Approach to Acute Paediatrics

Question 1

How is the airway of a child different to an adult

Answer 1

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 2

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Answer 2

Bradley was here

Question 3

How is breathing of a child different to an adult

Answer 3

Small total surface area for air tissue interface,
Lower airway small-easily obstructed,
Diaphragmatic breathing,
Fewer type 1 fibres (easy fatigue),
Soft non calcified bone- recession and drawing-in,
Horizontal ribs- Less expansion

Question 4

How is respiratory physiology different in children compared to adults

Answer 4

Higher metabolic rate/ oxygen consumption,
Oxygen dissociation curve shifted in neonates,
Immature lung vulnerable to insult,
Apnoea may occur in babies

Question 5

How is cardiovascular physiology different in children compared to adults

Answer 5

Circulating blood volume- 70-80ml/kg (small loss can make a big difference)
PDAs/ PFO may remain open for several months,
Stroke volume increases with size

Question 6

What does falling blood pressure and bradycardia represent in neonates

Answer 6

Falling BP late sign of problem,

bradycardia (<60) indicates life threatening pathology

Question 7

Other considerations to make with regards to difference in children and adults

Answer 7

Huge variation in shape and size,
Large surface area:weight ratio (rapid heat loss/ hypothermia),
Immature immune system at birth,
Huge spectrum of intellectual ability and emotional response

Question 8

Normal HR/ RR/ Systolic BP by age

Answer 8

Age: HR/ RR/ BP
<1: 110-160/ 30-40/ 80-90
1-2: 100-150/ 25-35/ 85-95
2-5: 95-140/ 25-30/ 85-100
5-12: 80-120/ 20-25/ 90-110
>12: 60-100/ 15-20/ 100-120

Question 9

What do they use instead of NEWS chart in paeds?

Answer 9

Paediatric Early Warning Score (PEWS