Assessing Acutely Ill Children Flashcards
What are the vital signs seen in <1 year old?
HR = 110-160 RR = 30-40 SBP = 70-90 UO = 2ml/kg/hr
What are the vital signs seen in 1-2 year old?
HR = 100-150 RR = 25-35 SBP = 80-100 UO = 1.5ml/kg/hr
What are the vital signs seen in 2-5 year old?
HR = 90-140 RR = 25-30 SBP = 80-100 UO = 1.5ml/kg/hr
What are the vital signs seen in 5-12 year old?
HR = 80-120 RR = 20-25 SBP = 90-110 UO = 1.0ml/kg/hr
What are the vital signs seen in >12 year old?
HR = 60-100 RR = 15-20 SBP = 100-120 UO = <0.5ml/kg/hr
Signs of deteriorating airway …
- Stridor
- Drooling
- Neck extension
What head position should be used to maintain an adequate airway in children?
- <12 months: aim for neutral position by lifting chin - DO NOT perform head tilt chin lift in infants
- Child: ‘sniff the morning air’ position i.e. half head-tilt
What airway adjuncts should be used in maintaining adequate airway in children?
- Insert guedel airway directly with tongue depressor (not turning upside down first) in children <8 y/o - to avoid damaging palate
- DO NOT use nasopharyngeal airway which may cause adenoidal bleeding
How is the airway secured?
- Endotracheal tube is used but needs to be shallow as trachea is much shorter
- Un-cuffed ET tube should be used so epithelium is not damaged, but this means NG tube is also required
- Needle cricothyroidotomy used instead of surgical cricothyroidotomy
Why is an NG tube required when ET tube is uncuffed?
Uncuffed ET tube means the ET tube cannot sit as low down in the trachea therefore the airway will not be protected from potential aspiration from the GIT.
NG tube is therefore required to prevent this.
What are the varying degrees of respiratory distress?
Mild distress = nasal flaring, intercostal recession
Moderate distress= head bobbing, subcostal recession, noisy breathing
Severe distress = sternal recessions, exhaustion
What is the best method of oxygenation in a child? what rate of oxygen should be provided?
Nasal cannulae:
- 0.5-1L/min
- 1-2L/min
- 1-4L/min
What are some signs of clinical dehydration ?
- Reduced skin turgor
- Dry mucous membranes
- Tachypnoea
- Tachycardia
- Sunken eyes and fontanelle
How are maintenance fluids prescribed based upon body weight?
Fluid requirement in 24 hours:
- First 10kg = 100ml/kg
- Second 10kg = 50ml/kg
- Subsequent kg = 20ml/kg
Rate of fluids:
- First 10kg = 4ml/kg/hr
- Second 10kg = 2ml/kg/hr
- Subsequent kg = 1ml/kg/hr
How is fluid deficit replaced?
Calculate amount needed to be replaced:
Weight (kg) x %fluid loss x 10 = fluid deficit
Replace this within 4 hours
Give in boluses of 20ml/kg - should be 25% of circulating vol –> if no improvement, escalate care