Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paeds > Lecture Day 1 Recognition of ill child > Flashcards

Lecture Day 1 Recognition of ill child Flashcards

1
Q

Common causes of 0-4 weeks

A

prematurity, congenital, trauma including asphyxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

1-12 months

A

prematurity, congenital, sudden unexplained death, resp infections, other infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Main causes of cardiac arrest in children

A

Circulatory:

  • fluid loss (vomit, burns, blood loss)
  • Fluid maldistribution (septic shock, anaphylaxis
Respiratory 
- Obstruction (foreign body, asthma, croup)
Resp depression (convulsions, poisoning, ↑ ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to take Hx from serious ill

A

Respiratory distress
Sudden onset
Febrile
Been to PICU before?

Rash
Glass test?

Ingestion of poison
What taken?

Head injury
Mechanism of injury?
LOC?
Vomiting? Etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examination ABC

Go through recognition A

A

Assess patency by
Looking for chest and/or abdominal movement
Listening for breath sounds and
Feeling for expired air.
Vocalisations, such as crying or talking, indicate ventilation and some degree of airway patency.
Paradoxical chest and abdominal movements
Signs of airway obstruction?
Foreign body visible?
Fully obstructed airway will be silent
Cyanosis/hypoxia is a late sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Response for A

A 
Call for help if signs of airway obstruction
Basic airway manoeuvres 
Older child: Head tilt, chin lift 
Infant: neutral position
Jaw thrust
Airway adjuncts 
Oropharyngeal airway
Nasopharyngeal airway
Suction secretions (Yankauer)
Give oxygen (O2)
Call an anaesthetist for definitive airway management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens to a childs airway if they become frightened

A

can obstruct futher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

infective causes of obstruction in child

A

epiglottis
croup
trachyitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Assessment of breathing

Sings of respiratory distress

A

Effort, efficacy, effects

Signs of respiratory distress:
Subcostal recession
Intercostal recession
Tracheal tug
Grunting
Nasal flare
Head bobbing
Sounds: inspiraptory stridor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When can increased effort be absent?

How to investigate

A
  1. Exhaustion
  2. Central respiratory depression
  3. Neuromuscular disease

Do ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to investigate efficacy?

A 
Chest expansion adequate?
Auscultation - Air entry OK?
Pulse oximetry (>94%)
Blood gas 
High CO2?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Effects of ↓ Resp effort

A

Heart rate
Tachycardia
Bradycardia

Skin colour
Pallor
Mottling

Mental status 
Agitated
Restless
Decreased GCS
LOC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pre-terminal signs

A

Silent chest
cyanosis
O2 sats < 88%
hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Response to breathing

A
  • No breath: bag-mask
  • 15 L/min NRM
  • O2 sat, ABG, CXR
  • Insert nasogastric tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Assessing Circulation

A 
Vital signs 
Heart rate 
Pulse volume 
Blood pressure 
Skin &amp; mucous membrane perfusion: 
Capillary refill time (central &amp; peripheral) 
Skin temperature 
Skin colour 
Organ Perfusion: 
Effects on breathing 
Mental status 
Urine output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Responding to C

A

Response
IV/IO access.
Blood gas (including lactate and ionised calcium), glucose stick test and laboratory tests including full blood count (FBC), urea & electrolytes (U&Es), renal and liver function, CRP, blood culture, cross-match & coagulation studies, (consider an ammonia level).
3-lead cardiac monitoring and/or a 12-lead ECG.
Fluid bolus (20mls/kg) and assess response

17
Q

What fluid bolus

A

20mls/kg 0.9% bolus

18
Q

Assessing Disability

A

Patient response: alert, verbal, pain, unresponsive (AVPU)
Pupils - size and reaction to light (dilated/constricted, fix or responsive, equal size?
Posture
- ↑ ICP decorticate or decerebrate
Blood glucose
Evidence of seizure activity?

19
Q

Responding to disability

A

Protect airway
Endotracheal tube if GCS < 8 (call for anaesthetic help)
Recovery position if airway not protected
Give glucose if hypoglycaemia (glucose < 4 mmol/L)
Treat seizure activity with benzodiazepines

20
Q

Exposure

A 
RASHES
TEMPERATURE 
INJURIES 
Fractures/bruising/burns
SMELLS 
Ketones
Poisons
21
Q

What charts are child obs recorded on

A

PAWS chart

22
Q

5 month old baby girl
Poor feeding 2-3 days
More sleepy
‘Not herself’

What would u do

A 
Airway
Patent
Breathing
Respiratory rate 70/min
Sternal + Subcostal recessions
O2 sats 92%
Pale
Circulation
Pulse 180/min
CRT – 3 seconds
Disability
AVPU – V
Exposure
Temp 39.2 oC
No rashes
Glucose 1.5mmol/l
A - patent
B - oxygen
C - i.v. fluids
D - 
E – i.v. antibiotics, 
paracetamol
G - i.v.10% dextrose
Senior help
THEN 
Full history +  examination
Send bloods 
	(at first i.v. access) +
Full septic screen
 (Urine, blood culture, LP, CXR)

X-R: can’t see R diaphragm or R boarder of heart. RL+M lobe pneumoia

23
Q

Management of this child

A

Child improves on iv antibiotics and fluids

Discharged home well on day 3 with oral antibiotics

24
Q 
8 year old boy
Known asthmatic
Having difficulty breathing
Very thirsty
Passing frequent urine
A 
Airway
Patent
Breathing
Respiratory rate 60/min
O2 sats 100% 
No wheeze
Good air entry
Pale
Circulation
Pulse 140/min
CRT – 4 secondsDisability
AVPU – A
Exposure
Temp 37.5 oC
Smells of ketones

BM 20 mmol/l

Respiratory distress: no wheeze, high glucose

GIVE 10mls/kg risk of cerebral oedema

25
Q

If you recognise DKA what is your fluid replacement

A

10mls/kg NaCl

26
Q

Response to this scenario

A 
A - patent
B - oxygen
C – i.v. fluids
D - 
E - 
G -insulin

GET Senior help

THEN
Full history + examination
Blood gas
Urine dipstick

Insulin infusion
i.v. fluids (and K+ when passing urine)
Monitor blood sugars
Monitor for signs ↑ICP

Diagnosis of diabetes. Must discharge with insulin pens and diabetic nurse input.

Paeds (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions