ca-cna-critical-care-pediatrics flashcards

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

Pediatric Glasgow Coma Scale

Age-specific scoring from 3 to 15 using eye, verbal, and motor components; children under 5 use different verbal and motor anchors than adults, so the scale version must be documented.

Cushing response

Hypertension with bradycardia and irregular respirations seen with raised intracranial pressure; it is a late and ominous sign of impending herniation requiring immediate intervention.

Decerebrate posturing

Extension of all four limbs with internal rotation after a painful stimulus; it localizes at or below the red nucleus and indicates a worse prognosis than decorticate posturing.

Cerebral perfusion pressure

Mean arterial pressure minus intracranial pressure; age-specific targets are maintained to preserve cerebral blood flow, generally aiming for at least 40 to 50 mmHg in young children.

Monro-Kellie doctrine

The skull has a fixed volume containing brain, blood, and cerebrospinal fluid; an increase in one compartment must be offset by a decrease in another or intracranial pressure rises.

External ventricular drain care

The drain measures intracranial pressure and drains cerebrospinal fluid; the transducer is leveled to the tragus or foramen magnum and strict sterile technique prevents infection.

Status epilepticus definition

Continuous seizure activity lasting five minutes or more, or recurrent seizures without return to baseline between events; treatment with a benzodiazepine begins at five minutes.

Refractory status epilepticus

Seizures that persist despite two appropriately dosed antiseizure medications; management requires continuous anesthetic infusion with continuous EEG monitoring, usually in an intensive care unit.

Febrile status epilepticus

A prolonged seizure with fever in a child six months to five years without central nervous system infection; the risk of later epilepsy is low but evaluation must exclude meningitis.

Neonatal seizure presentation

Often subtle with automatisms, apnea, or cycling movements and frequently electrographic only; phenobarbital is first-line therapy and continuous EEG is needed for diagnosis.

Severe pediatric traumatic brain injury

Post-resuscitation Glasgow Coma Scale of 3 to 8; management targets normoxia, normocapnia, normotension, normothermia, and normonatremia while avoiding hypotension.

Hyperventilation in herniation

Brief reduction of PaCO2 to 30 to 35 mmHg causes cerebral vasoconstriction and lowers intracranial pressure; it is reserved for acute herniation because prolonged hypocapnia causes ischemia.

Neurogenic shock

Hypotension with bradycardia from loss of sympathetic tone after spinal cord injury; treatment is volume resuscitation plus vasopressors such as norepinephrine or phenylephrine.

Autonomic dysreflexia

Hypertension, bradycardia, headache, and flushing triggered by bladder or bowel distension in lesions at T6 or above; treatment is removing the stimulus and giving antihypertensives.

Pediatric arterial ischemic stroke

Acute focal neurologic deficit from arterial occlusion, associated with arteriopathy, cardiac disease, sickle cell disease, and prothrombotic states; MRI with diffusion-weighted imaging is preferred for diagnosis.

Cerebral venous sinus thrombosis

Thrombosis of cerebral veins or sinuses presenting with headache, papilledema, seizures, and focal deficits; anticoagulation with low-molecular-weight heparin is standard even with hemorrhagic infarction.

Posterior reversible encephalopathy syndrome

Headache, seizures, visual changes, and hypertension with posterior white matter edema on imaging; treatment is blood pressure control and stopping the triggering agent.

Cerebral salt wasting versus SIADH

Both cause hyponatremia after brain injury; cerebral salt wasting is hypovolemic from renal sodium loss, while SIADH is euvolemic from inappropriate water retention.

Bacterial meningitis empiric therapy

Vancomycin plus ceftriaxone or cefotaxime; add ampicillin for neonates and Listeria risk, and give dexamethasone before or with the first antibiotic dose when Haemophilus influenzae type b is suspected.

Lumbar puncture contraindications

Focal neurologic deficit, papilledema, altered consciousness, seizures, hemodynamic instability, or coagulopathy; antibiotics and blood cultures should not be delayed when lumbar puncture is deferred.

Herpes simplex encephalitis

Fever, seizures, and temporal lobe findings caused by herpes simplex virus; intravenous acyclovir is required and should be started empirically when suspected.

Neonatal meningitis pathogens

Group B Streptococcus, Escherichia coli, and Listeria monocytogenes; presentation is often subtle with poor feeding, temperature instability, and apnea rather than classic meningismus.

Guillain-Barre syndrome

Ascending symmetric weakness with areflexia and elevated cerebrospinal fluid protein with normal cell count; treatment is intravenous immunoglobulin or plasma exchange with respiratory monitoring.

Guillain-Barre respiratory failure

Predicted by vital capacity below 15 to 20 mL/kg, inability to count to 20 in one breath, or bulbar weakness; serial vital capacity and negative inspiratory force guide intubation.

Myasthenic crisis

Worsening bulbar and respiratory weakness from myasthenia gravis; treat with acetylcholinesterase inhibitors, corticosteroids, intravenous immunoglobulin, or plasma exchange and avoid aminoglycosides and magnesium.

Botulism in children

Descending symmetric flaccid paralysis with ptosis and bulbar weakness caused by botulinum toxin; treatment is botulinum antitoxin plus supportive ventilation and secretion management.

Propofol infusion syndrome

Metabolic acidosis, rhabdomyolysis, hyperkalemia, and cardiac failure from prolonged high-dose propofol infusion; continuous propofol sedation is avoided in children.

Dexmedetomidine effects

Provides sedation and analgesia without significant respiratory depression but causes bradycardia and hypotension; it is unsuitable for deep sedation requiring airway protection.

Opioid reversal with naloxone

Naloxone reverses opioid-induced respiratory depression but may precipitate withdrawal and seizures in dependent patients; titrate small doses and monitor for renarcotization.

Continuous EEG indications

Unexplained altered mental status, refractory status epilepticus, and titration of anesthetic infusions; it detects nonconvulsive seizures and burst suppression not seen on clinical exam.

Near-infrared spectroscopy

Noninvasive monitoring of regional cerebral oxygen saturation; trends rather than absolute values guide interpretation and should be correlated with intracranial pressure and clinical findings.

Family-centered care in neurocritical care

Includes parents in rounds, explains findings in plain language, and supports family presence during resuscitation when safe; older children should be asked for assent to treatment.