ABCDE: Breathless Child, Unwell Child

Question 1

What is the normal RR in paeds aged:

a) <1

b) 1-2

c) 2-5

d) 5-12

e) >12

Answer 1

a) 30-40

b) 25-35

c) 25-30

d) 15-25

e) 12-20

Question 2

In some children, despite hypoxia there will be no signs of increased respiratory effort.

What are 3 examples of when this may happen?

Answer 2

1) Those who have had severe respiratory problems for some time and have become fatigued. Exhaustion (seen in life threatening asthma) is a pre terminal sign.

2) Neuromuscular disease – such as muscular dystrophy.

3) Central respiratory depression (from raised intracranial pressure, poisoning or encephalopathy).

Question 3

How does hypoxia affect HR?

Answer 3

Hypoxia will initially lead to tachycardia, however if it is prolonged or severe this will lead to bradycardia, which is a pre terminal sign.

Question 4

How may hypoxia or hypercapnia present?

Answer 4

Will lead to agitation or drowsiness, which may present as the child who will not cooperate with examination and seems very distressed or alternatively, unusually quiet and withdrawn.

Question 5

What O2 is required for all children with respiratory difficulty or hypoxia?

Answer 5

High flow O2 (15 litres/min) through a non-rebreathe.

Question 6

What resus fluids are indicated in paeds?

Answer 6

10 ml/kg bolus of saline over <10 minutes

Take into account pre‑existing conditions (e.g. cardiac disease or kidney disease), as smaller fluid volumes may be needed.

Question 7

What does a bubbling sound on airway & breathing assessment indicate?

What is the management?

Answer 7

Excessive secretions –> suctioning

Question 8

What does a harsh stridor and a barking cough indicate?

Answer 8

Croup

Question 9

Emergency management of croup?

Answer 9

1) Oral dexamethasone

2) Nebulised budesonide and adrenaline in severe cases

Question 10

What does a soft stridor, drooling and fever in a sick looking child indicate?

Answer 10

Bacterial tracheitis or epiglottitis

Question 11

Emergency management of bacterial tracheitis or epiglottitis?

Answer 11

Intubation by anaesthetist followed by IV antibiotics

Question 12

What does a fudden onset stridor with history of inhalation indicate?

Answer 12

Inhaled foreign body –> laryngoscopy for removal

Question 13

What does a stridor following ingestion or injection of a known allergen indicate?

Answer 13

Anaphylaxis

Question 14

How can fluid status be assessed in paeds?

Answer 14

1) Fontanelle - is it sunken?

2) Mucous membranes - are they dry?

Question 15

What should always be included in SBARR for paeds in ‘background’?

Answer 15

1) Gestational age at birth

2) Birth complications

Question 16

Acute management of bronchiolitis?

Answer 16

1) O2

2) Urgent senior review

3) ?IV fluids for rehydration

4) Suction if there is excessive upper airway secretions

5) Consider nasopharyngeal swab

Question 17

Key features of whooping cough (pertussis)?

Answer 17

1) Paroxysmal cough.

2) Inspiratory whoop.

3) Post-tussive vomiting.

Question 18

Acute management of whooping cough?

Answer 18

1) Isolate patient

2) Notify local health protection team who will advise on lab testing

3) Consider macrolide Abx if onset of cough is <21 days

4) Abx prophylaxis for household contacts

5) School exclusion for 48 hours following commencement of Abx

6) Senior review

Question 19

What is the most common causative organism of whooping cough?

Answer 19

Bordatella pertussis

Question 20

What is the most common causative organism of bronchiolitis?

Answer 20

RSV

Question 21

What lab tests can be used to confirm the diagnosis of whooping cough?

Answer 21

1) Swab culture of nasopharyngeal aspirates or nasal swabs

2) PCR of throat or nasopharyngeal swabs

3) Serology or oral fluid testing for anti-pertussis IgG

Question 22

What are the 3 most common causative organisms for bacterial meningitis in babies >3 months, children & adults?

Answer 22

1) Neisseria meningitidis

2) Strep. pneumoniae

3) Hib

Question 23

What are the 4 most common causative organisms for bacterial meningitis in neonates?

Answer 23

1) Strep. agalactiae (GBS)

2) E. coli

3) Strep. pneumoniae

4) Listeria monocytogenes