ABP Pediatric Critical Care Medicine flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Alveolar gas equation

PAO2 equals FiO2 times barometric pressure minus water vapor pressure, minus PaCO2 divided by respiratory quotient (about 0.8).

Oxygen content formula

Arterial oxygen content equals 1.34 times hemoglobin times arterial saturation plus 0.003 times PaO2; it quantifies oxygen carried per deciliter.

Driving pressure

Driving pressure is plateau pressure minus positive end-expiratory pressure; in pediatric ARDS, keeping it at or below 15 cm H2O may reduce ventilator-induced lung injury.

Permissive hypercapnia

Accepting elevated PaCO2 with pH above approximately 7.20 can limit tidal volume and lung stress, but is avoided with raised intracranial pressure or severe pulmonary hypertension.

Cardiac output equation

Cardiac output equals heart rate multiplied by stroke volume; cardiac index divides output by body surface area and normalizes it across pediatric sizes.

Pediatric hypotension thresholds

For infants one to twelve months, systolic pressure below 70 mm Hg is hypotensive; for children one to ten years, below 70 plus twice age.

Cold septic shock

Cold shock has low cardiac output and high systemic vascular resistance; epinephrine infusion is preferred after careful fluid boluses and reassessment in children.

Central venous oxygen saturation

ScvO2 above 70 percent suggests adequate oxygen delivery relative to consumption; lower values prompt evaluation for anemia, hypoxemia, low cardiac output, or increased demand.

Pediatric septic shock definition

Septic shock is sepsis with cardiovascular organ dysfunction, including hypotension, elevated lactate, or need for vasoactive infusion after adequate fluid resuscitation.

Neutropenic fever empiric therapy

Fever with absolute neutrophil count below 500 cells per microliter requires prompt antipseudomonal beta-lactam antibiotics after blood cultures, because bacterial sepsis risk is high.

Hydrocortisone in refractory shock

Hydrocortisone is considered for fluid- and vasoactive-refractory septic shock when adrenal insufficiency is suspected; it is not routine for all pediatric sepsis.

Disseminated intravascular coagulation

DIC produces prolonged clotting times, low fibrinogen, thrombocytopenia, and elevated D-dimer; treatment targets the underlying cause with platelet and factor support for bleeding.

Cerebral perfusion pressure

Cerebral perfusion pressure equals mean arterial pressure minus intracranial pressure; pediatric targets are approximately 40 to 50 mm Hg in infants and higher in older children.

Intracranial hypertension treatment

Sustained intracranial pressure above 20 mm Hg warrants treatment: elevate the head, ensure sedation and normocapnia, and use hyperosmolar therapy such as 3 percent saline or mannitol.

Status epilepticus first-line

First-line status epilepticus therapy is a benzodiazepine, such as lorazepam or midazolam, given promptly at weight-based doses while airway and glucose are checked.

Herniation hyperventilation

Brief hyperventilation to PaCO2 of 30 to 35 mm Hg can lower intracranial pressure during impending herniation, but prolonged use risks cerebral ischemia and should be avoided.

Parkland burn formula

Parkland formula gives 4 mL per kg per percent total body surface area of lactated Ringer over 24 hours, with half in the first 8 hours from burn time.

Abdominal compartment syndrome

Abdominal compartment syndrome is sustained intra-abdominal pressure above 20 mm Hg with new organ dysfunction; treatment includes decompression, drainage, sedation, and paralysis while avoiding excess fluids.

Tranexamic acid in trauma

Tranexamic acid, given within three hours of traumatic hemorrhage, reduces mortality; dose is weight-based and should not delay blood products or hemorrhage control.

Damage control resuscitation

Damage control resuscitation prioritizes hemorrhage control, balanced blood product transfusion, permissive hypotension when appropriate, warming, and correction of coagulopathy before definitive surgical repair.

KDIGO acute kidney injury

Acute kidney injury is a creatinine rise of at least 0.3 mg per dL within 48 hours, or 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours.

Hyperkalemia emergency treatment

Emergent hyperkalemia treatment includes intravenous calcium for cardiac stabilization, insulin with glucose, inhaled beta-agonist, and bicarbonate when acidotic; dialysis removes potassium in refractory cases.

Diabetic ketoacidosis cerebral edema

Cerebral edema is a serious DKA complication in children; avoid rapid fluid shifts, use isotonic fluids, and treat suspected edema with hyperosmolar therapy and reduced insulin infusion.

Adrenal crisis stress dosing

Suspected adrenal crisis requires immediate hydrocortisone at stress doses plus isotonic fluid and glucose; do not delay treatment for confirmatory cortisol testing in unstable children.

Pediatric compression-ventilation ratio

For two-rescuer pediatric resuscitation, use 15 compressions to 2 breaths with a compression rate of 100 to 120 per minute and depth one-third of chest diameter.

Pediatric defibrillation energy

Initial defibrillation is 2 J per kg, second dose 4 J per kg, and subsequent doses at least 4 J per kg up to 10 J per kg or adult maximum.

Intraosseous access

Intraosseous access is preferred when intravenous access is delayed in pediatric emergencies; drugs and fluids can be given, and complications include extravasation, fracture, and infection.

Rapid sequence intubation contraindication

Succinylcholine is contraindicated with hyperkalemia risk, such as burns after 48 hours, denervation, neuromuscular disease, or crush injury; use a nondepolarizing agent instead.

Withdrawing life-sustaining treatment

Ethically, withdrawing and withholding life-sustaining treatment are equivalent when they align with the child's best interests and family goals after informed discussion by the care team.

Assent for pediatric care

Assent seeks a minor's agreement to care proportional to developmental capacity, while parental or guardian permission provides legal authorization; dissent should be considered seriously.

Brain death determination

Pediatric brain death requires irreversible coma, absent brainstem reflexes, and apnea despite adequate PaCO2 challenge, with confounding factors excluded and consistent examinations or confirmatory testing.

Disclosing medical error

Clinicians should promptly disclose harmful medical errors to families, explain known facts, express empathy, and describe prevention steps while following institutional risk-management and documentation processes.