Acutely unwell child Flashcards
What is important to prepare for a paediatric resuscitation?
WETFLAG
Weight - (age+4) x2 in Kg
Energy - 4 joules/kg
Tube - (age/4) + 4 = mm
Fluids - 20ml/kg bolus
Lorazepam - 0.1mg/kg
Adrenaline - 0.1ml/kg
Glucose - 2ml/kg
What are some key signs of increased work of breathing in children?
Recession - subcostal, intercostal, tracheal tub
Sniffing the morning air position
Lethargy
What are the key ideas of a child with stridor?
An upper airway problem
Usually inspiratory but can be biphasic
What are some common causes of acute stridor in children?
Viral croup
Epiglottitis
Bacterial tracheitis
Foreign body
Anaphylaxis
What are the common causes of chronic stridor?
Laryngomalacia
Congenital airway abnormality
Birthmarks
Tumours
Vocal cord dysfunction
What is the most common cause of viral croup?
Parainfluenza A and B
What is the common cause of epiglottitis?
Haemophilius Influenza B
What should be included when assessing the airway of a child?
Look - conscious level, chest movement, drooling, swelling
Listen - vocalisation, snoring, stridor (supraglottic), stertor (snoring during sleep airway constriction in NP or OP), silent.
Feel - expired air
Describe the pattern seen in a CXR of a child with an airway obstruction.
What is the theory behind this?
Decreased opacity on the side of the obstruction
Caused by air trapping - ball valve effect enables the child to inhale but they can not exhale - leads to air trapping.
Note this may also be accompanied with a change from wheeze to silence as the obstruction passes further down into the lungs.
What are the signs of a laryngeal impaction?
Choking
Gagging
Hoarseness
Aphonia
Cyanosis
What are the signs of tracheal impaction?
Inspiratory stridor
Coughing
What are the key features of a foreign body ingestion/inhalation?
Peak 1-2yrs
Coins most common
Risk management - high risk object or airway comprise
Metal detector
May use x-ray
What foreign objects are concerning for ingestion in a child?
Button batteries
2 or more magenets
How to tell the difference between a button battery and a coin on ingestion?
Button battery - has a halo sign
Coin - same throughout
What are the concerning signs on this CXR of a 2-year-old who has swallowed a magnet?
More than one magnet
Gassless abdomen
Gastric and duodenal gas with air fluid levels
Suggests a bowel perforation
What is the key difference in symptoms between bronchiolitis and viral induced wheeze?
Bronchiolitis - wet inflamed lungs with secretions - gradually more severe, initial worse than VIW
Viral induced wheeze - bronchoconstriction -> starts at low severity, gradual rise, then sudden rise to high severity.
How does the age of the child influence the most likely cause of a wheeze?
Bronchiolotits most common in infants
Viral wheeze most common in pre-school
Asthma most common in school aged.
How should you assess the breathing of a child?
Effort = RR, recession, noises, gruting, accessory, nostril flaring, gaspring
Efficacy = chest expansion, auscultation, pulse oximetry.
Effect = HR, skin colour, mental status
What is grunting as breathing noise?
Expiration against a partially closed glottis in an attempt to increase airway pressure and prevent atelectasis.
What is the first line treatment for acute asthma?
- Bronchodilators - sulbutamol MDI 10 puffs or Nebs if O2 required
+/- ipratropium bromide nebuliser - Corticosteroid - oral prednisolone/dex, IV hydrocortisone if PO not possible
What are the second line treatment for Acute asthma management?
IV bronchodilators - IV magnesium, aminophylline, salbutamol
Regular IV corticosteroids - 6 hourly hydrocortisone.
When should intubation be considered for an acute asthma scenario?
SpO2 <92% despite high flow/face mask
Hypercapnia - CO2>6kPa.
Reduced conscious level
Poor air entry/silent chest.
What are some cardiovascular signs to be assessed in children?
Heart rate - bradycardia is pre-terminal
Pulses - including femoral
BP - Hypotension is a very late sign
CRP
Murmurs
Hepatomegaly, JVP, oedema
