20. Acute Paediatric Care Flashcards
What are the Formula’s for Calculating Ideal Weight in a Child:
- < 1 Year Old?
- > 1 Year Old?
- (0.5 x Age in Months) + 4 (Kg)
2. (Age + 4) x 2 (Kg)
What is the Structured Approach to the Seriously Injured Child?
- Primary Survey
- Resuscitation
- Secondary Survey
- Emergency Treatment
- Continuing Stabilization and Definitive Care
What is involved in the Primary Survey in a Structured Approach to the Seriously Injured Child?
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
What is Assessed in the Airway?
Look / Listen / Feel:
- Effort
- Efficacy
- Effects
What are the Features of the Airway of a Seriously Injured Child?
- Neutral Position - Large Occiput
- Short Neck with Larynx High and Anterior
- Soft Tissue Prominent and Easily Damaged
- Infants Obligate Nasal Breathers
Note - Don’t Forget the Neck
What is Assessed in Circulation?
- Effort
- Efficacy
- Effects
- Non-Compliant Ventricles
- High Blood Volume - Weight Ratio
What are the Main Physiological Differences in Airway / Circulation between Children and Adults?
- Airway / Breathing:
- a) High Metabolic Rate - High O2 Consumption / Respiratory Rate / Little Reserve
- b) High Chest Wall Complicance - May Mask Significant Injury / Sternal Recession
- Circulation:
- a) Small Stroke Volume
- b) Vascular Resistance Rises Continually from Birth
What is included in Disability?
- AVPU - Alert / Voice / Pain / Unresponsive
2. Pupils
What is included in Exposure?
- Keep Warm / Covered - Heat Loss / Embarrassment
- Splint Injuries
- Analgesia
What are the Features of Thermoregulation in Infants?
- Little Brown Fat and Immature Shivering
- Poikilothermic - Temperature Varies Considerably
- Environmental Considerations - e.g. RTC
What are the Features of Hypoglycaemia in Infants?
- Little Glycogen Stored
- Exacerbated by Hypothermia and Vice-Versa
- Develops Quickly in Sick Children
What are the Primary Survey Adjuncts?
- History - AMPLE - Allergies / Medications / Past Illness / Last Ate / Events and Environment
- Monitoring - ECG / B.P. / Pulse / Resp. Rate / G.C.S. / SpO2 / Temperature
- Imaging - X-Ray Chest and Pelvis (+/- C-Spine) / Ultrasound of Abdomen
- Tubes - Urinary / Nasogastric
- Analgesia
What should be done before Starting the Second Survey?
- Complete the Primary Survey
- Establish Resuscitation
Note - If Patient Deteriorates - Abandon and Repeat the Primary Survey
What are the Major Conditions to look for in doing a Primary Survey of a Child?
A - Airway Compromise T - Tension Pneumothorax O - Open Pneumothorax M - Massive Haemothorax F - Flail Chest C - Cardiac Tamponade Note - Be wary of NAI
What are the Main Injury Areas where a Child may present Differently?
- The Spine
- The Abdomen
- Head Injury and G.C.S.
- Burns / Scalds
- Hypothermia
- Fractures
What are the Features of Cervical Spinal Injury in a Child?
- May be Occult
- Assume it is there until confident otherwise
- 3-Point Immobilisation - Straight Lift / Tilt / Log Roll
- Beward of Spinal Cord Injury With-Out Radiological Abnormality (SCIWORA)
How is the Cervical Spine Assessed?
- Inspection
- Palpation
- Neurological Examination
- Plain X-Ray
- CT Scan
- Specialist Decision if Neurological Signs
When can Spinal Cord Immobilisation be Removed?
- Normal X-Ray - Plain Views +/- CT Scan
- No Significant Pain or Tenderness
- Normal Neurological Examination
- Good Range of Movement (RoM) Once Collar is Removed
When is Cervical Spine Imaging not Required?
- No Midline Cervical Pain / Tenderness on Direct Palpation
- No Neurological Signs
- Normal Conscious Level
- No Intoxication / Sedative Drugs
- No Painful Distracting Injury
- Once Collar Removed - No Pain on Full Range of Movement
What is the Significance of Acute Abdominal Injuries?
- Less Rib Protection
- Thinner Abdominal Wall
- More Horizontal Diaphragm
- Bladder Position Abnormal
How is the Acute Abdominal Injury Evaluated?
- No Bruising - Does not Exclude Injury
- Bruising - Severe Injury Likely
- Assessment:
- a) Repeated Gentle Examination by a Surgeon
- b) Imaging - Ultrasound Scan / CT Scan
What is the Management of Acute Abdominal Injury?
Non-Operative:
- Haemorrhage is often Self-Limiting
- Preservation of Splenic Function
- Decreased Mortality / Mobidity
Operative:
- Penetrating Injury
- Peritonitis
- Haemodynamic Instability
What are the Features of Acute Burns?
- Hypovolaemia occurs Relatively Late
- Hypothermia - Burned Children Lose Heat Rapidly
- If Shocked Look Elsewhere for a Cause
What is the Management of Acute Burns?
- Analgesia - Opiates (I.N. or I.V.) / Oral
- Remove Cold Therapy
- Sterile Towels / Cling-Film
- Avoid Unecessary Examination
- Only Ointments / Creams as Part of Definitive Care
- Specialized Treatment
What is the Pathology of Drowning?
- Submersion
- Voluntary Apnoea
- Acidosis / Hypoxia
- Involuntary Breath
- Laryngeal Spasm
- Involuntary Respiration
What is the Management of Drowning?
- Prevention
- Effective, Early Basic Life Support
- Assume C-Spine Injury
- Handle Gently if Hypothermic
- Intubate to Prevent Aspiration
- Gastric Drainage to Remove Swallowed Water
- Measure Core Temperature and Treat Hypothermia
- Full Trauma Assessment for other Injuries
What are the Methods of External Rewarming?
- Remove Wet Clothing
- Wrap Warmly
- Radiant Heat
- Warm Air System
- Direct Heat
What are the Methods of Core Rewarming?
- I.V. Fluids to 39 Degrees
- Ventilator Gases to 42 Degrees
- Gastric / Peritoneal / Pleural Lavage at 42 Degrees
- Endovascular Warming - ECMO / Bypass
What is the Management of Cardiac Arrest?
- Hypothermia may be Protective - Continue to Resus.
- Active Core Rewarming
- Do Not Give Medications until Core > 30 Degrees
- Give Initial Defibrillating Shocks but do not Repeat until Core > 30 Degrees
- Volume Expansion may be Needed
What are the Features of the Child Skeleton?
- Incompletely Calcified:
- a) Soft
- b) Springy
- c) Deforms Rather than Breaks
- d) Poor at Absorbing Energy
- Provides Less Protection for Vital Organs
What is the Classification used in
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
