LO11 Pediatrics Flashcards
Neonate and infant
- First month of life is neonatal. I
- infancy refers to the first 12 months of life
- infants between two and six months of age begin to hold their heads up
- 6 to 12 months infants begin to crawl in Babble
Toddler
Preschool aged
Toddler
- The toddler. Extends from ages 1 to 2 years
Preschool aged
- 3 to 5
- They will be able to tell you what hurts
School aged child
Adolescent
School aged child
- 6 to 12 years
- By eight years the child anatomy and physiology are similar to those of an adult
- Ask the child questions rather than the caregiver
Adolescent
- 13 to 18 years
Neck and airway
- The airway of a young child is also smaller than an adult airway making it more prone to obstruction
- During the first 4 to 6 months of life infants are obligate nose breathers and nasal obstruction with mucus can result in significant respiratory distress
- The narrowest part of a young child airway occurs at the level of the cricoid cartilage rather than at the vocal cords as an adult
Chest and lungs
- A child’s chest wall is quite then making it easy to hear heart and lung sounds but also means that sounds are transmitted throughout the chest
- Children have fewer rib fractures and flail chest events however thoracic organs may be more severe
- Children are more vulnerable than adults the pulmonary contusions, cardiac Tampa nod and diaphragmatic rupture
- Signs of a pneumothorax or haemothorax and children are often subtle
Heart
- During the first year of life ECG axis and voltage of shift to reflect left ventricular dominance
Abdomen and pelvis
- abdominal distension in a healthy infant is due to two factors the weakness of the abdominal wall muscles and the size of the solid organs
- liver extends below the rib cage in infants
- Abdominal injuries are the second leading cause of serious trauma in children
- The liver and spleen extend below the rib cage and do not have much boney protection as they do in an adult the kidneys as well
The musculskeletal system
- The growth plates of a child’s bones are made of cartilage, or relatively weak and are easily fractured
- Fractures are more common than sprains
PAT to form a general impression
- Begins with your general assessment of how the patient looks sick or not sick
- Including three elements the child’s parents work of breathing and circulation
Appearance
- Appearance reflects the adequacy of ventilation, oxygenation, brain perfusion, body homeostasis and central nervous system function
- TICLS pneumonic
highlights the most important features of a child’s appearance tone, interactiveness, consolability, look or gaze and speech or cry
Work of breathing
- Listening for abnormal airway sounds and looking for signs of increased breathing effort
- Abnormal positioning and retractions are physical signs of increased work of breathing that can easily be assessed without touching the patient
- Combined the characteristics of work of breathing abnormal airway sound, abnormal positioning, retraction, and nasal flaring to make your general assessment
- Grunting
involves exhaling against a partially closed glottis
o the short low pitch sound is best heard at the end of exhalation and is often mistaken for whimpering
o Grunting suggest moderate to severe hypoxia lower airway condition such as pneumonia, bronchitis and pulmonary oedema
sniffing position
- Tripod position
trying to align the axis of airways to improve patency and increase airflow
is creating the optimal mechanical advantage to use accessory muscles of respiration
- Retractions
represent the recruitment of accessory muscles of respiration to provide more muscle power to move air into and out of the lungs in the face of airway or lung disease or injury
o May be evident in the Super clavicular area above the clavicle, the intercostal area between the ribs, or the sub sternal area under the sternum
o Head bobbing is another form of retractions
- Nasal flaring
exaggerated opening of the nostrils during labour inspiration and indicates moderate to severe hypoxia
- The three Characteristics considered when assessing the circulation
pallor, modelling and cyanosis
- Pallor
may be the initial sign of poor circulation or even the only visual sign in a child with compensated shock
o May indicate anaemia or hypoxia
- Modelling
reflects vasomotor instability in the capillary beds as demonstrated by Alicia pattern in areas of vasoconstriction and vasodilation
Breathing assessment
- Calculating the respiratory rate, auscultating breath sounds, and checking pulse ox for oxygen saturation
assessment of circulation
pulse rate and quality, skin colour temperature in condition plus capillary refill time, and blood pressure
- Tachycardia may indicate
early hypoxia or shock or less serious condition such as fever, anxiety, pain or excitement
- Acceptable blood pressure in children 1 to 10 years is determined by
70 + (2 x age)
- Immediate transport
for trauma and the child has a serious mechanism of injury, physiological abnormality, potentially significant anatomic abnormality, or if the scene is unsafe
- In these cases stabilize the spine, manage the airway and breathing, stop external bleeding and begin transport attempt vascular access on the way
Focused history and physical exam
- Four objectives:
o Obtain complete description of the chief complaint using sample and OPQRST
o Determine the MOI or nature of illness
o Perform rapid trauma or medical assessment
o Obtain baseline and subsequent vital signs
Ongoing assessment
- Include the PAT, reassessment of patient priority, vital signs every five minutes for unstable every 15 minutes for stable, assessment of effectiveness of interventions, and reassessment of focussed examination areas
- Respiratory distress
increased work of breathing to maintain oxygenation or ventilation it is a compensated
o State in which increased work of breathing resulting in adequate pulmonary gas exchange
o Hallmarks of respiratory distress are classified as mild, moderate or severe these include retractions, abdominal breathing, nasal flaring and grunting
- Respiratory failure
Can no longer compensate for underlying pathologic or anatomic problem by increased work of breathing so hypoxia and carbon dioxide retention occurs
o Signs include decreased or absent retractions going to fatigue, altered mental status owing to inadequate oxygenation and an abnormally low respiratory rate
o Decompensated state
- Respiratory arrest
implies that patient is not breathing spontaneously
