28 - Recognition and Management of the Sick Child Flashcards
How do you do an A to E in a sick child quickly?
Don’t forget pupils, AVPU, BM and fontanelles
If a child is unconscious what manoeuvre should be done to open their airway?
Head tilt chin lift
Infant: Neutral position
Child: Sniffing position
What is normal respiratory rate in children and what do you need to be thinking when assessing their breathing?
How much effort is going in to breathing?
e.g flaring, grunting, subcostal recessions
Gasping is a late sign
Raised respiratory rate is a sign of hypoxia. Which children despite hypoxia will have a normal respiratory rate?
- Severe respiratory problems for some time and have become fatigued e.g exhaustion in life threatening asthma
- Neuromuscular disease e.g muscular dystrophy
- Central respiratory depression e.g raised ICP, poisoning, encephalopathy
Hypotension is a late sign of circulatory failure in children. What are some earlier signs that may appear before this and how can this be managed?
- Raised respiratory rate (due to metabolic acidosis)
- Reduced urine output
- Mottled skin with pale, cool peripheries
- Altered mental state
Resuscitation
- 10-20ml/kg bolus of 0.9% sodium chloride, administered over 10 minutes. Inotropes if more than two boluses needed. If in DKA use 10ml/kg bolus due to risk of cerebral oedema
- If cannot get venous access get intraosseous
If a child has bradycardia and hypertension what do you need to consider?
Raised ICP leading to coning
How is hypoglycaemia in children managed?
Bolus of 2ml/kg 10% glucose IV or IO, followed by a glucose infusion to prevent recurrence
What is the diagnosis of the following?
CHD may present a few days after birth if not already picked up due to switches from fetal to neonatal circulation. If a duct dependent lesion is suspected what needs to be given?
IV dinoprostone (Prostaglandin E2)
What is the most common arrhythmia in children and how is this managed?
Supraventricular tachycardia (SVT)
If SVT is identified on ECG do vagal manoeuvres followed by a rapid bolus of IV adenosine or synchronous DC shock
What is a POPS score and how is this calculated?
Used in ED, if scoring 8 or more need immediate doctor assessment and moved to resus
What core parameters are included in a PEWS score?
Use age specific chart
Parental concern and effort of breathing are scores on PEWS
How do you assess mild, moderate and severe respiratory effort in children?
What are some additional parameters in the PEWS score?
Assess cap refill centrally
Who should you refer to with different PEWS scores?
Anything above 7 or scoring red in one section is urgent immediate referral
What is the NICE traffic light system?
Identify risk of serious illness in under 5’s
What are some red flags of a seriously ill child?
‘GRUNTING’
