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3rd Year - Paediatrics > 20. Acute Paediatric Care > Flashcards

20. Acute Paediatric Care Flashcards

1
Q

What are the Formula’s for Calculating Ideal Weight in a Child:

  1. < 1 Year Old?
  2. > 1 Year Old?
A
  1. (0.5 x Age in Months) + 4 (Kg)

2. (Age + 4) x 2 (Kg)

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2
Q

What is the Structured Approach to the Seriously Injured Child?

A
  1. Primary Survey
  2. Resuscitation
  3. Secondary Survey
  4. Emergency Treatment
  5. Continuing Stabilization and Definitive Care
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3
Q

What is involved in the Primary Survey in a Structured Approach to the Seriously Injured Child?

A 
C - ABCDE - (DEFG):
C - Catastrophic Haemorrhage
A - Airway (with C-Spine Control)
B - Breathing (and Oxygenation)
C - Circulation (and Haemorrhage Control)
D - Disability 
E - Exposure / Environment 
(DEFG) - Don't Ever Forget Glucose
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4
Q

What is Assessed in the Airway?

A

Look / Listen / Feel:

  1. Effort
  2. Efficacy
  3. Effects
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5
Q

What are the Features of the Airway of a Seriously Injured Child?

A
  1. Neutral Position - Large Occiput
  2. Short Neck with Larynx High and Anterior
  3. Soft Tissue Prominent and Easily Damaged
  4. Infants Obligate Nasal Breathers
    Note - Don’t Forget the Neck
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6
Q

What is Assessed in Circulation?

A
  1. Effort
  2. Efficacy
  3. Effects
  4. Non-Compliant Ventricles
  5. High Blood Volume - Weight Ratio
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7
Q

What are the Main Physiological Differences in Airway / Circulation between Children and Adults?

A
  1. Airway / Breathing:
  2. a) High Metabolic Rate - High O2 Consumption / Respiratory Rate / Little Reserve
  3. b) High Chest Wall Complicance - May Mask Significant Injury / Sternal Recession
  4. Circulation:
  5. a) Small Stroke Volume
  6. b) Vascular Resistance Rises Continually from Birth
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8
Q

What is included in Disability?

A
  1. AVPU - Alert / Voice / Pain / Unresponsive

2. Pupils

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9
Q

What is included in Exposure?

A
  1. Keep Warm / Covered - Heat Loss / Embarrassment
  2. Splint Injuries
  3. Analgesia
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10
Q

What are the Features of Thermoregulation in Infants?

A
  1. Little Brown Fat and Immature Shivering
  2. Poikilothermic - Temperature Varies Considerably
  3. Environmental Considerations - e.g. RTC
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11
Q

What are the Features of Hypoglycaemia in Infants?

A
  1. Little Glycogen Stored
  2. Exacerbated by Hypothermia and Vice-Versa
  3. Develops Quickly in Sick Children
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12
Q

What are the Primary Survey Adjuncts?

A
  1. History - AMPLE - Allergies / Medications / Past Illness / Last Ate / Events and Environment
  2. Monitoring - ECG / B.P. / Pulse / Resp. Rate / G.C.S. / SpO2 / Temperature
  3. Imaging - X-Ray Chest and Pelvis (+/- C-Spine) / Ultrasound of Abdomen
  4. Tubes - Urinary / Nasogastric
  5. Analgesia
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13
Q

What should be done before Starting the Second Survey?

A
  1. Complete the Primary Survey
  2. Establish Resuscitation
    Note - If Patient Deteriorates - Abandon and Repeat the Primary Survey
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14
Q

What are the Major Conditions to look for in doing a Primary Survey of a Child?

A 
A - Airway Compromise
T - Tension Pneumothorax
O - Open Pneumothorax
M - Massive Haemothorax
F - Flail Chest
C - Cardiac Tamponade
Note - Be wary of NAI
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15
Q

What are the Main Injury Areas where a Child may present Differently?

A
  1. The Spine
  2. The Abdomen
  3. Head Injury and G.C.S.
  4. Burns / Scalds
  5. Hypothermia
  6. Fractures
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16
Q

What are the Features of Cervical Spinal Injury in a Child?

A
  1. May be Occult
  2. Assume it is there until confident otherwise
  3. 3-Point Immobilisation - Straight Lift / Tilt / Log Roll
  4. Beward of Spinal Cord Injury With-Out Radiological Abnormality (SCIWORA)
17
Q

How is the Cervical Spine Assessed?

