Assessing Seriously Ill Children

Question 1

What is the traffic light system for assessing young children?

Answer 1

Green: taking most feeds okay, normal colour, responds to social cues, alert or wakens quickly, lusty cry or playing and breathing calmly

Amber: taking half or less of feeds, pale, not responding to social cues, hard to wake, reduced activity, no smiling, tachypnoea, less than 95% sats, crepitations, nasal flaring, reduction in number of wet nappies and if <1yr cap refill > 3s

Red: Pale, mottled, ashen, blue, doesn’t stay awake when roused, consciousness decreased, skin turgor decreases any GRUNTING signs

Question 2

What are the grunting signs?

Answer 2

Grunting, weak or continuous high-pitched cry and tachypnoeic

Rib recession and retraction of sternomastoid, nasal flaring, wheeze and stridor

Unequal or unresponsive pupils, focal CNS signs, fits and marked hypotonia

Not using limbs/lying still, odd or rigid posture, decorticate(flexed arms, extended legs) or decerebrate (arms and legs extended).

Temperature >38 if <6months or >39, especially if cold or shutdown peripherally

I have a bad feeling about this baby

Neck rigidity, non-blanching rash, meningism, bulging fontanelle

Green bile in vomit (GI obstruction e.g. atresia, volvulus, intussusception)

Question 3

What are the normal breathing rate, pulse and Systolic BP for an infant <1yrs

Answer 3

RR 30-60

HR 110-160

BP 70-90

Question 4

What are the normal breathing rate, pulse and Systolic BP for a toddler - 1-3yr

Answer 4

RR 24-40

HR 90-150

SBP 80-100

Question 5

What are the normal breathing rate, pulse and Systolic BP for a preschooler - 3-6yrs

Answer 5

RR 22-34

HR 80-140

SBP 90-110

Question 6

What are the normal breathing rate, pulse and Systolic BP for a school age child (6-12yrs)

Answer 6

RR 18-25

HR 70-120

SBP 100-120

Question 7

What commonly causes a child to become seriously Ill

Answer 7

Infection
Sepsis and meningitis
D and V/gastroenteritis

Neurology
Seizures
Reye’s syndrome

Surgical
Obstruction – volvulus, atresia or intussusception
FPIES (food protein- induced enterocolitis syndrome)

Metabolic
DKA or Hypoglycaemia
U&E imbalance
Metabolic errors

Cardiac
Congenital cardiac abnormality, cardiomyopathies, arrhythmias and myocarditis

Hematological
DIC
Haemolytic uraemic syndrome

Question 8

How should sepsis be managed in a child?

Answer 8

High flow Oxygen
Obtain IV/IO access and take blood cultures, blood gas, FBC, CRP, coagulation and Us + Es
Monitor urine out put
Give IV antibiotics STAT broad spectrum according to policy
Consider fluid resuscitation, Lactate >2mmol/L give 20ml/kg of normal saline over 5-10mins (10ml/kg if ketoacidosis)
Escalate to senior Doctor
Consider ionotropic support such as adrenaline

Question 9

What is the paediatric CPR algorithm?

Answer 9

• Unresponsive
• Shout for help
• Open airway and check for obstruction
• Listen, look and feel for breathing
• If not breathing, then 5 rescue breaths
• Check for pulse and breathing
• If no signs of life then 15 chest compressions
• Continue CPR with 2:15 ratio of breaths to compressions

When giving rescue breaths don’t forget head tilt chin lift.

Compressions are 2 fingers for an infant and one hand for a child.

Question 10

What is the paediatric algorithm for choking?

Answer 10

• Head tilt chin life and assess airway for obstruction that can be reached
• Turn on back and give 5 back blows
• In infant now do 5 chest thrusts – like compressions but more forceful
• In child give 5 abdominal thrusts
• Cycle between back blow and chest thrusts/abdominal thrusts until choking stops or breathing stops and then start BLS.