Acute Paediatrics

Question 1

What are the airway anatomical differences in the child?

Answer 1

Large head to body size
Short necks
Large tongue
Obligate nasal breathers
Nasal passages easily obstructed
Compressible floor of mouth and trachea
High anterior larynx

Question 2

What are breathing anatomical differences in the child?

Answer 2

Small total surface area for air tissue interface
Lower airways small, easily obstructed
Diaphragmatic breathing
Fewer type I (slow twitch) fibres - easy fatigue
Soft non-calcified bones - v. compliant chest wall so recession and in-drawing
Horizontal ribs - less expansion
Immature lung vulnerable to insult
Apnoea may occur in babies

Question 3

How do metabolic rate and oxygen consumption differ in children?

Answer 3

They are higher

RR higher but gradually falls

Question 4

How does the oxygen dissociation curve differ in neonates?

Answer 4

Oxygen dissociation curve shifted left in neonates (HbF predominance)
Neonates tolerate slightly lower saturations

Question 5

What is the circulating blood volume in children?

Answer 5

70-80 ml/kg

Question 6

How long DA and FO remain open?

Answer 6

months

Question 7

What do ECG features vary with?

Answer 7

Age

Question 8

How does stroke volume change with size?

Answer 8

Increases with size

Question 9

What HR indicates life-threatening pathology?

Answer 9

60bpm

Question 10

What are the consequences of the large surface area to weight ratio of children?

Answer 10

Rapid heat loss/hypothermia

Question 11

What are the issues with babies’ immune systems?

Answer 11

They are immature at birth so more vulnerable to infections

Question 12

What can an acceptable O2 sat be for a baby?

Answer 12

92/93%

Question 13

How would you manage a deteriorating viral induced wheeze?

Answer 13

Same as acute asthma