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
How is hypoglycaemia treated in children?
Give 2ml/kg of 10% glucose
What should always be assessed in the febrile child?
After A-E approach, an ENT exam is appropriate.
Resuscitation doses for children…
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
What are the main causes of cardiac arrest in children?
Hypoxaemia
Circulatory failure
Paediatric BLS algorithim…
- Check responsiveness of patient
- Open airway using manouveres and look, listen and feel for 10 seconds
- Provide 2 gentle rescue breaths
- Assess for signs of life: movement, central pulse, pulse rate <60bpm
- Perform CPR and rescue breaths in 15:2 ratio - use two thumbs on infant, and heel of one hand on small child
Treatment of anaphylaxis in children…
A-E approach:
- Lie patient flat and raise legs
- Adrenaline: 0.15ml in <6 years
- IV fluid challenge : 20ml/kg in children
- Chlorphenamine: 250mcg/kg in <6 mths, 2.5mg in 6mth-6yrs
- Hydrocortisone: 25mg in <6 mths, 50 mg in 6mths-6yrs