o administer immediate bag mask ventilation with supplemental oxygen to prevent progression to cardio pulmonary arrest
Foreign body aspiration or obstruction
- In the absence of fever, cough or respiratory congestion suspect foreign body aspiration when a child has a sudden onset of respiratory distress accompanied by coughing, gagging, strider or wheezing
Epiglottitis
- The severe inflammation of supraglottic structures usually due to bacterial infection
- Classic presentation is easily distinguished using the PAT and initial assessment the child will look sick and anxious, will sit up right in the sniffing position and maybe drooling because of an inability to swallow secretions
- The work of breathing is increased, and pallor or cyanosis may be evident there may be strider, muffled voice, decreased or absent breath sounds and hypoxia
Bronchiolitis
- Is an inflammation of small airways in the lower respiratory tract due to viral infection
- An infant with a first time wheezing episode occurring in the late fall or winter likely has bronchiolitis
- Mild to moderate retractions, tachypnea, diffuse wheezing and diffuse crackles and mild hypoxia characteristics
Bag mask ventilations
- Deliver breath at a rate of 12 to 20 breaths per minute for infants and children squeeze in the bag only until you see chest rise
- Ventilate at the appropriate rate and volume over approximately one second until the chest visibly rises do not hyperventilate
- Tachypnoea without retractions or abnormal airway sounds
is common in an infant or child with primary cardiac problems it is a mechanism for blowing off carbon dioxide to compensate for metabolic acidosis related to poor perfusion
- For suspected cardiovascular compromise
start with airway and breathing and provide support care as needed
- Ensure adequate oxygenation and ventilation and then assess the circulation by checking heart rate, pulse quality, skin CTC, and blood pressure
o A child and compensated shock
tachycardia and signs of decreased peripheral perfusion such as cool extremities with prolonged Capillary refill
- Decompensated shock
shock is a state of inadequate perfusion in which the bodies on mechanisms to improve perfusion are no longer sufficient to maintain a normal blood pressure by definition a child a decompensated shock will be hypotensive for his or her age
o A child in decompensated shock may have
an altered appearance, reflecting inadequate perfusion of the brain
o Hypertension is it late and I’m gonna sign in an infant or younger child an urgent intervention is needed to prevent cardiac arrest
Hypovolemic shock
- Most common cause of shock in infants and young children with lots of volume occurring due to illness or trauma
- The child may appear pale, modelled or cyanotic
- Signs of dehydration such as sunken eyes, dry mucous membranes, poor skin turgor or delayed calf refill with cool extremities
Distributive shock
- Decreased vascular tone develops, resulting in vasodilation and third spacing of fluids due to increased vascular permeability
- May be due to sepsis, anaphylaxis and spinal cord injury
- Early in distributive shock the child may have warm flushed skin and bounding pulses as a result of peripheral vasodilation
- The symptoms and signs of late distributive shock will look much like hypovolaemic shock on initial assessment fever is a key finding in septic shock
Obstructive shock
- There is impaired filling of the heart thus reduce cardiac output
- A child with obstructive shock usually has a history of abrupt onset symptoms of shock and or a history of trauma to the chest
- Sign specific to the underlying cause such as asymmetric chest rise an absent breath sounds on the side of a tension pneumothorax, or muffled heart sounds and an elevated jugular venous pressure in cardiac tamponade
Cardiogenic shock
- Is the result of a pump failure
- Myocardial function is poor
- Uncommon in paediatric and less they have an underlying congenital heart disease
Bradydysrythmias
- Most often occur secondary to hypoxia rather than as a result of primary cardiac problem
- Initiate electronic cardiac monitoring as part of your initial assessment
- If the child’s pulse rate is lower than normal for age but perfusion is poor despite providing adequate oxygenation and ventilation begin chest compressions and ventilations
Menegitis
- Entails inflammation or infection of the meninges the covering of the brain and spinal cord
- most often caused by a viral or bacterial infection
- Viral meningitis is rarely a life-threatening infection bacterial meningitis is potentially fatal
- Young infants will have to have a fever, lethargic, irritability, poor feeding at a bulging fontanel along with neck stiffness
- Meningococcal meningitis with sepsi
is typically characterized bypetechial (small purple nonblaching spots on the skin or purpuric (larger purple or black spots) rash in addition to other menegitis symptoms
Febrile seizures
- Child must be between three months and six years old have a fever and no identifiable precipitating cause
- Simple febrile seizure
brief generalized tonic clonic seizures lasting less than 15 minutes that occur in a child without underlying neurologic abnormalities
- Aytipical febrile seizure
: longer than 15 minutes, or focal or occur in a child with baseline developmental or neurologic abnormalities
- Status epilepticus
: is defined as a condition in which seizures recur every few minutes or last more than 20-30mins
Sudden Unexpected Infant Death 3 causes
- Sudden infant death syndrome
- Unkown cause
- Adccidental suffocation and strangulation in bed
Brief resolved unexplained event (BRUE)
- A brief resolved unexplained event formally known as an apparent life-threatening event is an episode during an infant becomes pale or cyanotic chokes gags or has an acne expel or loses muscle tone
Burns
Assessment
- For infants to head and trunk each account for 18% of body surface area, the arms each count as 9% and the legs each count as 13.5%
CSF
- Hydrocephalus
is a condition resulting from impaired circulation in absorption of CSF leading to the increase size of the ventricles and increased ICP
- CSF shunts
: inserted to drain excessive fluid from brain normalizing ICP
o When pressure buildup in ventricle the one-way valve opens and CSF drains into the peritoneum word is reabsorbed
- A CSF shunt obstruction
occurs when the drainage of fluid from the brain through the shunt becomes blocked without adequate fluid drainage the CSF fluid continues to accumulate resulting in increased ICP
- Typical symptoms include headache, fatigue, vomiting
