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  « REMUE-MENINGES » PEDIATRIQUE Ref: Américan Heart Association, American Academy of Pediatrics, Fondation des Maladies D...
CAS N°1 <ul><li>Un enfant de 5 ans, conscient, présente une tachycardie supra ventriculaire (fc    220/mn) mal tolérée su...
CAS N°1 <ul><li>Quelle autre manœuvre vagale pourrait-être utilisée? </li></ul><ul><ul><li>poser sur le visage de l’enfant...
CAS N°1 <ul><li>La manœuvre vagale est un échec, l’état clinique de l’enfant s’aggrave avec apparition d’une obnubilation ...
CAS N°2 <ul><li>Vous prenez en charge à domicile un enfant de 2 ans présentant une toux rauque, aboyante, intermittente d’...
CAS N°2 <ul><li>1.respecter la position spontanée de l’enfant et le garder calme </li></ul><ul><li>2.oxygéner l’enfant san...
CAS N°3 <ul><li>Vous prenez en charge un bébé de 5 mois qui vomit et a une diarrhée depuis 24h. </li></ul><ul><li>Il est a...
CAS N°3 <ul><li>Les réactions attendues: </li></ul><ul><li>Oxygénothérapie  </li></ul><ul><li>abord vasculaire: si une VVP...
CAS N°3 <ul><li>Vous surveillerez l’évolution clinique et pourrez renouveler l’administration d’un bolus complémentaire de...
QUELQUES PARAMETRES <ul><li>L’hypotension en chiffres: </li></ul><ul><ul><li>Jusqu’à 1 mois    60 mmHg </li></ul></ul><ul...
QUELQUES PARAMETRES
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Remue Meninges » Pediatrique

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Remue Meninges » Pediatrique

  1. 1. « REMUE-MENINGES » PEDIATRIQUE Ref: Américan Heart Association, American Academy of Pediatrics, Fondation des Maladies DU CŒUR du CANADA
  2. 2. CAS N°1 <ul><li>Un enfant de 5 ans, conscient, présente une tachycardie supra ventriculaire (fc  220/mn) mal tolérée sur le plan hémodynamique. </li></ul><ul><li>Quel traitement choisiriez vous d’administrer en premier, sans délai: </li></ul><ul><ul><li>Exercer une légère pression sur les yeux </li></ul></ul><ul><ul><li>Demander à l’enfant de souffler dans une paille fine </li></ul></ul><ul><ul><li>Faire une cardioversion synchronisée entre 0.5 et 1 J/Kg </li></ul></ul>
  3. 3. CAS N°1 <ul><li>Quelle autre manœuvre vagale pourrait-être utilisée? </li></ul><ul><ul><li>poser sur le visage de l’enfant (front, yeux) un gant ou un sac plastique rempli d’eau glacée pendant 10 ou 15 secondes. </li></ul></ul>
  4. 4. CAS N°1 <ul><li>La manœuvre vagale est un échec, l’état clinique de l’enfant s’aggrave avec apparition d’une obnubilation que faites vous? </li></ul><ul><ul><li>Oxygénothérapie </li></ul></ul><ul><ul><li>Accès veineux </li></ul></ul><ul><ul><li>Cardio-version synchronisée à 0.5J/kg sous faible dose de midazolam (0.1mg/ml) </li></ul></ul>
  5. 5. CAS N°2 <ul><li>Vous prenez en charge à domicile un enfant de 2 ans présentant une toux rauque, aboyante, intermittente d’apparition brutale dans un contexte de rhinite préexistante avec un battement des ailes du nez, un tirage sus-sternal et sus-claviculaire et un cornage </li></ul><ul><ul><li>Quelles sont vos 4 réactions immédiates </li></ul></ul>
  6. 6. CAS N°2 <ul><li>1.respecter la position spontanée de l’enfant et le garder calme </li></ul><ul><li>2.oxygéner l’enfant sans le stresser </li></ul><ul><li>3.mettre en place un oxymètre de pouls </li></ul><ul><li>4.commencer une nébulisation: épinéphrine </li></ul>
  7. 7. CAS N°3 <ul><li>Vous prenez en charge un bébé de 5 mois qui vomit et a une diarrhée depuis 24h. </li></ul><ul><li>Il est allongé sur son lit, apathique, présente: </li></ul><ul><ul><li>une fréquence respiratoire à (50/mn) non laborieuse </li></ul></ul><ul><ul><li>une TA à 60/43 mmHg avec une fréquence cardiaque à 170/mn </li></ul></ul><ul><ul><li>Une température à 36.1°C </li></ul></ul><ul><ul><li>Le pouls est présent mais faible </li></ul></ul><ul><ul><li>Le temps de recoloration cutané est de 5 ‘’ </li></ul></ul><ul><ul><ul><ul><ul><li>You can do it!!!!!! </li></ul></ul></ul></ul></ul>
  8. 8. CAS N°3 <ul><li>Les réactions attendues: </li></ul><ul><li>Oxygénothérapie </li></ul><ul><li>abord vasculaire: si une VVP n’est pas possible rapidement ne pas différer la mise en place d’une voie intra osseuse </li></ul><ul><li>administration de bolus de cristalloides de 20ml/kg en moins de 15’ </li></ul><ul><li>faire une glycémie capillaire </li></ul>
  9. 9. CAS N°3 <ul><li>Vous surveillerez l’évolution clinique et pourrez renouveler l’administration d’un bolus complémentaire de cristalloides si besoin. </li></ul><ul><li>L’hypoglycémie éventuelle sera corrigée L’enfant sera transporté aux urgences pédiatriques son état stabilisé. </li></ul>
  10. 10. QUELQUES PARAMETRES <ul><li>L’hypotension en chiffres: </li></ul><ul><ul><li>Jusqu’à 1 mois  60 mmHg </li></ul></ul><ul><ul><li>De 1 à 12 mois  70 mmHg </li></ul></ul><ul><ul><li>De 1 an à 10 ans  70 mmHg + (age en années x2) mmHg </li></ul></ul><ul><ul><li>À partir de 10 ans  90 mmHg </li></ul></ul>
  11. 11. QUELQUES PARAMETRES

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