1 Pediatric Respiratory and Pediatric Respiratory and Shock Assessment Shock Assessment Shock Assessment Shock Assessment Scottie B. Day, M.D. Assistant Professor Heinrich A. Werner Division of Pediatric Critical Care Director, Pediatric Transport and Outreach Kentucky Children’s Hospital/UK Healthcare Background Background • UK College of Medicine, 2002 • Indiana University Internal Medicine/Pediatrics Residency, 2006 • Riley Hospital for Children Transport Physician, 2004-2006 • Cincinnati Children’s Hospital Pediatric Critical Care Fellow, 2006-2009 Fellow, 2006 2009 • Kaiser Moanalua Hospital, Honolulu, HI • Maui Memorial Medical Center, Wailuku, HI
31
Embed
Pediatric Respiratory and Shock AssessmentShock Assessment and Shock for Providers.pdfPediatric Respiratory and Shock AssessmentShock Assessment Scottie B. Day, M.D. Assistant Professor
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
Pediatric Respiratory and Pediatric Respiratory and Shock AssessmentShock AssessmentShock AssessmentShock Assessment
Scottie B. Day, M.D.
Assistant Professor
Heinrich A. Werner Division of Pediatric Critical Care
Director, Pediatric Transport and Outreach
Kentucky Children’s Hospital/UK Healthcare
BackgroundBackground• UK College of Medicine, 2002
• Indiana University Internal Medicine/Pediatrics Residency, 2006
• Riley Hospital for Children Transport Physician, 2004-2006
• There are no financial relationships to discloseThere are no financial relationships to disclose
• Member, American Academy of Pediatrics Section on Transport Medicine
• EMS-C Member, Kentucky Board of Emergency Medical Services
3
ObjectivesObjectives
• Are kids just small adults?• Are kids just small adults?
• Overall goal of an effective pediatric transport
• General Respiratory Assessment
• Upper airway disease and management
• Lower Airway Disease and management
• Early evaluation and management of Shock
WhatsWhats the Goal?the Goal?
• Reach persons in need quickly• Reach persons in need quickly
• Stabilize patient’s condition
• Transfer to a facility with the ability of providing more extensive care that ill impro e o tcomesthat will improve outcomes.
4
Case #1Case #1
• 7 mo presents w/wheezing stridor and• 7 mo presents w/wheezing, stridor, and severe retractions. Poor tone and not responsive to surroundings. RR 80 HR 190 T:38.6 C (101.5F) SaO2: 80% on RA
• Former 28 week gestation; intubated at birth and on mech ventilation for 6 weeks beforeand on mech ventilation for 6 weeks before hospital discharge;
• Patient also has Pierre robin Syndrome
Case #1Case #1
• How would you assess and• How would you assess and categorize airway?
• What special precautions would you take in airway management?
5
The FactsThe Facts• Primary Cardiac Arrest in Infants and Kids rare
• Usually preceded by respiratory failure and/or shocky p y p y
• Septic Shock is the most common form of shock in pediatrics
• Terminal rhythm in children is usually bradycardia that progresses to PEA and asystole.
DevelopmentDevelopment
• Children are just small adults. jRight?
6
Pediatric AirwayPediatric Airway
• Small Short airway
• Large tongue
• Cephalad(towards the head) larynx
• Funnel shaped larynx
• Epiglottis is short, narrow, and angled away
• Large occiput• Large occiput
• Small peripheral airways
• R = (8L)/(r4)
ResistanceResistance
7
ResistanceResistance
• R = (8L)/(r4)• R = (8L)/(r4)• i.e. 1mm circumferential edemareduce
airway diameter by 2mm resulting in 16 fold increase in airway resistance in the pediatric
airway vs adult.
• Why do airways in children• Why do airways in children collapse?
8
PHYSICSPHYSICS• Venturi: flow of gas increases in
velocity as it flows through a partiallyvelocity as it flows through a partially obstructed tube
• Bernoulli: increase in velocity is associated with a decrease in pressure (and vice versa)
• Cartilage in kids less developed• Cartilage in kids less developed
Pediatric AirwayPediatric Airway
• Small Short airway
• Large tongue
• Cephalad(towards the head) larynx
• Funnel shaped larynx (narrowest portion is cricoid not glottis)
• Epiglottis is short narrow and angled awayEpiglottis is short, narrow, and angled away
• If severe respiratory distress, intubation in ER or OR.
AnaphylaxisAnaphylaxis
• Epinephrine 0 01mL/kg of 1:1000 solution to• Epinephrine, 0.01mL/kg of 1:1000 solution to a maxium of 0.3mL intramuscularly, repeat every 15 minutes if necessary
• Albuterol
• H1- and H2-antihistamines
M th d i l IV• Methyprednisolone IV
• Epinephrine (1:10,000 or 1:100,000 solution IV if cardiopulmonary failure.
FAMILY PRESENCEFAMILY PRESENCE• Most clinicians are concerned that parents
ill i t f ith if ll d t b twill interfere with care if allowed to be present
• Rarely,the case
• No evidence to suggest that legal risk increases with parental presence
• What would you want if it were your child?
SUMMARYSUMMARY
• Systematic Approach• Systematic Approach
• Prepare before you move and minimize interventions in route
• ABCs
29
Two Key Two Key decision pointsdecision points
1) Should the child be transported and1) Should the child be transported and which facility?
Two Key decision pointsTwo Key decision points
2) Who should transport the child?2) Who should transport the child?
30
LiabilityLiability
• Once the pediatric critical careOnce the pediatric critical care transport team arrives, it’s a consultant
• Once the pediatric critical care transport team leaves, responsibility p , p yand greater liability is assumed by this transport team
UK Healthcare/Kentucky Children’s HospitalUK Healthcare/Kentucky Children’s HospitalAcuity Trigger for Air Medical AutoAcuity Trigger for Air Medical Auto--LaunchLaunch
<30 weeks gestation• <30 weeks gestation
• Abdominal Wall defect
• Suspected cyanotic heart defect
• Diaphragmatic Hernia
• Patient intubated <8 years of age
AUTO-LAUNCH
31
KCH Critical Care KCH Critical Care Transport TeamTransport Team
ThanksThanks
• Any questions, advice, problems, or suggestions please feel free to contact me