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PILS > 2. A-E of unwell child > Flashcards

2. A-E of unwell child Flashcards

1
Q

What does it tell you if a child responds to tactile stimulation?

A
  • patent airway
  • they are breathing
  • they are perfusing cerebrum
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2
Q

What is choanal atresia?

A

Where the posterior nasal airway is occluded by soft tissue
Baby becomes cyanotic when feeds, then cyanosis resolves when they cry

Congenital blocking of nasal passages by soft tissue/bone

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3
Q

List causes of airway obstruction in children

A
  • foreign body
  • secretions/vomit
  • reduced CNS
  • choanal atresia
  • infection/swelling
  • epiglottitis
  • laryngotracheobronchitis (croup)
  • nasal tubes (feeding/O2)
  • trauma
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4
Q

List causes of CNS depression in children

A

Hypoxia due to
- inborn errors of metabolism
- hypoglycaemia
- head trauma
- decompensated resp failure
- decompensated circulatory failure

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5
Q

What does inspiratory stridor indicate?

A

Partial airway obstruction

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6
Q

How is partial airway obstruction managed?

A
  • maintain airway patency to avoid development of total occlusion
    -> head positioning (head tilt chin lift/jaw thrust)
    -> clearing secretions/foreign bodies
    -> adjuncts (NPA/OPA)
    -> getting senior help
  • administer O2 as soon as possible to minimise effects of hypoxia
  • avoid feeding
  • treat fever to reduce metabolic demand
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7
Q

What is respiratory distress?

A

A clinical syndrome with
- increased WOB
- attempts to increase tidal volume
- can be associated with tachypnoea or bradypnoea

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8
Q

What is the definition of respiratory failure biochemically?

A

Failure of the resp system to maintain an arterial O2 level (PaO2) of >9kPa with 21% inspired O2

and or

an arterial PaCO2 level <6.5kPa

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9
Q

What does PaO2 of 9kPa correspond to in peripheral oxygen saturations (SpO2)

A

90% SpO2

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10
Q

What are the signs that a child is tiring of respiratory distress?

A

Reduced consciousness
Cyanosis
Hypotonia
Reduced RR drive
Sweating
Bradycardia

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11
Q

List sign of increased WOB

A
  • increased RR
  • intercostal recession
  • subcostal recession
  • sternal recession
  • nasal flaring
  • tracheal tug
  • head bobbing (use of accessory muscles)
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12
Q

Are you more worried about intercostal recession in 5 day old or 5 year old child?

A

5 year old more concerning
Takes mild resp compromise in day old baby to cause recession and bones very cartilaginous and soft
In 5 year old child the chest wall is less compliant so it will take more force to cause recession

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13
Q

What is inspiratory stridor a sign of?

A

extrathoracic (upper) airway narrowing

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14
Q

What is wheeze a sign of?

A

intrathoracic (lower) airway narrowing

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15
Q

What causes grunting and what is it a sign of?

A

Grunting = exhaling against a partially closed glottis, trying to generate PEEP and stop lungs closing at the end of expiration

indication of severe respiratory compromise

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16
Q

What does the sniffing the morning air position do?

A

Optimises upper airway patency

17
Q

When might you not see increased WOB in resp failure?

A

NMD
Exhaustion
Reduced GCS and central resp depression

18
Q

What does hypoxia do to heart rate?

A

Tachy -> then brady which is a pre-terminal sign

19
Q

What does hypoxia do to skin?

A

Causes vasoconstriction, mottling and pallor

20
Q

What is the target SpO2 in children?

A

94-98%

21
Q

Describe compensated vs decompensated circulatory failure

A

Compensated = normal BP but signs of abnormal perfusion (tachycardia, poor skin perfusion, weak pulses, tachypnoea, reduced urine output)

Decompensated = low BP with compromised organ perfusion

22
Q

What is distributive shock?

A

Inadequate distribution of oxygenated blood to the tissues -> sepsis, anaphylaxis

23
Q

What is obstructive shock?

A

Tamponade, tension PTX, constrictive pericarditis

24
Q

What is dissociative shock?

A

Reduced O2 carrying capacity of the blood (CO poisoning)

25
Q

What does pulse volume give you an indication of?

A

Stroke volume

26
Q

How much of childs circulating volume can be lost before hypotension occurs?

A

40%

hypotension signals imminent cardiorespiratory arrest

27
Q

How many wet nappies should a child have per day on average as normal?

A

6 wet nappies per day

28
Q

What is normal urine output in children?

A

> 1ml/kg/hr

29
Q

What is normal urine output in infants?

A

> 2ml/kg/hr

30
Q

How much fluid bolus volume should be given and what type of fluid?

A

10ml/kg of crystalloid (plasmalyte/0.9% Na)

31
Q

What is the equivalent GCS score for a child who is only responsive to pain (sternal rub) on the AVPU scale?

A

GCS 8

32
Q

What should be assessed at D?

A

AVPU
Pupils
Blood glucose
General posturing (decorticate/decerebrate?)

33
Q

What is Cushing’s triad and what is it a sign of?

A

Raised ICP

Hypertension
Bradycardia
Irregular respirations

PILS (11 decks)

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