ABCDE: Breathless Child, Unwell Child Flashcards
What is the normal RR in paeds aged:
a) <1
b) 1-2
c) 2-5
d) 5-12
e) >12
a) 30-40
b) 25-35
c) 25-30
d) 15-25
e) 12-20
In some children, despite hypoxia there will be no signs of increased respiratory effort.
What are 3 examples of when this may happen?
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).
How does hypoxia affect HR?
Hypoxia will initially lead to tachycardia, however if it is prolonged or severe this will lead to bradycardia, which is a pre terminal sign.
How may hypoxia or hypercapnia present?
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as the child who will not cooperate with examination and seems very distressed or alternatively, unusually quiet and withdrawn.
What O2 is required for all children with respiratory difficulty or hypoxia?
High flow O2 (15 litres/min) through a non-rebreathe.
What resus fluids are indicated in paeds?
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.
What does a bubbling sound on airway & breathing assessment indicate?
What is the management?
Excessive secretions –> suctioning
What does a harsh stridor and a barking cough indicate?
Croup
Emergency management of croup?
1) Oral dexamethasone
2) Nebulised budesonide and adrenaline in severe cases
What does a soft stridor, drooling and fever in a sick looking child indicate?
Bacterial tracheitis or epiglottitis
Emergency management of bacterial tracheitis or epiglottitis?
Intubation by anaesthetist followed by IV antibiotics
What does a fudden onset stridor with history of inhalation indicate?
Inhaled foreign body –> laryngoscopy for removal
What does a stridor following ingestion or injection of a known allergen indicate?
Anaphylaxis
How can fluid status be assessed in paeds?
1) Fontanelle - is it sunken?
2) Mucous membranes - are they dry?
What should always be included in SBARR for paeds in ‘background’?
1) Gestational age at birth
2) Birth complications
Acute management of bronchiolitis?
1) O2
2) Urgent senior review
3) ?IV fluids for rehydration
4) Suction if there is excessive upper airway secretions
5) Consider nasopharyngeal swab
Key features of whooping cough (pertussis)?
1) Paroxysmal cough.
2) Inspiratory whoop.
3) Post-tussive vomiting.
Acute management of whooping cough?
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
What is the most common causative organism of whooping cough?
Bordatella pertussis
What is the most common causative organism of bronchiolitis?
RSV
What lab tests can be used to confirm the diagnosis of whooping cough?
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
What are the 3 most common causative organisms for bacterial meningitis in babies >3 months, children & adults?
1) Neisseria meningitidis
2) Strep. pneumoniae
3) Hib
What are the 4 most common causative organisms for bacterial meningitis in neonates?
1) Strep. agalactiae (GBS)
2) E. coli
3) Strep. pneumoniae
4) Listeria monocytogenes
