Critically Ill Child

Question 1

Pediatric Assessment Triangle:

Answer 1

appearance, work of breathing, circulation to skin.

Question 2

Pediatric Assessment Triangle: appearance, work of breathing, circulation to skin.

what to assess?

Answer 2

TICLS

tone

interactiveness

consolability

look/gaze

speech/cry

Question 3

Pediatric Assessment Triangle: appearance, work of breathing, circulation to skin.

how to assess for work of breathing?

Answer 3

abnormal SOUNDS (stridor, wheeze)

abnormal POSITION

RETRACTION

Nasal FLARING
Gasping/apnea

Question 4

Pediatric Assessment Triangle: appearance, work of breathing, circulation to skin.

how to assess for circulation to skin?

Answer 4

pallor, mottling, cyanosis

Question 5

how is the airway in peds changed that can lead to a harder airway management?

Answer 5

• huge head
• smaller airway diameter
• obligate nose breathers– will not breath through mouth– will be apneic before breathing throuhg mouth
• large tongue, tonsils and adenoids.

Question 6

how are breathing structures changed in peds that make it harder to breath ?

Answer 6

• more horizontal ribs

less developed cheset muscles

more rleiance on diaphragm and ab muscles

smaller airways

fewer alveoli

reduced functional residual capacity

increasd O2 consumption

• weaker resp muscles and more vulnerable lungs can lead to easier fatiguability and prone to hypoxia

Question 7

Circulation Considerations: blood volume is relatively __ but absolute volume is __.

Systemic vascular resistance is __ → __ BP

Hypotension late sign of _: compensatory mechanisms include (increased __ and increased __)

There is a fixed __ __ in infants/younger children, and thus need to increased HR for adequate CO

Less blood __, __ BP, reliant on increased __ can lead to tachycardia and hypotension. CANNOT REGULAT CONTRACTILITY Provide fluids!

Answer 7

Circulation Considerations: blood volume is relatively larger but absolute volume is smaller.

Systemic vascular resistance is LOWER → LOWER BP

Hypotension late sign of shock: compensatory mechanisms include (increased HR and increased vasoconstriction)

There is a fixed stroke volume in infants/younger children, and thus need to increased HR for adequate CO

Less blood volume, lower BP, reliant on increased HR can lead to tachycardia and hypotension. Provide fluids!

Question 8

normal RR in infant

Answer 8

30-60

Question 9

noraml RR in toddler

Answer 9

24-40

Question 10

normal RR in preschooler

Answer 10

22-34

Question 11

normal RR in child

Answer 11

18-30

Question 12

normal RR in adolescent

Answer 12

adult. 12-16

Question 13

determining minimum systolic BP

Answer 13

70+(2x age in years)

Question 14

using the pediatric assessment triangle, come up with general diagnosis with these presentations:

(don’t look at the asnwers)

Answer 14

Question 15

Ill Neonate Presenting complaints: problems with…
• Eating: poor feeding, vomiting
• Sleeping: lethargy, irritability, excessive crying
• Pooping: not passing stools, passing blood
• Peeing: decreased urine output
• Other: high/low temperature, difficulty breathing, jaundice, query seizures Investigations:
• Sick or not sick? Abnormal appearance (lethargic, seizing), abnormal breathing (apnea, laboured),
abnormal circulation (blue, mottled). If SICK, GET HELP! • Physical Exam: as above

Question 16

management of a crtically ill child

Answer 16

Management: the first 5 minutes– identify critically ill child, move to resus room, resus team, standard precautions, monitor, full vitals, O2, establish IV, beside glucose, ABC