advanced paediatric life support

Question 1

recession

Answer 1

more readily develops in younger children due to more compliant chest wall
presence in children over 6-7 indicates severe respiratory failure
the child who has become exhausted - recession decreases as they develop respiratory failure

Question 2

stridor

Answer 2

more pronounced on inspiration
sign of laryngeal or tracheal obstruction

Question 3

wheeze

Answer 3

indicates lower airway narrowing
more pronounced on expiration

Question 4

grunting

Answer 4

expiration agains a partially closed glottis
sign of severe respiratory distress
characteristically seen in infants with pneumonia or pulmonary oedema

Question 5

children presenting with respiratory failure without increased work of breathing

Answer 5

1. exhaustion will reduce increased effort of breathing
2. cerebral depression from raised ICP, poisonging or encephalopathy will decreaase respiratory drive
3. children with neuromuscular disease

Question 6

rales

Answer 6

bubbling, clicking or rattling sounds in the lungs
incoming air opens up closed air spaces in the lungs

Question 7

ronchi

Answer 7

harsh, rattling sounds that resemble snoring
occur as a result of blockage or inflaammation of the small airways

Question 8

pulse oximetry

Answer 8

used to measure arterial oxygen saturation
in severe shock or hypothermia, there may be poor pulse detection
should be 97-100%

Question 9

heart rate

Answer 9

hypoxia produces tachycardia in the older infant and child
anxiety and fever will also cause tachycardia
severe or prolonged hypoxia leads to bradycardia, this is a pre-terminal sign

Question 10

skin colour

Answer 10

hypoxia produces vasoconstriction and skin pallor
cyanosis is a late and pre-terminal sign

Question 11

mental status

Answer 11

hypoxic or hypercapnic child will be agitated or drowsy

Question 12

pulse volume

Answer 12

blood pressure is maintained until shock is severe
absent peripheraal pulses or weak centraal pulses are serious signs of advanced shock

Question 13

Cap refill

Answer 13

should occur within 2 seconds
slow refill time may indicate early septic shock

Question 14

blood pressure

Answer 14

hypotension is a late and pre terminal sign of circulatory failure - cardiac arrest is imminent
hypertension may be the cuase or result of come or raied ICP

Question 15

urinary output

Answer 15

urine output of less than 1 ml.kg.hr for children or less than 2 ml/kg/hr in infants indicates inadequate renal perfusion during shock
history of reduced wet nappies or urine production sshould be sought

Question 16

AVPU

Answer 16

alert
responds to voice
responds to pain
unresponsive

Question 17

systemic hypertension with sinus bradycardia

Answer 17

cushings response
indicates compression of the medulla oblongata caused by herniation of the cerebellar tonsil through the foramen magnum
late and pre terminal sign

Question 18

temperature

Answer 18

fever suggests infection but may also suggest prolonged conculsions or shiveering
in young infants, infection may present with low body temperature

Question 19

primary assessment of airway

Answer 19

look for chest/abdo movement, listen for breath sounds, vocalisations
if there is obvious airway ventilation, assess for signs of stridor or recession
if there is no evidence of air movement then use chin lift or jaw thrust, use of airway adjunct, tracheaal intubation

Question 20

resus if resp difficulty or hypoxia

Answer 20

high flow oxygen through a mask with a reservoir bag to any child with respiratory difficulty or hypoxia

Question 21

resus for children with inadequate circulation

Answer 21

high flow oxygen
venous or interosseus access should be gained an an immidiate infusion of crystalloid given
urgent blood samples, especially blood glucose, can be taken at this point

Question 22

resus of disability

Answer 22

consider intubation in any patient with a conscious level recorded as P or U
if hypoglycaemia is identified, treat with bolus of glucose followed by IV infusion of glucose, after taking blood for glucose

Question 23

how to manage fits

Answer 23

benzodiazepines ie. IV lorazepam, buccal midazolam or rectal diazepam

Question 24

if bubbly secretions are heard

Answer 24

the airway is full of secretions and way require suction

Question 25

if there s harsh stridor assocated with barking cough and severe respiratory distress

Answer 25

uper airway obstruction due to croup should bee suspected and the child should be given nebulised adrenaline

Question 26

if there is quiet stridor, drooling and short history of sick looking child

Answer 26

consider epiglottitis or trachietis
intubation likely to be urgently required

Question 27

stridor following ingestion/injection of a known allergen

Answer 27

suggests anaphylaxis
children should recieve IM adrenaline

Question 28

children with history of asthma and significatn respiratory distress

Answer 28

oxygen therapy
inhaled B2 agonists

Question 29

in a chiild who is unconscious with pinpoint pupils

Answer 29

consider opiate poisoning
trial of naloxone