A
  1. Inspection
  2. Palpation
  3. Neurological Examination
  4. Plain X-Ray
  5. CT Scan
  6. Specialist Decision if Neurological Signs
18
Q

When can Spinal Cord Immobilisation be Removed?

A
  1. Normal X-Ray - Plain Views +/- CT Scan
  2. No Significant Pain or Tenderness
  3. Normal Neurological Examination
  4. Good Range of Movement (RoM) Once Collar is Removed
19
Q

When is Cervical Spine Imaging not Required?

A
  1. No Midline Cervical Pain / Tenderness on Direct Palpation
  2. No Neurological Signs
  3. Normal Conscious Level
  4. No Intoxication / Sedative Drugs
  5. No Painful Distracting Injury
  6. Once Collar Removed - No Pain on Full Range of Movement
20
Q

What is the Significance of Acute Abdominal Injuries?

A
  1. Less Rib Protection
  2. Thinner Abdominal Wall
  3. More Horizontal Diaphragm
  4. Bladder Position Abnormal
21
Q

How is the Acute Abdominal Injury Evaluated?

A
  1. No Bruising - Does not Exclude Injury
  2. Bruising - Severe Injury Likely
  3. Assessment:
  4. a) Repeated Gentle Examination by a Surgeon
  5. b) Imaging - Ultrasound Scan / CT Scan
22
Q

What is the Management of Acute Abdominal Injury?

A

Non-Operative:

  1. Haemorrhage is often Self-Limiting
  2. Preservation of Splenic Function
  3. Decreased Mortality / Mobidity

Operative:

  1. Penetrating Injury
  2. Peritonitis
  3. Haemodynamic Instability
23
Q

What are the Features of Acute Burns?

A
  1. Hypovolaemia occurs Relatively Late
  2. Hypothermia - Burned Children Lose Heat Rapidly
  3. If Shocked Look Elsewhere for a Cause
24
Q

What is the Management of Acute Burns?

A
  1. Analgesia - Opiates (I.N. or I.V.) / Oral
  2. Remove Cold Therapy
  3. Sterile Towels / Cling-Film
  4. Avoid Unecessary Examination
  5. Only Ointments / Creams as Part of Definitive Care
  6. Specialized Treatment
25
Q

What is the Pathology of Drowning?

A
  1. Submersion
  2. Voluntary Apnoea
  3. Acidosis / Hypoxia
  4. Involuntary Breath
  5. Laryngeal Spasm
  6. Involuntary Respiration
26
Q

What is the Management of Drowning?

A
  1. Prevention
  2. Effective, Early Basic Life Support
  3. Assume C-Spine Injury
  4. Handle Gently if Hypothermic
  5. Intubate to Prevent Aspiration
  6. Gastric Drainage to Remove Swallowed Water
  7. Measure Core Temperature and Treat Hypothermia
  8. Full Trauma Assessment for other Injuries
27
Q

What are the Methods of External Rewarming?

A
  1. Remove Wet Clothing
  2. Wrap Warmly
  3. Radiant Heat
  4. Warm Air System
  5. Direct Heat
28
Q

What are the Methods of Core Rewarming?

A
  1. I.V. Fluids to 39 Degrees
  2. Ventilator Gases to 42 Degrees
  3. Gastric / Peritoneal / Pleural Lavage at 42 Degrees
  4. Endovascular Warming - ECMO / Bypass
29
Q

What is the Management of Cardiac Arrest?

A
  1. Hypothermia may be Protective - Continue to Resus.
  2. Active Core Rewarming
  3. Do Not Give Medications until Core > 30 Degrees
  4. Give Initial Defibrillating Shocks but do not Repeat until Core > 30 Degrees
  5. Volume Expansion may be Needed
30
Q

What are the Features of the Child Skeleton?

A
  1. Incompletely Calcified:
  2. a) Soft
  3. b) Springy
  4. c) Deforms Rather than Breaks
  5. d) Poor at Absorbing Energy
  6. Provides Less Protection for Vital Organs
31
Q

What is the Classification used in

A

Type 1 - A Complete Physeal Fracture with/without Displacement
Type 2 - A Physeal Fracture that Extends through the Metaphysis, producing a Chip-like Fracture on it
Type 3 - A Physeal Fracture that Extends through the Epiphysis
Type 4 - A Physeal Fracture plus Epiphyseal and Metaphyseal Fractures
Type 5 - A Compression Fracture of Growth Plate

3rd Year - Paediatrics (40 decks)

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