29 - Emergency Paediatrics 1 Flashcards
What is the last parameter to go in a child during shock?
BP (Cap Refill better than BP)
Why do we have to contact PICU if having to give more than 40ml/kg to children?
Risk of pulmonary oedema so need intubation and inotropes
If newborn has CRP>10 what do you have to investigate?
Need a LP as 33% of infections in newborns are meningitis
FULL SEPTIC SCREEN!
What is the most common cause of paediatric cardio-respiratory arrest?
Respiratory problem causing prolonged hypoxaemia resulting in cardiac arrest
e.g birth asphyxia, inhalation of foreign body, acute asthma or bronchiolitis
Unlikely to be primary cardiac cause
What is the process of neonatal life support?
How do you do paediatric basic life support in hospital? (WATCH VIDEO VERY IMPORTANT)
https://www.youtube.com/watch?time_continue=132&v=IzbnQ3JJsFY&feature=emb_title
Safety, Stimulate, Shout for Help/Ask for 2222!!!!!!!!!!!!!!
- Check then open airway (neutral if <1, sniffing if older) and check breathing for 10 seconds
- Give 5 rescue breaths with BVM
- If no spontaneous breathing, HR<60 or no central pulse after 10 secs start next step
- 15 chest compressions to 2 breaths for 4 cycles/1 minute and get help if none yet
What pulse should you feel in paeds BLS?
Children: carotid, brachial or femoral artery
Infants: brachial artery
When are chest compressions started in paediatric BLS and what is the technique for this?
No sign of life, no pulse, HR<60
Compression of the lower half of the sternum by around 1/3 of its depth with full recoil. 100-120/min
Infants: hand encircling if 2 rescuers, 2 finger if 1 rescuer
Children: heel of their hand over the lower half of the sternum
How do you give rescue breaths out of the hospital?
Infant: cover nose and mouth with rescuer mouth
Child: pinch nose and breath in mouth
What are correctable causes of cardiorespiratory arrest?
What are some causes of cardiac and respiratory arrest?
Think of any cause of respiratory distress
- Sepsis
- Pneumonia
- Asthma
- Raised ICP
- Foreign body
- Aspiration
- Seizure
- Neonatal apnea
When should you pause in paediatric ALS to check for shockable rhythms?
After every 2 minutes of CPR
When do we need immediate vascular access via IO in children?
- Cardiorespiratory arrest
- Severe burns
- Prolonged status epilepticus
- Hypovolaemic and septic shock
What are some contraindications to IO access?
Best site is proximal tibia (can also do distal tibia or distal femur)
- Osteoporosis
- Osteogenesis imperfecta
- Infection or fracture at the site of insertion
If a child is choking, should you clear their airway?
- If can be retrieved by pincer grip yes
- Do not perform a blind finger sweep as can push foreign body further into airway
How do you manage an infant that is choking?
- Encourage coughing
- 5 back blows checking after each one if foreign body has been removed
- 5 chest thrusts
- If unconscious CPR
How do you manage a child that is choking?
- Encourage coughing
- 5 back blows checking after each
- 5 abdominal thrusts (fist with hand over top) checking after each
- If unconscious CPR
What is shock and the four causes of this?
Life threatening condition caused by the systemic failure of the circulatory system, causing inadequate perfusion of major organs
- Hypovolemic
- Obstructive – obstruction of blood flow to and from the heart
- Cardiogenic – pump failure
- Distributive
- Septic
What are three signs of compensated shock?
ALWAYS CONSIDER IF CHANGE IN MENTAL STATE
- Tachycardia to increase cardiac output
- Redistribution of blood flow to increase perfusion of more important organs at the expense of others (e.g. skin and kidneys)
- Tachypnoea to reduce anaerobic respiration and reduce lactic acidosis formation
- Reduced urine output
- Increased cap refill
What are two causes of distributive shock?
Sepsis and Anaphylaxis
Systemic vasodilation due to loss of sympathetic tone because of the release of vasodilators
What are some causes of hypovolaemic shock?
- Dehydration e.g. diarrhoea, vomiting, burns, inadequate feeding in infants, or diuresis in DKA
- Third spacing e.g sepsis and anaphylaxis, the release of inflammatory mediators increases the permeability of capillaries, leading to fluid in the capillaries moving to the interstitial space
- Haemorrhage.
What are some causes of cardiogenic shock?
Very rare in children and poor prognosis
Viral myocarditis or acute deterioration of heart failure secondary to CHD
Should be suspected if not responding to fluid therapy and BP remains low and/or is demonstrating signs of pulmonary overload (tachypnoea, respiratory distress, hepatomegaly)
What are some causes of obstructive shock?
Least common shock in children, obstruction to the outflow of blood from the heart itself or the great vessels
Coarctation of the aorta, cardiac tamponade, tension pneumothorax or massive pulmonary embolism
Shock is an emergency so management and investigations should occur simultaneously. What investigations should be done?
- Lactate and blood gases: look for ischaemia
- Creatinine: look for AKI
- U+Es: see if electrolytes off due to diarrhoea etc
- FBC, CRP, Blood cultures: if suspect sepsis
What is the management for shock?
- A to E
- 20ml/kg bolus with saline. Get IO line if IV difficult
- Blood products/inotropes if not responding to fluids e.g IV adrenaline ordopamine
- Escalate to PICU
- Treat underlying cause e.g sepsis 6
In children with suspected cardiogenic shock, be cautious with fluid resuscitation and start with 5ml/kg fluid boluses
What are some complications of shock?
What is the most common cause of shock in children and how does it appear when it becomes decompensated?
Sepsis
- Hypotension
- Decreased O2 sats
- Chest/abdominal pain
- Weak, thready pulse
- Cold, grey or mottled skin
- Decreased body temperature
What are some causes of dehydration in children?
Inadequate intake or Excessive Loss
Diarrhoea and Vomiting most common cause of dehydration
What questions can you ask in the history to determine the level of dehydration in a child?
- How many episodes of D+V and how much fluid in each?
- Is the child still eating and drinking, how much?
- Is the chill still urinating, is it concentrated or dilute?