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Pediatric Emergency Cases

Pediatric Emergency Cases. Melissa Joy, RN Michael Mojica , MD Todd P Chang, MD. …Peace puts her everywhere…. Case 3A. Case 3A - Briefing. 4-week-old male Progressive non-bilious vomiting x 3 days No urine output x 20 hours Difficult to awaken. go. 4wk listless vomiting. Laboratory 1.

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Pediatric Emergency Cases

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  1. Pediatric Emergency Cases Melissa Joy, RN Michael Mojica, MD Todd P Chang, MD

  2. …Peace puts her everywhere… Case 3A

  3. Case 3A - Briefing 4-week-old male Progressive non-bilious vomiting x 3 days No urine output x 20 hours Difficult to awaken

  4. go 4wk listless vomiting Laboratory 1 Laboratory 2 Radiography 1 Temperature (Axillary) Glucose Radiography 2 Temperature (Rectal) Blood Gas Lytes Blood Gas

  5. 4wk listless vomiting

  6. 4wk listless vomiting

  7. 4wk listless vomiting 36.7 C = 98.1 F

  8. 4wk listless vomiting 37.4 C = 99.3 F

  9. 4wk listless vomiting

  10. 4wk listless vomiting

  11. 4wk listless vomiting

  12. 4wk listless vomiting

  13. Pediatric shock

  14. Infant Shock HR b/p

  15. Infant Shock HR b/p

  16. Heart Rates

  17. Blood Pressure Total Gestational Age (weeks) = (Mean Arterial Pressure)

  18. The model The pump The vessels The tissues

  19. The Pump fluid !

  20. The Fluid !

  21. The Vessels !

  22. Hypovolemic Shock

  23. Hypovolemic Shock

  24. Hypovolemic Shock

  25. Hypovolemic Shock Estimates of body surface area: Newborn (0.25m2) 8 years old (1m2) 2 years old (0.5m2) non-obese adult (1.5m2)

  26. Push-Pull

  27. …Peace puts her olives everywhere… Pyloric Stenosis

  28. Pyloric Stenosis

  29. Pyloric Stenosis

  30. Rule of 6’s If you are ******** age, and you have a surgical abdomen, then you have…

  31. Rule of 6’s

  32. Rule of 6’s

  33. Rule of 6’s

  34. Rule of 6’s

  35. Rule of 6’s

  36. Rule of 6’s

  37. Rule of 6’s

  38. Pyloric Stenosis • Peaks @ 6 weeks • M to F 4 to 1 • Non-bilious emesis • “Projectile” is rare • “Olive” is very rare • Look for vomiting with allfeeds

  39. Pyloric Stenosis • Hypochloremic alkalosis • Single large stomach Abdominal Xray • Paucity of gas distal of stomach

  40. Pyloric Stenosis • 3+mm thick or • 15+mm long

  41. Pyloric Stenosis

  42. Pyloric Stenosis

  43. Maintenance Fluids

  44. Maintenance Fluids

  45. Tubes • Endotracheal Tube Size: 4 + (Age (yr) / 4) • Subtract ½ for the cuff

  46. Tubes

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