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Pediatrics > Assessing the acutely ill child-respiratory failure and arrest > Flashcards

Assessing the acutely ill child-respiratory failure and arrest Flashcards

1
Q

Common presentations of acutely unwell child (10)

A 
Acute onset high fever
Non-blanching rash (septicemia)
Convulsions
Altered level of consciousness
Anaphylaxis
Acute asthma
Choking, inhalation of foreign body
Drug ingestion
Severe dehydration
Burns and scalds
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2
Q

What does cardiac arrest usually follow

A

Circulatory failure or respiratory failure

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3
Q

Division of circulatory failure in children and causes

A

Fluid loss:

  • Blood loss
  • Vomiting
  • Dehydration
  • Burns

Fluid maldistribution

  • Septic shock
  • Cardiac
  • Anaphylaxis
  • Nephrotic syndrome
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4
Q

Division of respiratory failure in children and causes

A

Respiratory distress:

  • Asthma
  • Bronchiolitis
  • Pneumonia
  • Croup
  • Foreign body

Respiratory depression:

  • Opiates
  • ICP
  • Poisoning
  • Convulsions
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5
Q

Features in ill child to recognise (5)

A

Colour
Activity
Respiratory
Hydration

Specific other features

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6
Q

Features of a low risk child

A

Normal skin colour
Responding to social cues, smiling, alert/awake, strong cry
Nil respiratory changes
Normal skin, eyes and moist mucus membranes

Nil features of intermediate/high risk

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7
Q

Features of intermediate risk child

A 
Pallor (as reported by carer)
Not responding normal, need ++stimulation, decreased activity, not smiling
Nasal flaring
6-12 months >50 breaths/min
12 months >40 breaths/min
O2 sats 3 seconds, -ve urine output

Fever >5 days
Swollen limb/not weight bearing
New lump >2cm

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8
Q

Features of a high risk child

A

Pale/mottled/ashen
Not rousable/doesn’t stay awake, appear ill to healthcare, no response to social clues
Grunting, indrawing, tachyP >60
Reduced skin turgor

Age 0-3 months T >38
Age 3-6 months T >39

Non blanching skin rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological
Focal seizures

Bile stained vomiting

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9
Q

Causes of shock

A 
Blood loss
Fluid loss- DKA, nephrotic, diarrhea, vomiting
Dehydration
Septic shock
Burns
Heart failure
Anaphylaxis
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10
Q

Clinical features

A 
TachyC
Thready pulse
Delayed CRT
Mottled
Cool extremities
Hypotension (very late)
TachyP
Restlessness
-ve urine
Metabolic acidosis

Fever->sepsis
Purpuritic rash->meningicoccal
Hepatomegaly-> HF
Focus of infection

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11
Q

Management of circulatory failure

A 
ABC, call for help
High flow oxygen, resp support.
IVF bolus
Consider ionotropic support
Antibiotics for sepsis
Adrenaline and hydrocortisone for anaphylaxis
Complete investigations
Admit
Regular observations
Determine a cause
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12
Q

Causes of respiratory failure

A

Upper airway:

  • Foreign body
  • epiglotitis
  • croup
  • Loss of pharyngeal tone
  • Flexion/hyperextension of neck

Lower airway:

  • Asthma
  • Bronchiolitis
  • Pneumonia
  • CF
  • Neonatal lung disease

Neurological

  • ICP
  • Head injury
  • Meningitis
  • Muscle weakness

Severe cardiac failure
Drug ingestion

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13
Q

Clinical feature of respiratory failure

A 
Respiratory distress->nasal flare, indrawing, grunting, stridor
TachyP
Cyanosis
Restless
Confusion

Wheee
Crackles
Neurological weakness

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14
Q

Investigations

A

CXR
ABG
Oxygen saturation

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15
Q

Management

A 
ABC, call for help
Assess severity
High flow oxygen
Intubate and ventilate if +PCO2
Treat underlying cause->antibiotics, bronchoD + steroids, bronchoscopy etc
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16
Q

Define respiratory failure

A

Inadequate respiration to maintain normal arterial oxygenation and CO2 concentration

17
Q

If epiglotitis is suspected, what must you not do

A

Examine the child’s throat

18
Q

What is the glass test and what to do if positive

A

Any rash, place glass over to see if blanching. If non-blanching, seek urgent medical attention

19
Q

When should meningicoccal be suspected

A 
Fever + non blanching rash
Child looks ill
>2mm purpura
Neck is stiff
CRT >3 seconds
20
Q

Presentation of staphylococcal TSS

A

High fever
Muscle pain
Desquamating rash
Severe circulatory failure

21
Q

Neurological warning signs

A 
Drowsy, lethargy, ALOC
Severe headache (vomiting)
Irritability, high pitched cry
Bulging fontanelle in infants
Neck stiffness
Sudden onset of muscle weakness
Any new cranial nerve lesion
Abnormal movements
Convulsions
22
Q

Importance of irritability

A

Consider hypoxia or CNS infection

Pediatrics (58 decks)

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