EAC Recognition of the Seriously Ill Child - Medical Flashcards
A and P differences in paediatrics compared to adults:
Airway
Narrow nostrils Large tongue Loose teeth Compressible floor of mouth Horseshoe-shaped epiglottis High anterior larynx
A and P differences in paediatrics compared to adults:
Cardiovascular
generally healthy hearts
minimum equipment required when attending a paediatric patient
O2 bag
Defib
PALS kit bag: contains various paediatric sized versions of normal kit - OP’s, NP’s, Suction catheters, Non rebreather O2 mask
importance of early recognition of S and S of a seriously ill or injured child
Good assessment allows the child with actual or potential life threatening illness or injury to be rapidly identified and managed.
Paediatric patients will suffer organ damage before their heart gives up making it important to recognise illness or injury early to prevent this. Once they do arrest they stand less chance then adults of successful resuscitation.
the two main pathways that lead to paediatric cardiac arrest
Circulatory failure
Respiratory failure
describe:
Paediatric Assessment Triangle
- Appearance
- Work of Breathing
- Circulation to Skin
All covered during primary survey. Helps to identify time critical illness or injury
Paediatric Assessment Triangle:
Appearance
Tone Interactiveness Consolability Look/gaze Speech/cry
Paediatric Assessment Triangle:
Work of Breathing
Effort: Respiratory effort Recession Accessory muscles Nasal flare Stridor/Wheeze Expiratory grunting
Efficiency ad Effort: Chest expansion Air entry (auscultate) Pulse oximetry Pulse rate Colour Mental status
Paediatric Assessment Triangle:
Circulation to Skin
Colour
Capillary refill
Warmth of Skin
describe:
Paediatric Primary Survey
Airway Breathing Circulation Disability -AVPU -Pupils -BM Expose Frequently Reassess
signs and symptoms of:
Deteriorating Paediatric Patient
Increasing recession Increasing RR Fatigue Altered mental state Cyanosis
respiratory illnesses that occur in paediatric patients
Croup Epiglottitis Asthma Bronchiolitis URTI's LRTI's/Pneumonia
signs and symptoms of:
Croup
Cough - harsh and barking Stridor - due to inflammation and narrowing of the airways Use of accessory muscles Runny nose Hoarseness Sore throat May follow a cold but can appear out of the blue -fever -feeling unwell -being off food -general aches and pains
signs and symptoms of:
Epiglottitis
Fever
Unwell/distressed
Stridor (all children with stridor must be transferred to further care)
Sitting up/ Drooling/ Chin out
management of:
Croup and Epiglottitis
DRcABCDE (time critical correct A and B then transport)
High flow O2 if required
Consider paramedic assistance
Keep child in position of comfort
Keep calm approach and assess the patient in a reassuring and not over-bearing manner
Place noting in the child’s mouth
Blue call if required (always epiglottitis)
REMEMBER:
Upper airway compromise can be made worse by any procedure that may distress the child. This includes measurement of blood pressure, administrations of nebulizers or the forced administration of medication.
signs and symptoms of:
Asthma (Paediatric)
Moderate: able to talk in sentences SpO2 >92% PEFR>50% best Hear Rate 5yrs RR 5yrs
Acute severe: Cant talk in sentences
SpO2 140 2-5yrs – >125 >5yrs
RR >40 2-5yrs – >30 >5yrs
Life Threatening: Silent Chest, Cyanosis
SpO2
management of:
Asthma (Paediatric)
move to calm quiet environment
Encourage use of own inhaler - 2 puffs every 2 minutes max of 10
High % O2
Administer Nebulised Salbutamol O2 Driven
Administer Nebulised Ipratropium Bromide O2 Driven = TIME CRITICAL TRANSFER
Continue with Salbutamol Nebulisation unless clinically significant side effects occur
Consider Adrenaline
Positive Pressure Nebulisation using BVM and T piece
BLUE CALL
Be prepared for respiratory/cardiac arrest
signs and symptoms of:
Bronchiolitis
Reduced SpO2 Increased RR Recession Irregular Breathing Inspiratory Crackles Expiratory Wheeze Low Grade Fever Possible Apnoea
management of:
Bronchiolitis
DRcABCDE - time critical correct A and B then transport
Provide respiratory support if needed
Salbutamol/Ipratropium Bromide Nebuliser
Transfer to further care if required (remember LAS non conveyance policy)
signs and symptoms of:
Upper Respiratory Tract Infections URTI
Tonsillitis/Sore Throat Otitis Media Common Cold Rhinosinusitis Strep throat
management of:
Upper Respiratory Tract Infections URTI
DRcABCDE - time critical correct A and B then transport
Provide respiratory support if needed
Assess hydration status
Transfer to further care if required (remember LAS non conveyance policy)
Refer onwards if not conveying
signs and symptoms of:
Pneumonia/Lower Respiratory Tract Infection LRTI
Fever Cough Tachypnoea Nasal Flaring Recession SpO2
management of:
Pneumonia/Lower Respiratory Tract Infection LRTI
DRcABCDE - time critical correct A and B then transport
Provide respiratory support if needed
Assess hydration status
Consider pre-alert
Consider O2, analgesia and antipyretics
Transfer to further care if required (remember LAS non conveyance policy)
Refer onwards if not conveying
how to assess: Febrile Illness (paediatric)
Temperature >38C significant. reported parental perception of fever must be considered valid. Duration of illness Other symptoms Fluid intake/dehydration status (head swollen or sunken) Chronic conditions Drug history Contact with acute illnesses Foreign travel
Assess for the presence or absence of signs and symptoms using the NICE ‘traffic light’ tool
consider specific illness
management of: Febrile Illness (paediatric)
DRcABCDE - time critical correct A and B then transport
Antipyretics
Use NICE ‘traffic light’ tool to ensure appropriate care pathway (remember LAS non conveyance policy)
causes of:
Convulsions (paediatric)
Febrile Brain Insults: -Infection -Trauma -Hypoxia -Hypoglycaemia -Hypertension Epilepsy Convulsive Status Epilepticus (>5min seizure)
management of:
Convulsions (paediatrics)
DRcABCDE - time critical correct A and B then transport
Provide high % O2 whilst seizing
Seek underlying cause and correct if possible:
-BM (hypo if
management of:
Overdose/poisoning (paediatric)
DRcABCDE - time critical correct A and B then transport Provide high % O2 Ascertain substance: -name -time -quantity -treatment already administered Never induce vomiting Milk for caustic/petroleum ingestion Full set of observations: -RR and depth -ECG -BP -BM -SpO2 Hospital with sample (substance/vomit) and containers
signs and symptoms of: Meningococcal Meningitis (paediatric)
Added respiratory sounds Increased RR and effort Increased heart rate Increased capillary refill Skin cool, mottled SpO2
management of: Meningococcal Meningitis (paediatric)
DRcABCDE - time critical correct A and B then transport
Provide high % O2
EtCO2
SpO2
consider paramedic assist
Full set of observations inc. BM en route
Hospital
PATIENT NEEDS PENICILLIN
