Chapter 4 Flashcards
What are the signs of increased work of breathing?
Raised respiratory rate Recession - intercostal, subcostal, sternal, suprasternal (tracheal tug) Accessory muscle use Nasal flaring Grunting
Why do infants grunt?
Caused by exhaling against a partially closed glottis
Attempt to generate PEEP and prevent airway collapse
Seen with respiratory pathology, raised ICP, abdominal distension and peritonism
Why might a child with respiratory failure not demonstrate increased work of breathing?
- Tiring/exhaustion
- Cerebral depression
- Background neuromuscular disease e.g. SMA, muscular dystrophy
When can spO2 monitoring be innacurate?
Carbon monoxide poisoning Motion artifact High levels of ambient light Saturations <70% Cool peripheries Peripheral shut down e.g shock
What can cause bounding pulses?
Increased cardiac output e.g septicaemia
AV shunt e.g PDA
Hypercapnia
What are the components to assessing respiratory function?
Respiratory rate SpO2 Mental status Skin colour Work of breathing Chest expansion Chest auscultation
What are the components of assessing the circulatory system?
Heart rate Pulse volume - central vs peripheral Capillary refil time Blood pressure Auscultation of heart sounds Skin colour Mental status Urinary output
What urinary output thresholds would suggest poor renal perfusion in infants and children?
Children <1mL/kg/hr
Infants <2mL/kg/hr
What features if present would suggest a cardiac cause of respiratory failure?
Cyanosis not correcting with O2 therapy Tachycardia out of proportion to respiratory difficulty Raised JVP Gallopr rhythm/murmur Enlarged liver Absent femoral pulses
What are the components of assessing disability?
Conscious level- AVPU, GCS
Posture
Pupils - size, symmetry, response to light
What are the components to assessing exposure?
Temperature
Rash and bruising
Reassessment
What are the stages to assessing the seriously ill child?
Primary assessment
Resuscitation
Secondary assessment and looking for key features
Emergency treatment
Stabilisation and transfer to definitive care
What dose of fluid bolus is used in resus?
20mL/kg
What dose is used for IV treatment of hypoglycaemia?
2mL/kg 10% glucose
