Acutely ill child Flashcards
risk factors for NAI
history of intimate partner violence and abuse
substance abuse in caregiver
mental health condition in caregiver
excessive crying
unintended pregnancy
developmental problems
presentation of NAI
bruises
bites
lacerations/abrasions
thermal injuries
fractures
intracranial injuries
eye trauma
spinal/ visceral injuries
differentials of NAI
coagulopathy
osteogenesis imperfecta
skeletal survey in NAI
Head/chest (including AP and lateral skull)
Spine/pelvis
Upper limbs
Lower limbs
Skeletal survey should be repeated at 11-14 days.
This is to ensure that injuries too new to appear on the initial skeletal survey are detected.
11-14 days is used as this is the maximal time take for the periosteal reaction to occur, allowing fractures to be visualised on X-ray.
possible physical presentations of child abuse
bruising
fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
torn frenulum: e.g. from forcing a bottle into a child’s mouth
burns or scalds
failure to thrive
sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas
features where you should consider child neglect abuse
Severe and persistent infestations (e.g. Scabies or head lice)
Parents who do not administer essential prescribed treatment
Parents who persistently fail to obtain treatment for tooth decay
Parents who repeatedly fail to attend essential follow-up appointments
Parents who persistently fail to engage with child health promotion
Failure to dress the child in suitable clothing
Animal bite on an inadequately supervised child
features where you should suspect neglect child abuse
Failure to seek medical advice which compromises the child’s health
Child who is persistently smelly and dirty
Repeat observations that:
poor standards of hygiene that affects the child’s health
inadequate provision of food
living environment that is unsafe for the child’s development stage
features where you should consider sexual abuse
Persistent dysuria or anogenital discomfort without a medical explanation
Gaping anus in a child during examination without a medical explanation
Pregnancy in a young women aged 13-15 years
Hepatitis B or anogenital warts in a child 13-15 years
features where you should suspect sexual abuse
Persistent or recurrent genital or anal symptoms associated with a behavioural or emotional change
Anal fissure when constipation and Crohn’s disease have been excluded as the cause
STI in a child younger than 12 years (where there is no evidence of vertical or blood transmission
Sexualised behaviour in a prepubertal child
features where you should consider physical abuse
Any serious or unusual injury with an absent or unsuitable explanation
Cold injuries in a child with no medical explanation
Hypothermia in a child without a suitable explanation
Oral injury in a child with an absent or suitable explanation
features where you should suspect physical abuse
Bruising, lacerations or burns in a child who is not independently mobile or where there is an absent or unsuitable explanation
Human bite mark not by a young child
One or more fractures if there is an unsuitable explanation, including:
fractures of different ages
X-ray evidence of occult fractures
Retinal haemorrhages with no adequate explanation
high risk colour
pale
mottlesd
ashen
blue
high risk activity
no response to social cues
appears ill to a healthcare professional
doesn’t wake or if roused doesn’t stay awake
weak, high-pitched or continuous cry
high risk respiratory
grunting
tachypnoea, RR>60
moderate or severe chest indrawing
high risk circulation and hydration
reduced skin turgor
other high risk features
age <3 months
temperature >38
non-blanching rash
buldging fontanelle
neck stiffness
status epilepticus
focal neuro signs
focal seizures
CT head criteria <1 hour
Suspicion of non-accidental injury
Post-traumatic seizure but no history of epilepsy.
On initial emergency department assessment, GCS less than 14, or for children under 1 year GCS (paediatric) less than 15.
At 2 hours after the injury, GCS less than 15.
Suspected open or depressed skull fracture or tense fontanelle.
Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
Focal neurological deficit.
For children under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head
Paediatric BLS compression ratio
15:2
paediatric BLS
unresponsive?
shout for help
open airway
look, listen, feel for breathing
give 5 rescue breaths
check for signs of circulation
infants use brachial or femoral pulse, children use femoral pulse
15 chest compressions:2 rescue breaths (see above)
chest compressions should be 100-120/min for both infants and children
depth: depress the lower half of the sternum by at least one-third of the anterior–posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child)
in children: compress the lower half of the sternum
in infants: use a two-thumb encircling technique for chest compression
causes of paediatric cardiac arrest
Causes could include birth asphyxia, inhalation of foreign body, acute asthma or bronchiolitis. Respiratory arrest can also be secondary to neurological dysfunction or ingestion of drugs such as opiates.
pathophysiology of cardiac arrest in children
The outcome of cardiac arrest in children is poor. In children, the most common cause of cardiorespiratory arrest is due to a respiratory problem causing prolonged hypoxaemia resulting in cardiac arrest. At the point of arrest the organs, including the brain, have experienced significant hypoxic damage; a primary cardiac cause is very rare.
risk factors for children at risk of aspiration
decreased GCS
an underlying cardiac condition
anaphylaxis
drug ingestion
neuromuscular disorders
respiratory pathology
foreign body
post cardiac surgery
drowning
trauma
medication that causes a reduction in GCS
any anatomical abnormality with the ability to obstruct the airway
non accidental injury (see our child protection article for more information)
airway opening manoeuvre for <1 year infant
neutral position
airway opening manoeuvre for older children
sniffing morning air
