Assessing Acutely Ill Children Flashcards

1
Q

What are the vital signs seen in <1 year old?

A
HR = 110-160
RR = 30-40
SBP = 70-90
UO = 2ml/kg/hr
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2
Q

What are the vital signs seen in 1-2 year old?

A
HR = 100-150
RR = 25-35
SBP = 80-100
UO = 1.5ml/kg/hr
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3
Q

What are the vital signs seen in 2-5 year old?

A
HR = 90-140
RR = 25-30
SBP = 80-100
UO = 1.5ml/kg/hr
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4
Q

What are the vital signs seen in 5-12 year old?

A
HR = 80-120
RR = 20-25
SBP = 90-110
UO = 1.0ml/kg/hr
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5
Q

What are the vital signs seen in >12 year old?

A
HR = 60-100
RR = 15-20
SBP = 100-120
UO = <0.5ml/kg/hr
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6
Q

Signs of deteriorating airway …

A
  • Stridor
  • Drooling
  • Neck extension
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7
Q

What head position should be used to maintain an adequate airway in children?

A
  • <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
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8
Q

What airway adjuncts should be used in maintaining adequate airway in children?

A
  • 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
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9
Q

How is the airway secured?

A
  • 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
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10
Q

Why is an NG tube required when ET tube is uncuffed?

A

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.

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11
Q

What are the varying degrees of respiratory distress?

A

Mild distress = nasal flaring, intercostal recession

Moderate distress= head bobbing, subcostal recession, noisy breathing

Severe distress = sternal recessions, exhaustion

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12
Q

What is the best method of oxygenation in a child? what rate of oxygen should be provided?

A

Nasal cannulae:

  • 0.5-1L/min
  • 1-2L/min
  • 1-4L/min
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13
Q

What are some signs of clinical dehydration ?

A
  • Reduced skin turgor
  • Dry mucous membranes
  • Tachypnoea
  • Tachycardia
  • Sunken eyes and fontanelle
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14
Q

How are maintenance fluids prescribed based upon body weight?

A

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
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15
Q

How is fluid deficit replaced?

A

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

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16
Q

How is hypoglycaemia treated in children?

A

Give 2ml/kg of 10% glucose

17
Q

What should always be assessed in the febrile child?

A

After A-E approach, an ENT exam is appropriate.

18
Q

Resuscitation doses for children…

A
WET FLAG:
Weight (estimated): <12 months = (age in months/2) + 4 
1-10 years = (age in years +4) x 2
Energy: 4 joules/kg
Tube: 
 - Diameter = (age/4)+4 
 - Length= (age/2) +12

Fluids: Resuscitation = 20ml/kg
Lorazepam: 0.1ml/kg
Adrenaline: 0.1ml/kg of 1 in 10,000
Glucose: 2ml/kg of 10% dextrose

19
Q

What are the main causes of cardiac arrest in children?

A

Hypoxaemia

Circulatory failure

20
Q

Paediatric BLS algorithim…

A
  1. Check responsiveness of patient
  2. Open airway using manouveres and look, listen and feel for 10 seconds
  3. Provide 2 gentle rescue breaths
  4. Assess for signs of life: movement, central pulse, pulse rate <60bpm
  5. Perform CPR and rescue breaths in 15:2 ratio - use two thumbs on infant, and heel of one hand on small child
21
Q

Treatment of anaphylaxis in children…

A

A-E approach:

  1. Lie patient flat and raise legs
  2. Adrenaline: 0.15ml in <6 years
  3. IV fluid challenge : 20ml/kg in children
  4. Chlorphenamine: 250mcg/kg in <6 mths, 2.5mg in 6mth-6yrs
  5. Hydrocortisone: 25mg in <6 mths, 50 mg in 6mths-6yrs