Chapter 4 Structured approach to the seriously ill child

Question 1

Why do infants grunt in respiratory distress?

Answer 1

Expiration against partially closed glottis in attempt to generate PEEP.
Seen in conditions causing stiff lungs, most often pneumonia and pulmonary oedema

Question 2

In children with raised intracranial pressure. Will their respiratory rate increase or decrease?

Answer 2

Decreased due to decrease respiratory drive

Question 3

Name three conditions where a child may be in respiratory failure without an increased respiratory effort

Answer 3

1) exhaustion - preterminal
2) Respiratory depression due to raised intracranial pressure, poisoning or encephalopathy
3) Neuromuscular disease

Question 4

If a child is hypoxic with bradycardia, what should this signal to you ?

Answer 4

Bradycardia in the setting of hypoxia is preterminal

Question 5

If central cyanosis is present, what should this signal to you?

Answer 5

Late signs of hypoxia and signals impending respiratory arrest.
Only seen when O2 sats < 70%

Question 6

What should hypotension signal to you?

Answer 6

Pre-terminal sign, imminent cardiac arrest

Question 7

What should tachypnoea with increased tidal volume but no recession give a clue to?

Answer 7

Metabolic acidosis

Question 8

What feautures would suggest cardiac cuase of respiratory inadequacy?

Answer 8

1) Cyanosis not correcting with O2
2) Tachycardia out of proportion with respiratory difficulty
3) Raised JVP
4) Gallop rhythm/murmur
5) Enlarged liver
6) Absent femoral pulses

Question 9

What is the likely management of bacterial epiglottitis or tracheitis?

Answer 9

Intubation (ideally senior anaesthetist) then cefotaxime or ceftriaxone IV

Question 10

When should you consider inotropes? After how much fluid?

Answer 10

After the 3rd fluid bolus

Question 11

How much hypertonic saline do you give for raised intracranial pressure?

Answer 11

3ml/kg or 3% saline over 15- 30min