Misc Flashcards
Reference FLACC
Merkel et al. 1997
Reference opioid guideline
Royal college of anaesthetics 2020
How do NSAIDs work?
Reduce inflammation
Block enzyme cycle-oxygenate
Reference analgesia ladder
WHO 2022
Use the more intense analgesia in conjunction with mid
Symptoms of neonates in pain
- unusual - cry, intake, nappies
- green vomits
- grows
- floppy
- reduced awareness
- pale
- wheeze
- blood in nails
- increased cap refill
- rash
- increased temperature
Psysiological differences neonates
- foremen ovals hole close - pressure in left and right atrium
- ductus arteriuosus close - increased O2 and maternal prostaglandin constrict - can be held open with prostin medication
- nose breathers - large epiglottis
- apnoea
- less fibres and chest wall compliance
- horizontal ribs
- poor elastic
Priorities of treating neonates
Golden triangle
1. hypothermia - humid incubator, dry and blankets
2. hypoglycaemia - IV access and TPN - commence feeds
3. hypoxia - O2 therapy and positioning prone try to prevent acidosis
normal neonate urine output
2ml/kg/hr
Reference PEWS
NHS england 2023
SBAR reference
Newman et al. 2023
Situation
Background
Assessment
Recommendations
Reference advance life support
Resuscitation council 2021
Reference Gilick competence
Scott et al. 2020
Reference of reasonable adjustments
Equality Act 2010
reference neonates pathophysiology
Glasper 2015
Priorities treatment trauma
- IV acccess
- Blood gas - eg. glucose (4-7)
- Fluid bolus - 500ml or 100ml for 10kg - 50ml for 20kg - 30ml
- blood transfusion - SBAR consult with medical staff - blood type
- manage major wounds
- tests - x-ray and CT
Reference resus fluids adults?
NICE 2013
Algorithm for IV fluids of adults
Reference NEWS2
Royal College of Physicians
2022
Child physiology airway
- large head and short neck with inability to support head
- large tongue
- easily compressible floor of mouth
- under 6 months - nose breathers
- small diameter airway
- epiglottis horseshoe shaped
- larynx high and anterior
- trachea short and soft - cricoid cartilage narrowest portion of neck
- increased secretions block airway easily
Physiology of children effecting breathing
- diaphragmatic breathing
- ribs horizontal
- reduced chest expansion
- muscle easily fatigue
- sternum and ribs cartilaginous
- chest wall soft and intercostal muscles poorly developed
- increased metabolic rate
- increased resp demand for xylene compunction and CO elimination
- lung comp;i acne and. high chest wall compliance
- small amount of elastic and collagen tissue
Physiology of children effecting circulation
- circulating blood volume higher per weight than adults
- stroke volume is small and relatively fixed in infants
- cardiac output is directly related t heart rate
- by 2 years myocardial function and response to fluid similar to adults
- after birth systemic vascular resistance starts rising until adulthood
reference child vital signs
glasper et al. 2022
Vital signs under 1 year old
RR - 30-40
HR - 110-160
systolic - 70-90
Vital signs years 2-5
RR - 20-30
HR - 95-140
systolic - 80-100
Vital signs 5-12 years
RR - 15-20
HR - 80-120
systolic - 90-110
GLASPER et al. 2022
Vital signs children over 12
RR - 12-20
HR - 60-100
Systolic - 100-120
Vital signs adults
RR - 12-20
HR - 60-100
Systolic - 100-139
Peate et al. 2021
target Oxygen saturations
94-98% (88-92% COPD)
BTS 2017
92-96% Chu et al. 2018
Priorities of fever found in children
NICE 2007 - last updated 2021
- Immediate IV fluid bolus of 10ml/kg of 0.9% sodium chloride (2007)
- Give immediate parenteral antibiotics if shocked, unrousable or show signs of meningococcal disease (2007)
- Give IV aciclovir if signs suggest herpes simplex encephalitis (2007)
- Oxygen if saturations under 92% in air (2007)
Symptoms fever children need immediate attention
NICE traffic light - 2013
red
1. pa,le, mottled, ashen or blue
2. not responsive to social cues - not wake when roused or stay awake - weak, high pitched cry
3. grunting
4. tachypnoea - over 60bpm
5. moderate or serve chest indrawing
6. reduced skin turgor
7. temperature more than 38 degrees
8. non-blanching rash
9. bulging fontanelle
10. stiff neck
11. focal seizures - reduced LOC - (herpes simplex encephalitis)
Reference traffic lights identify risk of serious illness in child
NICE 2013
Normal temperature
normothermia
36.5-37.5 (adult and child with 38 being a fever - NICE 2023 - feverish child)
NICE 2013 - surgical site infection
What NMC professional values to include?
NMC 2018
- respect and uphold human rights - convention on the rights of children - health care - 1989
- work in partnership with patient and family
- encourage and empower
- communicate clearly
Reference - A-E
Resus council 2021
reference NEWS2
NHSE 2017
Adult fluid maintainance
25-30 ml/kg/day water
Include potassium, sodium or chloride and glucose as required.
Algorithm adult fluid - NICE 2013