L3: Recognition of Critically Ill Infants

Question 1

Intro

Answer 1

Question 2

Recognition of Potential Respiratory Failure

Answer 2

Question 3

Recognition of Potential Respiratory Failure

• Effort of breathing

Answer 3

Question 4

Recognition of Potential Respiratory Failure

• Effort of breathing (RR)

Answer 4

Question 5

Recognition of Potential Respiratory Failure

• Effort of breathing (Recession)

Answer 5

Question 6

Recognition of Potential Respiratory Failure

• Effort of breathing (Inspiratory & Expiratory)

Answer 6

Stridor, Wheeze and Grunting

Question 7

Recognition of Potential Respiratory Failure

• Effort of breathing (accessory Muscles)

Answer 7

Sternomastoid may be used as an accessory respiratory muscle when the effort of breathing is increased
- Head bobbing up and down with each breath

Question 8

Recognition of Potential Respiratory Failure

• Effort of breathing (Grasping)

Answer 8

This is a sign of severe hypoxia and may be pre-terminal

Question 9

Recognition of Potential Respiratory Failure

• Effort of breathing (Flaring Ala Nasi)

Answer 9

….

Question 10

Causes of Absent / decreased evidence of ⇡⇡ effort of breathing

Answer 10

• Exhaustion (exhaustion is a pre-terminal sign)
• CNS depression
• Neuromuscular disease (such as spinal muscular atrophy or muscular dystrophy)

Question 11

Diagnosis of respiratory failure

Answer 11

• Observing the efficacy of breathing
• Looking for other signs of respiratory inadequacy

Question 12

Recognition of Potential Respiratory Failure

• Efficacy of Breathing

Answer 12

Question 13

Recognition of Potential Respiratory Failure

• Efficacy of Breathing (Auscultation)

Answer 13

A silent chest is a pre-terminal sign

Question 14

Recognition of Potential Respiratory Failure

• Efficacy of Breathing (Pulse Oximetry)

Answer 14

• Can be used to measure the arterial oxygen saturation (SaO2).
• Normal SaO2 is 97 – 100 %

Question 15

Recognition of Potential Respiratory Failure

• Effects of respiratory inadequacy on other organs

Answer 15

Question 16

Recognition of Potential Respiratory Failure

• Effects of respiratory inadequacy on other organs (Heart)

Answer 16

◈ Early, hypoxia produces tachycardia.
◈ Severe or prolonged hypoxia leads to bradycardia.
◈ Bradycardia is a pre-terminal sign.

Question 17

Recognition of Potential Respiratory Failure

• Effects of respiratory inadequacy on other organs (Skin)

Answer 17

◈ Pallor: hypoxia (via catecholamine release) ⇢ VC and skin pallor.

◈ Cyanosis: is a late and pre-terminal sign of hypoxia

Question 18

Recognition of Potential Respiratory Failure

• Effects of respiratory inadequacy on other organs (Mental Status)

Answer 18

◈ The hypoxic or hypercapnic child will be agitated and/or drowsy

◈ Gradually drowsiness ⇡⇡ and eventually consciousness is lost

Question 19

Reassessment

Answer 19

Question 20

Recognition of Potential Respiratory Failure

• Pre-terminal signs

Answer 20

Question 21

Recognition of Potential Circulatory Failure

Answer 21

Question 22

Recognition of Potential Circulatory Failure

• CVS Status

Answer 22

Question 23

Recognition of Potential Circulatory Failure

• CVS Status (HR)

Answer 23

Question 24

Recognition of Potential Circulatory Failure

• CVS Status (BP)

Answer 24

◈ Hypotension is a late and pre-terminal sign of circulatory failure.

◈ Once a child’s blood pressure has fallen, cardiac arrest is imminent

Question 25

Recognition of Potential Circulatory Failure

• CVS Status (Pulse Volume)

Answer 25

◈ Compare peripheral and central pulses.

◈ Absent peripheral pulses & weak central pulses
- Serious signs of advanced shock

Question 26

Recognition of Potential Circulatory Failure

• CVS Status (CRT)

Answer 26

Question 27

Recognition of Potential Circulatory Failure

• Effects of circulatory inadequacy on other organs

Answer 27

Question 28

Recognition of Potential Circulatory Failure

• Effects of circulatory inadequacy on other organs (Resp)

Answer 28

Tachypnea without recession is caused by
- Metabolic acidosis resulting from circulatory failure

Question 29

Recognition of Potential Circulatory Failure

• Effects of circulatory inadequacy on other organs (Skin)

Answer 29

Mottled, cold, pale skin peripherally indicates poor perfusion

Question 30

Recognition of Potential Circulatory Failure

• Effects of circulatory inadequacy on other organs (Mental Status)

Answer 30

◈ Agitation and then drowsiness leading to unconsciousness are characteristic of circulatory failure.

◈ These signs are caused by poor cerebral perfusion

Question 31

Recognition of Potential Circulatory Failure

• Effects of circulatory inadequacy on other organs (Urine Output)

Answer 31

◈ A urine output of < 1 ml/kg/hour in children
- Inadequate renal perfusion during shock.

◈ A history of oliguria or anuria should be sought

Question 32

• Signs more in favor of underlying circulatory failure “Rather Than Respiratory Failure”

Answer 32

Question 33

Recognition of Potential CNS Failure

Answer 33

Question 34

Recognition of Potential CNS Failure

• Neurological Functions

Answer 34

As coma

Question 35

Recognition of Potential CNS Failure

• Efficacy of CNS inadequacy on other systems

Answer 35

Question 36

Recognition of Potential CNS Failure

• Efficacy of CNS inadequacy on other systems (Resp)

Answer 36

Question 37

Recognition of Potential CNS Failure

• Efficacy of CNS inadequacy on other systems (CVS)