Acutely Ill Child

Question 1

Give four anatomical and one physiological important differences between adults and children

Answer 1

1. Infants have a large head and prominent occiput - important in CPR
2. Relatively large surface area to volume - important for calculating fluid replacement therapy in burns
3. High anterior larynx/epiglottis
4. More flexible ribs - don’t hesitate in CPR
5. HbF at birth - greater affinity for oxygen so infant is better oxygenated

Question 2

What is the commonest reason for acute illness in children?
How does it present?
Treatment?

Answer 2

Sepsis
No particular signs – ma just be fever, off feeding, irritability, non-specific rash. Very hard to differentiate between this and a simple viral or upper respiratory tract infection.
Treat children with antibiotics for 24-48 hours until you’re sure they don’t have bacterial sepsis.
Treatment is supportive – maintain airway, breathing, circulation, fluids and nutrition as required.

Question 3

Bronchiolitis

• Who gets it?
• Bacterial or viral?
• Treatment?

Answer 3

Commonest in infant and toddler – by the time you reach 2-3 years old if they catch RSV they will just get a cough, but not bronchiolitis.
Viral – respiratory syncytial virus is most common cause, though other pathogens.
Treatment is still entirely supportive.

Question 4

Laryngotracheobronchitis

• Aka?
• Bacterial or viral?
• Differential?
• X-ray appearance?
• Treatment

Answer 4

Croup
Viral
DD – anything else which causes upper airway obstruction. Worry is epiglottitis (caused by haemophilus influenza). Also foreign bodies – usually have a history of some sort of inhalation episode which is very acute.
Steeple sign with narrowing of the tracheal air column at the larynx and distension of the hypopharynx.
Steroids

Question 5

What is the best test to do in suspected meningitis?

Answer 5

Lumbar puncture

Question 6

What does a positive Tumbler test indicate?

Answer 6

Non-blanching rash - most likely bacterial meningitis but can also be sepsis

Question 7

What is the most common arrhythmia in children?

Answer 7

Supraventricular tachycardia

Question 8

What is a reflex anoxic seizure?

Answer 8

Child has a brief period of asystole lasting around 10s and they go white

Question 9

What is a breath holding attack?

Answer 9

Child takes a big breath in, then exhales, then stops breathing and turns blue - in response to noxious stimulus

Question 10

What should you consider in a child with recurrent UTI?

Answer 10

Abnormal renal tract

Question 11

What are the three E’s in assessment of breathing?

Answer 11

Effort - rate, accessory muscle use, grunting, nasal flaring
Efficacy - pulse oximetry
Effects on end organs - conscious level, pallor, tachycardia

Question 12

What volume of saline should you give a child?

Answer 12

20 mls/kg
May need more if trauma/haemorrhage
At 60 mls/kg PICU should be informed