Chapter 1 introduction & Changes in the 7th edition

Question 1

What is the standard fluid bolus given to a child between 9-14years?

Answer 1

10ml/kg

Question 2

Worldwide data from the World Health Organization (WHO) show the leading cause of death in age range of <5’s is? (3)

Answer 2

1. Pneumonia
2. pre-term birth
3. diarrhoeal illness

Question 3

What is the leading cause of death for <5’s in the USA? (1)

Answer 3

Gun related injuries

Question 4

Leading cause of death of death as per the ONS for <5’s in the UK? (3)

Answer 4

1. Cancer
2. Accidents/Trauma
3. Congenital abnormalities

Question 5

In the APLS structured approach it is essential to remember that: (5)

Answer 5

1. Child’s family need support from an appropriate member of the team
2. absolute size and body proportions change with age
3. observations and therapy must be related to their age and weight
4. must consider psychological needs
5. support your team

Question 6

Why might children deteriorate rapidly when severely ill or injured?

Answer 6

due to their significantly lower physiological reserves

Question 7

the outcomes for children who have an out of hospital cardiac arrest are generally poor. Why is this?

Answer 7

because less commonly related to cardiac arrhythmia

more commonly a result of hypoxia and / or shock with associated organ damage and dysfunction.

by the time cardiac arrest occurs, there has already been substantial damage to various organs.

Question 8

What are the common pathways to cardiac arrest in children?

Answer 8

Question 9

What ways do we have of estimating weight in a child?

Answer 9

1. Broselow or sandell tapes
2. Formulae

Question 10

What anatomical airway differences are their in children?

Answer 10

1. occiput is large and neck is short = neck flexion and airway narrowing when child is laid flat
2. face and mandible are small
3. teeth may be loose
4. tongue is large and tends to obstruct the airway AND impede laryngoscopy views
5. floor of the mouth is easily compressible = care when holding jaw for airway positioning

Question 10

<6 month olds are at particular risk of what with regards to their airways?

Answer 10

they are nasal breathers

with narrow nasal passages which are easily obstructed by mucous secretions

Question 10

what age is adenotonsillar hypertrophy a problem?

Answer 10

ages 3-8 years
but can be all ages
can cause obstruction and difficulty if taking nasal route to pass pharyngeal, gastric or tracheal tubes.

Question 11

with reference to the trachea what anatomical considerations need to be taken into account with children?

Answer 11

it is soft and short

therefore over extension or flexion can cause tracheal compression

the short trachea and the symmetry of the carinal angles mean that tube displacement and FB is more likely to be displaced into the left as the right main stem bronchus

Question 11

when considering breathing what differences are there to adults in illness?

Answer 11

air-tissue interface has a small total surface area in the infant.

upper and lower airways are small and thus obstruction is more likely (resistance to flow is inversely proportional to the fourth power of the airway radius)

thus halving the radius increases resistance 16 fold so small obstructions can have significant effects on air entry in children.

Question 11

what muscles do infant rely on to breath?

Answer 11

diaphragm

their muscles are more likely to fatigue as they have fewer type 1 fibres compared with adults

the ribs lie more horizontally in infants and therefore contribute less to chest expansion.

Question 12

what circulation differences are there between adults and children?

Answer 12

small circulating blood volume thus small amounts of blood loss can be critically important

Question 13

what is the relevance of children’s body surface area?

Answer 13

small children with a high ratio lose heat more rapidly and so prone to hypothermia

Question 14

what physiological differences are relevant in children?

Answer 14

1. Respiratory physiology = greater metabolic rate and O2 consumption.

Coupled with constant (relatively low) TV

= limited respiratory reserve and thus will desaturate quickly

2. Cardiovascular = small SV at earlier ages and SV x HR = CO thus explains higher HR at younger ages. Children are equally unable to increase their HR >30% where as adults can increase by >300%

by 2 years myocardial function and response to fluid are similar to those of an adult.

Question 15

what are the triage levels for children. The number, colour and time to see a clinician?

Answer 15

Question 16

triage these children as per the triage tool

1. atypical behaviour normal obs
2. responds to voice or pain only
3. Signs of meningism
4. currently fitting
5. hypoglycaemia
6. not passing urine for 24hrs

Answer 16

1. green
2. orange
3. orange
4. red
5. red
6. yellow