Mid-Semester Revision Flashcards
Airway Anatomical Differences
- Larger Occiput – need to raise head to maintain airway.
- Tongue is disproportionately large – more able to obstruct airway
- Larynx higher in neck and narrowest point is the cricoid (below vocal chords which is narrowest point in adult) so obstruction may lodge lower than in adult
- Vocal cords angled down – airway conical in shape
- Large floppy epiglottis
- Compressible floor of mouth – may obstruct airway with grip if not cautious
- Short soft trachea
- Loose teeth
- Small changes are proportionally more significant
Breathing Anatomical Differences
- Diaphragmatic breathers (esp. small children).
- Diaphragmatic splinting – Abdominal Distension and obesity push the diaphragm into the thorax lead to increased work of breathing (CPR ventilation can cause abdominal distention)
- Compliant chest and horizontal ribs limit ability of thorax to increase tidal volume. Accommodate by increased RR
- Minute volume = rate dependant
- Lower proportion of type 1 muscle fibres
- Increased WOB leads to earlier fatigue
- Lower proportional lung surface area + increased basal metabolic rate = higher demand proportional to adult
- Decreased FRC (Functional Residual Capacity) = more likely to have alveolar collapse
- Higher RR also increases risk of inhaling airborne pathogens
Circulation Anatomical Differences
- Limited ability to increase SV (stroke volume), especially at < 2 years of age o Rate dependent Cardiac Output - Impressive ability to maintain BP with vessel tone – vasoconstriction o Compensate well but BP can fall rapidly!! - Low total blood volume o 70/80mL/kg
Body Surface Area Anatomical Differeces
- Proportionally larger than adults - Increased risk of excessive loss of heat and fluids. More quickly affected by toxins absorbed through the skin - Also thinner skin increased absorption through skin
Immune System Physiological Differences
- Immature immune system. Greater risk of infection through skin and inspiration. - Less hard immunity to infections.
Key Physiological and Psychological Development milestones
6 months – rolling over 10 months – sitting alone 12 months – crawling 12 months – talking (at all) 18 months – walking 24 months – talking with basic sentences
Drug Calculation Formula - APLS
Age < 1 year – (months + 8)/2 Age 1-5 – (Age x 2) + 8 Age >5 – (Age x 3) + 7
Normal Vital Signs
Formula for Calculating ETT size and depth of insertion
Size ETT (mm internal diameter) = Age/4 + 4
Length ETT (cm at lips) = Age/2 + 12
*If using cuffed ETT, use half a size smaller (0.5 mm)
Endotracheal Intubation - Indications
Airway obstruction - airway trauma, foreign body, congenital malformation, infection
Respiratory failure - impaired gas exchange or respiratory pump failure
Inability of patient to protect airway
Endotrachal Intubation - Equipment required
SOAPIM
Suction
Oxygen
Airway equipment - ETT, Laryngoscope, Bite block, BVM, Magill’s forceps, lubrication
Pharmacological agents
Intravenous access
Monitoring
Endotrachal Intubation - Complications
Oesophageal intubation
Main bronchus intubation
Trauma to Oropharynx
Pneumothorax
Hypoxaemia
Damage to teeth or tongue
Damage to C-Spine
Needle Thoracocentesis - Define
Process of rapidly intering pleural cavity to relieve threatening physiological derangement caused by accumulation of air in pleural cavity
- Temporary measure prior to intercostal catheter insertion
Tension Pneumothorax - Signs and Symptoms
Signs
- Tachypnoea
- Tracheal deviation
- Resonance on percussion
- Decreased breath sounds on affected side
- Cardiac apex deviation on affected side
- Hypoxia and Shock
- Distendded neck veins
Symptoms
- SOB
- Pleuritic Pain
- Impending sense of doom
Needle Thoracocentesis - Complications
- Pneumothorax (10-20% chance if patient does not have tension pneumothorax)
- Nerve bundle damage
- Kinking or dislodgement of catherter leading to re-accumulation of pneumothorax
- Damage to intrathoracic or intraabdomina structures (especially if abdomen distended)
Needle Thoracocentesis - Proceedure
- Identify the 2nd intercostal space in the mid-clavicular line on the side of the pneumothorax (the opposite side to the direction of tracheal deviation)
- Swab the chest wall with antiseptic solution or alcohol wipe.
- Attach the syringe to the cannula. Fluid in the cannula will assist in the identification of air bubbles.
- Insert the cannula perpendicular to the chest wall, just above the rib space, aspirating all the time.
- If air is aspirated remove the needle, leaving the plastic cannula in place.
- Tape the cannula in place and proceed to chest drain insertion as soon as possible.
IO access- Contraindications
- Recent fracture of bone to be used
- Osteogenesis imperfecta
- Osteoporosis
IO access - sites
Tibia, femur, humerus
IO access - complications
- Osteomuelitis
- Cellulitis and subcutaneous abscess
- Device not within correct space/in soft tissue of bone or through bone
- Fat embolization
- Fracture and damage to growth plate (avoid angling needle towards joint)
- Septicaemia or Bacteraemia
Pelvic Fracture Epidemiology and Aetiology
Pelvic fractures are rare in paediatric patients
Common causes - MVA, fall from height, paedestrian/car collision
Pelvic Binder - Procedure
- Place folded bed sheet underneath the patient – between the iliac crests and greater trochanters.
- Two team members should cross the sheet across the pubic symphysis and pull the sheet firmly so it tightly fits around and stabilises the pelvis.
- A third person should clamp the sheet at the four points (away from laparotomy / angiograph access points).
C-Spine Anatomical Difference
- Higher fulcrum of neck motion
- Larger occiuput à relative kyphosis when supine
- Weaker neck muscles
- Increased antoeror-posterior motion due to horizontal facet joints and ligament laxity
- Pseudosubluxation
- Greater cartilaginous component
- Presence of growth plates and tapered anterior vertebrae
C-Spine Immobilisation - complications
- Airway compromise with bleeding, vomiting or aspiration due to supine position
- Worsening of cervical spine injury in uncooperative or struggling patient
- Hyperextension or flexion of neck
- Limited visualisation of shifted tachea, subcutaneous emphysema or expanding neck haematoma
- Impairment of vascular raining due to compression of external jugular veins
C-Spine Injury - Physical Findings
- Midline cervical pain
- Traumatic torticollis
- Limitation of cervical motion
- Motor weakness
- Sensory changes
- Diaphragmatic breathing without retractions
- Hypotension without tachycardia
- Bowel or bladder dysfunction
