Children are not Young Adults Flashcards
What are the physiological differences and how do these relate to differing presentations in children? [6]
Large SA: volume = more cold
Smaller target = greater amount of energy absorbed
Reduced metabolic reserves = hypoglycaemia and dehydration
Smaller mass = drug dose and fluid differ
Skeleton not calcified = deforms and less protection Less elastic tissue =degloving
Less type 1 respiratory fibres
What is the most common form of hypoglycaemia in <5
Ketotic hypoglycaemia
Common in skinny 1-2 y/o with intercurrent illness
What are CVS differences in children [5]
What cardiovascular differences happen as children grow older? [3]
- Faster pulse (110-160)
- Faster RR (30-40) Lower BP - can maintain until very shocked (60-70)
- Sats threshold <92%
- Smaller circulating volume
SV increases as increase size
Pulmonary resistance decreases as get older
Systemic resistance increases
What are conditions that are not seen in adults [10]
- Febrile convulsion
- Abdominal migraine
- Bronchiolitis, Croup Viral induced wheeze
- Glue ear
- IVH
- Toddler diarrhoea
- VUJ reflux
- NAI
- Sudden unexplained death of infants
What are chronic conditions with childhood onset [7]
Asthma
Autism
Cerebral palsy
CF
Gastroschisis
Hirschsprung
Spina bifida
What accounts for reduced mortality in children
- Obstetric care
- Better housing
- Better nutrition
- Immunisations
- Antibiotics
- NHS
Who most commonly presents to inpatient and how long do they stay [3]
- <2 years
- Respiratory illnesses
- <48 hours
What are other causes of acute admission [5]
- Asthma, Wheeze
- Acute LRTI, URTI
- Bronchiolitis, Croup
- Febrile convulsion, Fever
- Gastroenteritis, Vomiting
What is decreased birthweight associated with [6]
- Impaired glucose tolerance / DM
- Hypertension
- CHD
- Stroke
- Renal failure
- Asthma
How does metabolism differ in children
Brown fat
Immature shivering
Hypoglycaemia as little glycogen stores which exacerbates hypothermia
How do you assess paed
ABCDE
When do you start oxygen / neb
Sats <92%
What do you do for viral wheeze
SABA
What do you do if child deteriorates [5]
- ABCDE
- IV access
- Fluid Increase
- O2
- Nebulised SABA / steroid ABG / CXR
What are respiratory differences children vs adults [7]
- RR higher
- Higher O2 requirement
- Smaller airway
- Diaphragmatic / accessory muscles to breath
- Easily fatigued
- Soft bones = compliant chest wall so indrawing and recession can be seen
- Can tolerate lower sats
Airway differences in babies [5]
Large head to body ratio
Large tongue, Large adenoids
Nasal breather so obstruct easily
Narrow airway, Short neck
Pediatric vital signs
Look at this table and try to identify patterns in the numbers
State HR and RR ranges:
- Age <1
- Age 2-5
- Age >12
<1: HR 110-160, RR 30-40
2-5: HR 90-140, RR 25-30
>12: HR 60-100, RR 15-20
Now fill in the blanks! State HR and RR ranges:
Age 1-2
Age 5-12
1-2: HR 100-150, RR 25-35
5-12: HR 80-120, RR 20-25
The Apgar score is used to assess the health of a newborn baby. What are the parameters? [5] What is the scoring system like? [1]
Parameters:
- Pulse
- Respiratory effort
- Colour
- Muscle tone
- Reflex irritability
Scoring: each parameter can be scored from 0, 1, 2
Apgar score 0
- Pulse: absent
- Respiratory effort: nil
- Colour: blue all over
- Muscle tone: flaccid
- Reflex irritability: nil
Apgar score 1
- Pulse: <100
- Respiratory effort: weak, irregular
- Colour: body pink, extremities blue
- Muscle tone: limb flexion
- Reflex irritability: grimace
Apgar score 2
- Pulse: >100
- Respiratory effort: strong crying
- Colour: pink
- Muscle tone: active movement
- Reflex irritability: cries on stimulation/sneezes coughed
What does the calculated apgar score indicate about the newborn [3]
- A score of 0-3 is very low score
- between 4-6 is moderate low
- between 7 - 10 means the baby is in a good state
- Assess at 1 and 5 minutes
