CLS 202 Flashcards
What are the steps for the paediatric assessment
- Scene safety
- PAT
- Primary Survey DRABCDE
Any critical interventions - Secondary Survey
History and Vital signs - Management and treatments
- Differential and provisional diagnosis
- Transport decision
What are the three sides to the PAT
- Appearance
- Work of breathing
- Circulation
Describe TICLS
- Tone- floppy lethargic or moving spontaneous.
- Interactions- do they interact normally interested in objects and sounds or uninterested.
- Consolabilty- can they be consoled or are they agitated
- Look- make eye contact or vacant glazed stare.
- Speech- sound strong and spontaneous or weak and muffled.
Four things to look for in Work of Breathing
- Listen for sounds, strider, wheeze grunt.
- Patients position
- Accessory muscle use.
- Nasal flaring
Three things to look for in circulation
- Pale
- Mottling
- Cyanosis
5 signs of respiratory distress
- Intercostal retraction
- Nasal flaring
- Sternal retraction
- Pallor
- Tracheal tug
Why do kids grunt to breath
Trying to generate PEEP to splint the alveolar.
Typically seen in pneumonia
What is the ratio for CPR and what age does it change?
15:2
Changes to 30-2 at 9 years
Drug protocols for cardiac arrest in shockable rhythms
- Adrenaline after second shock. Then every second shock
- 10mcg/kg 1:10,000 - Amiodarone after three shocks
- 5mg/kg
Drug protocols for non shockable cardiac arrest
Adrenaline once IV access is obtained. Same as shockable.
What is the weight formula for patients less than 1 year of age
(0.5 x Age in months) + 4 = kg
What is the weight formula for patients 1-6 years
(2 x age in years) + 8 = Kg
What is the weight formula for patients 6-16 years
(3 x age in years) + 7 = Kg
How do you calculate the Joules for peads
Joules = weight x 4
What are the three types of breech birth?
1- complete
2- footling
3- frank
What’s the process for delivering a Breech birth?
1-POSTURE- get mum standing or on all fours to allow gravity to assist
2- BIRTH- HANDS OFF as much as possible to limit stimulation and breath.
Ensure foetal spine is opposite mums.
Ensure foetal head is in Flection (chin to chest)
Hands off allow gravity to deliver legs and torso.
Place pointers into groin and thumbs on sacrum.
Let the baby ease out until you visualise the scapula.
Gentler rotate in lovaetts manoeuvre. With same side pointer finger place over the shoulder into the antecubital fossa and flex arm out. Repeat for other arm
Once nape of the neck is visualised move to Mauriceau smellie veit
Place info at on forearm pointer an rude finger on cheek upper hand on occipital apply gentle pressure to maintain flextion
As the mother is pushing stand up, maintain flection deliver in a J shape.
What is a cord prolapse
Cord drops through the open cervix before baby
How to manage pt with prolapse cord
If visualised mum may be able to place the cord back in. If not
Walk mum to stretcher and get her to lay in the exaggerated sims position.
Urgent transport. Hi flow oxygen
Signs of shoulder dystocia
Head fails to be delivered despite good effort
Foetal head fails to rotate
Face and chin of foetus may seem to be being pulled back into the vagina (turtle sign)
Anterior shoulder is not visible externally
What does Gravidity mean
How many times the lady has been pregnant
What does Parity mean
Total number of times a women has given birth.
What does G1P1 mean
Been pregnant once given birth once
Describe ECOLOGY in terms of history taking.
Estimated Date of delivery
Contractions
Obstetrics- previous pregnancies, ectopic, c sections, previous pregnancies.
Loss- colour and quantity
Observations-
Gynaecology history- contraception, ovarian cysts, endometriosis.
Y use of drugs- prescription non prescription.
How to deliver shoulder dystocia
Posture supine
Attempt McRoberts
- push both legs to chest
- encourage the women to push apply gentle downwards traction max 30seconds.
Apply supra public pressure to the anterior shoulder
Move to gaskin
- all fours position
- when pushing apply gentle traction delivering anterior shoulder
If unsuccessful transport in mcroberts
Attempt supra pubic pressure
Paediatric treatment of anaphylaxis is?
Position pt
Adrenaline (1:100) 10mcg/kg every 5 minutes whilst indicated
Oxygen target 94%
Salbutamol Neb over 5= 5mg under 5= 2.5mg whilst indicated
Fluids IV 20ml/kg
Hydrocortisone IV 4mg/kg once
Clinical manifestations of epiglottis
Fever 4-8 hours prior Acute onset of upper airway obstruction Lethargy Drooling Dysphagia
What is the asthma treatment?
Both life threatening and non life threatening
O2- 94-98%
Salbutamol- under 5= 2.5 mg over 5= 5mg whilst indicated
Ipatropium Bromide- 2-6years 250mcg, max dose = 500mcg
Life threatening start with
Adrenaline- 10mcg/kg every five minutes
Then as above
Croup Manifestations
1 history of common cold
- Low grade fever
- Seel bark
- Strider on inspiration
What is treatment for severe croup
- O2 94-98
- Adrenaline
- Neb
- 500mcg/kg
- every 30 minutes
Seizure treatment whilst actively fitting
- Protect Pt by removing objects
- Consider backup
- Consider cause. Eclampsia etc.
- Midazolam
- IM 0.15mg/kg
- every 5 minutes
- 0.45mg/kg max dose
No contra indications.
What things to find out with History taking of a seizure patient
1- Time of onset 2- Mechanism of injury 3- fever, aloc 4- past Med Hx 5-meds 6- Allergies
Treatment of Hypoglycaemia
1- glucose get if able to swallow
-entire tube 15grams
If unable to swallow 2- glucose 10% -IV 15g bolus greater then 10 years 0.2g/kg less than 10
Glucagon
Treatment for hyperglycaemia
1-administer compound sodium lactate
- 10ml/kg
- max dose 10ml/kg
