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2 Critically Ill Pediatric Patients

2 Critically Ill Pediatric Patients

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Published by xlarralde

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Published by: xlarralde on Apr 24, 2009
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01/31/2013

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CRITICALLY ILL PEDIATRIC PATIENTS**Pediatric Patients Are Defined As ≤14 Years of Age**
I. Assessment and documentation on all pediatric patients should include thefollowing:A. Primary and secondary assessment including presence and quality of allextremity pulses.B. Cardiac ECG rhythm and SpO2 oxygen saturations.C. If coarctation (congenital heart anomaly) is suspected and extremity pulsesare diminished, then obtain, and document, a B/P in each extremity.II. Treatment will follow the general guidelines established by the American HeartAssociation in the Pediatric Advanced Life Support course. All newborns or infantswho present in shock or respiratory failure should be assumed to be septic until proven otherwise. Specific interventions for all critically ill children will include:A. Airway – Ensure airway is patent. Utilize appropriately sized ETT or LMA. (Broselow tape or pediatric standard calculations may be utilized todetermine size.)B. Breathing1. Injured children – Provide supplemental oxygen to maintain SpO2> 92% unless patient suffers from Congenital Heart Defect (CHD)then use O2 as per guideline2. Provide ETCO2 monitoring on all intubated patients. Adjustventilation parameters to maintain ETCO2 between 35-45 mmHg.C. Circulation1. Assess and monitor vital signs (including BP’s) and temperatureson all children. Monitor cardiac rhythm and provide thermalregulatory support as necessary.2. Treat specific dysrhythmias per guidelines3. Place combination defibrillation / pacer pads on children withevidence of or possibility of rhythm disturbances in flight.
 
4. Initiate venous access by peripheral, IO or femoral venous routes.Umbilical vein catheterization may be performed in newborns.a. Newborns – D10% ¼ NS if available. Otherwise, use Normal Saline.14 b. Infants / Children > 3 mo. Age – D5% ½ NS if available.Otherwise, use Normal Saline.5. Calculate maintenance fluids for patients < 8 y/o:a. Holiday – Segar Method:i. First 10 Kg = 4cc/kg/hr ii. Second 10 Kg = 2cc/kg/hr iii. Each additional Kg over 20 = 1cc/kg/hr  b. EXAMPLE: 24kg child1st 10 kg = 4 x 10 = 40cc2nd 10 kg = 2 x 10 = 20cc4 kg (> 20 kg) = 4 x 1 = 4ccTOTAL maintenance fluids = 64cc/hr 6. Monitor arterial line if placed by transferring facility.7. If sepsis is suspected, request transferring physician to initiateantibiotic therapy prior to transfer. Document dose and time of medication(s) administered.D. Deficits1. Assess for and document the following:a. GCS b. Pupil size and response to light accommodationc. Bulging or sunken fontanelsE. Additional Interventions1. Consider NG or OG tube placement and apply Low IntermittentSuction for unresponsive patients, those with absent bowel sounds,or those whom are intubated.3. Pain control as per guideline4. Other interventions per specific guideline

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