peripheral orcentral)
Principles of management:
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Principles of management:
Maintain ventilation and maximize
oxygen delivery
Correct hypoxia and hypercapnea
Treat the underlying cause
Minimize extrapulmonary organ
failure
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