Acutely ill children

Question 1

what are the trends in BP, HR and RR as you get older

Answer 1

HR and RR start high get lower, BP starts low and gets higher

Question 2

what is you’re blood pressure when your >1

Answer 2

70-90

Question 3

describe the differences in head anatomy in children (simple)

Answer 3

large head, prominent occiput, high anterior larynx/ floppy epiglottis

Question 4

why is the large surface area of babies important

Answer 4

if they get burned will be a large proportion of skin affected- will lose more fluid

Question 5

why is the floppy epiglottis and high anterior larynx

Answer 5

when intubating have to lift up epiglottis

high larynx means when opening airway put head in neutral position up till age 1 to prevent obstructing airway

Question 6

why do children get costal recession when breathing hard

Answer 6

as ribs are flexible- why is very usual for children to break their ribs

Question 7

what is childrens blood volume

Answer 7

80mls/kg

Question 8

what type of haemoglobin do children have

Answer 8

HbF

Question 9

what are the most common causes of childrens abdominal pain

Answer 9

gastroenteritis and constipation

Question 10

what is bronchiolitis

Answer 10

acute inflammatory injury of the bronchioles, viral cause- mainly RSV

Question 11

what are the signs of bronchiolitis

Answer 11

widespread fine crackles throughout lung fields, cold that goes to chest, struggling with feed. might need oxygen, tends to be over 5 days

Question 12

what is the treatment for bronchiolitis

Answer 12

supportive- may need oxygen, change to smaller meals more often if stuggeling to eat

Question 13

what is the risk of children under a month who get bronchiolitis

Answer 13

can get apnoea- need CPAP

Question 14

what is croup

Answer 14

larygnotracheobronchitis, viral - usually parainfluenza, causes narrowing of the upper air way (stridor)

Question 15

what is the treatment for croup

Answer 15

steroids (very low morbidity and mortality)

Question 16

what can cause upper airway obstruction

Answer 16

epiglotisitis, bacterial infection, croup, inhaled foreign body

Question 17

what are the signs of asthma

Answer 17

prolonged expiratory phase, wheezy

Question 18

what are the signs of pneumonia

Answer 18

crackles on one side, temp, cough, can affect any age- different pathogens for different ages

Question 19

what causes encephalitis

Answer 19

commonly viral- coxsackie

Question 20

what do tou get in encephalitis

Answer 20

focal neurological deficit

Question 21

what can cause meningitis

Answer 21

bacterial- meningococcal, strep, e coli

viral

Question 22

what are the investigations into CNS infections

Answer 22

lumbar punctures, imaging

Question 23

describe the rash in meningitis

Answer 23

fulminant pupura, non blanching

Question 24

what are febrile seizures

Answer 24

reaction to temperature- will last less than 5 mins

Question 25

what is a reflex anoxic seizures

Answer 25

when you get a fright/ bangs head and stops breathing can make fitting movement - do no treat with anti epileptics

Question 26

what are breath holding attacks

Answer 26

when you cry and then hold it and then cry again

Question 27

what are absence episodes

Answer 27

seizures lasting 10-30 seconds where you dont know whats happened can just not be listening

Question 28

what injuries are suspicious of NAI

Answer 28

broken ribs, retinal haemorrhages from shaking, bruising behind ear

Question 29

what are the common GI/UG problems

Answer 29

viral gastroenteritis, GI obstruction (congenital pyloric stenosis, volvulus, intussusception and malrotation), acute abdomen (appendicitis), UTI, testicular torsion

Question 30

should you give children IV drips

Answer 30

avoid, get better a lot quicker when have food in belly

Question 31

what are common CVS complications

Answer 31

congenital heart disease (cyanosis, HF), arrhythmias (SVT) bacterial endocarditis is rare but severe

Question 32

what is the commonest reason for acute illness in children

Answer 32

sepsis

Question 33

what children are at increased risk of sepsis

Answer 33

infants <3/12 immunosuppressed/ immunocompromised/ chemotherapy/ long term steroids recent surgery indwelling devices/ lines complex neurodisability/ long term conditions high index of clinical suspicious (tachypnoea, rash, leg pain, biphasic illness, poor feeding) significant parental concern

Question 34

what is the paediatric sepsis 6

Answer 34

six things to do within an hour (ideally within 15 mins) -high flow oxygen -take bloods (cultures, glucose (target low), lactate) -give IV or IO (into bone marrow) antibiotics if shocked -consider fluid resuscitation -consider inotropic support early involve senior clinicians/ specialists early

Question 35

what can cause circulatory failure

Answer 35

fluid loss- blood loss, gastroenteritis, burns fluid maldistribution- septic shock, cardiac disease, anaphylaxis

Question 36

what can cause respiratory failure

Answer 36

resp distress- foreign body, croup, asthma resp depression- convulsions, raised ICP, poisoning

Question 37

how do you asses the effort of breathing

Answer 37

rate, recession, accessory muscle use, head bobbing, costal recession, grunting (can be due to being cold, low BG, or way of giving themselves CPAP), nasal flaring

Question 38

how do you asses the efficacy of breathing

Answer 38

expansion, additional noises (inspiratory stridor, expiratory wheeze), pulse oximetry, effects on end organs (conscious level, pallor, tachycardia)

Question 39

what can prolong cap refill time in kids

Answer 39

being cold or sepsis

Question 40

hoe can you assess circualtion

Answer 40

HR, rhythm, BP, cap refill, effects on other organs- conscious levels, skin perfusion (temp, colour), urine output

Question 41

what does hypotension suggest

Answer 41

very bad- pre terminal sign

Question 42

how do you manage poor circulation in kids

Answer 42

20mls/kg of 0.9% saline repeat if still shocked (may also need inotropes) if 60mls/kg used then involve PICU

Question 43

when might you need blood transfusions in children

Answer 43

trauma/ haemorrhage

Question 44

what are the signs of 5-10% dehydration

Answer 44

mucous membranes, fontanelles/eyes mildly dry skin turgor slightly decreased urine output midly reduced conscious level normal

Question 45

what are the signs of >10% dehydration

Answer 45

mucous membranes, fontanelles/eyes dry ++, sunken skin turgor decreased urine output significantly reduced conscious level altered

Question 46

how do you asses a childs conscious level

Answer 46

AVPU GCS pupils posture- decorticate (hand and feet inwards) /decerebrate (hands and feet outwards)

Question 47

what are decorticate/decerebrate postures a sign of

Answer 47

problems with brain stem, show neurological bruising | decerebrate worse