approach to acute paediatrics

Question 1

in what ways are children different to adults

Answer 1

• anatomical differences
• physiological differences
• compensate well and decompensate quickly
• communication challenges
• parents - usually present and anxious

Question 2

airway differences in children

Answer 2

• large head to body size
• short necks
• large tongue
• obligate nasal breathers
• nasal passages easily obstructed
• compressible floor of mouth and trachea
• high anterior larynx

Question 3

breathing differences in children

Answer 3

• small total SA for air tissue interface
• lower airways are smaller - easily obstructed
• diaphragmatic breathing
• fewer type I (slow twitch) fibres - easy fatigue
• soft non-calcified bones, very compliant chest wall, recession and indrawing

Question 4

adult vs infant CXR

Answer 4

• child is much more bell shaped at the top
• heart taking up a bigger space
• mediastinum and thymus is much wider
• ribs are more horizontal

Question 5

physiology of breathing in children

Answer 5

• higher metabolic rate/oxygen consumption
  
  • resp rate higher and gradually falls
• oxygen dissociation curve shifted left in neonates - HbF predominace
• neonates tolerate slightly lower saturations
  
  • immature lung is vulnerable to insult
• apnoea may occur in babies - marker of illness rather than fast RR

Question 6

physiology of cardiovascular system in children

Answer 6

• circulating blood volume (70-80ml/kg)
  
  • small loss can make a big difference
• circulation changes from in-utero to ex-utero
  
  • PDAs/PFO may remain open for several months
• ECG features vary with age
• stroke volume increases with size
  
  • HR higher and gradually falls
• systemic vascular resistance progressively rises from birth
  
  • BP lower and rises
  • special cuffs/charts needed for different ages
• falling BP is a late sign (relatively maintained cf. adults)
• bradycardia (<60) indicates life threatening pathology (but may be seen in anorexia)

Question 7

what to do if there are any signs of life threatening pathology in a child

Answer 7

manage as arrest if no response/poor perfusion

Question 8

communication in children

Answer 8

• babies have no/limited language - can’t describe their symptoms
• talkative children can be quiet - look for non-verbal clues (colour, activity, play), age appropriate discussion
• fear - emergency care is scary
  
  • affects physiological parameters
  • parental anxiety - must be able to stay w/ child
• clear communication (+/- play) needed

Question 9

normal vital signs by age

Answer 9