approach to acute paediatrics

Question 1

child airway anatomy

Answer 1

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

Question 2

child anatomy - breathing

Answer 2

• small surface area for air tissue interface
• lower airway small - easily obstructed
• diaphragmatic breathing
• fewer T1 fibres: easy fatigue
• soft non-calcified bones + compliant chets wall = recession and in-drawing
• horizontal ribs, less expansion

Question 3

child physiology - respiratory

Answer 3

• higher metabolic rate/O2 consumption: resp rate higher and gradually falls
• oxygen dissoc curve shifted left in neonates- HbF predominance
• immature lung vulnerable to insult
• apnoea

Question 4

child physiology - cardiovascular

Answer 4

• blood volume 70-80ml/kg: small loss makes big difference
• changes from in-utero to ex-utero: PDAs/PFO may remain open few months
• ECG features vary
• stroke volume inc with size - HR higher and gradually falls

Question 5

child CVS physiology - systemic vascular resistance

Answer 5

progressively rises from birth

• BP lower and rises
• special cuffs/charts needed for different ages

Question 6

child bradycardia

Answer 6

<60

indicates life threatening pathology

Question 7

child physiology - large surface area : weight ratio

Answer 7

rapid heat loss/hypothermia

Question 8

child physiology - immune system

Answer 8

immature

babies more susceptible to infections

Question 9

child CVS physiology - pulm and systemic pressure

Answer 9

pulm pressure starts high and lowers

vice versa for systemic