2. A-E of unwell child Flashcards
What does it tell you if a child responds to tactile stimulation?
- patent airway
- they are breathing
- they are perfusing cerebrum
What is choanal atresia?
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
List causes of airway obstruction in children
- foreign body
- secretions/vomit
- reduced CNS
- choanal atresia
- infection/swelling
- epiglottitis
- laryngotracheobronchitis (croup)
- nasal tubes (feeding/O2)
- trauma
List causes of CNS depression in children
Hypoxia due to
- inborn errors of metabolism
- hypoglycaemia
- head trauma
- decompensated resp failure
- decompensated circulatory failure
What does inspiratory stridor indicate?
Partial airway obstruction
How is partial airway obstruction managed?
- 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
What is respiratory distress?
A clinical syndrome with
- increased WOB
- attempts to increase tidal volume
- can be associated with tachypnoea or bradypnoea
What is the definition of respiratory failure biochemically?
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
What does PaO2 of 9kPa correspond to in peripheral oxygen saturations (SpO2)
90% SpO2
What are the signs that a child is tiring of respiratory distress?
Reduced consciousness
Cyanosis
Hypotonia
Reduced RR drive
Sweating
Bradycardia
List sign of increased WOB
- increased RR
- intercostal recession
- subcostal recession
- sternal recession
- nasal flaring
- tracheal tug
- head bobbing (use of accessory muscles)
Are you more worried about intercostal recession in 5 day old or 5 year old child?
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
What is inspiratory stridor a sign of?
extrathoracic (upper) airway narrowing
What is wheeze a sign of?
intrathoracic (lower) airway narrowing
What causes grunting and what is it a sign of?
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
What does the sniffing the morning air position do?
Optimises upper airway patency
When might you not see increased WOB in resp failure?
NMD
Exhaustion
Reduced GCS and central resp depression
What does hypoxia do to heart rate?
Tachy -> then brady which is a pre-terminal sign
What does hypoxia do to skin?
Causes vasoconstriction, mottling and pallor
What is the target SpO2 in children?
94-98%
Describe compensated vs decompensated circulatory failure
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
What is distributive shock?
Inadequate distribution of oxygenated blood to the tissues -> sepsis, anaphylaxis
What is obstructive shock?
Tamponade, tension PTX, constrictive pericarditis
What is dissociative shock?
Reduced O2 carrying capacity of the blood (CO poisoning)
What does pulse volume give you an indication of?
Stroke volume
How much of childs circulating volume can be lost before hypotension occurs?
40%
hypotension signals imminent cardiorespiratory arrest
How many wet nappies should a child have per day on average as normal?
6 wet nappies per day
What is normal urine output in children?
> 1ml/kg/hr
What is normal urine output in infants?
> 2ml/kg/hr
How much fluid bolus volume should be given and what type of fluid?
10ml/kg of crystalloid (plasmalyte/0.9% Na)
What is the equivalent GCS score for a child who is only responsive to pain (sternal rub) on the AVPU scale?
GCS 8
What should be assessed at D?
AVPU
Pupils
Blood glucose
General posturing (decorticate/decerebrate?)
What is Cushing’s triad and what is it a sign of?
Raised ICP
Hypertension
Bradycardia
Irregular respirations
