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CSB339 > Neonate and paediatric physiology and resuscitation > Flashcards

Neonate and paediatric physiology and resuscitation Flashcards

1
Q

What age range does paediatric medicine usually cover?

A

Birth to 14 years (sometimes 18 years)

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2
Q

What is the average weight of a neonate between birth and 1 month?

A

3.5kg

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3
Q

What is the normal HR range for a neonate between birth and 1 month old?

A

100 - 160bpm

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4
Q

What is the normal RR range for a neonate between birth and 1 month old?

A

25 - 50

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5
Q

A neonate’s head is __/__ the total length of its body

A

1/4

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6
Q

A neonate’s head is __/__ of its body weight

A

1/3

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7
Q

List some physiological features of a neonate (birth to 1 month)

A
  • Large occiput
  • Open fontanelles and unfused sutures
  • Soft cranial bones
  • Cartilaginous ribs
  • Diaphragmatic breathers
  • Nasal breathers
  • Apnoea and bradycardia occurs under stress (including cold stress and physiological stress)
  • Predisposed to hypothermia
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8
Q

What is the significance of the large occiput of a neonate?

A

Easily hyperextends or hyperflexes and can occlude the airway (sniffing position).

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9
Q

Hormonal changes which instigate onset of labour also commence…

A

Reabsorption of foetal lung fluid.

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10
Q

Crying of a just-birthed neonate is evidence of…

A

Significant inspiration and expiration on closed glottis (-ve pressure)

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11
Q

What instigates the closing of the ductus arteriosus and the foramen ovale (foetal valves) and allows pulmonary circulation after birth?

A

Pressure changes (reduced to pulmonary blood supply); inflates lungs and displaces fluid into lymphatics.

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12
Q

What is triggered by cord clamping/spontaneous umbilical vein constriction?

A

An increase in systematic blood pressure; the ductus venousus starts to close.

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13
Q

What are some keys to successful interaction when assessing a neonate?

A
  • Likes to be held and kept warm
  • Avoid loud noises, bright lights
  • May be soothed if allowed to feed
  • Warm your stethoscope and hands before touching infant
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14
Q

List the characteristics typical of a neonate during assessment.

A
  • Normally alert, looking around
  • Focuses well on the face of the person holding them
  • Flexed extremities and responsive to stimulus
  • Intact neurology demonstrated by reflexes (Moro, Rooting, Palmar Grasp)
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15
Q

What is the weight range of an infant between 1 and 12 months?

A

3.5 to 10kg

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16
Q

What is the normal HR range for an infant between 1 and 12 months?

A

90 to 150bpm

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17
Q

What is the normal RR range for an infant between 1 and 12 months old?

A

25 to 50

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18
Q

How long does it take for an infant’s birth weight to double?

A

6 months

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19
Q

How long does it take for an infant’s birth weight to triple?

A

1 year

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20
Q

List some physiological features of an infant (1 to 12 months old)

A
  • Obligatory nose breathers
  • Diaphragmatic breathers
  • Cartilaginous vocal chords (easily damaged)
  • Thin and pliable chest wall
  • Underdeveloped cervical structures
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21
Q

The posterior fontanelle of an infant is closed by…

A

8 to 10 weeks

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22
Q

The anterior fontanelle of an infant is closed by…

A

10 to 14 months

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23
Q

When does an infant usually begin crawling?

A

5 to 12 months

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24
Q

When does an infant usually begin walking?

A

10 to 18 months

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25
Q

What might a sunken fontanelle indicate?

A

Poor hydration

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26
Q

What might a bulging fontanelle indicate?

A

Raised ICP

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27
Q

Is a fontanelle an accurate measure of pulse?

A
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28
Q

List some keys to successful interactions when assessing an infant.

A
  • Likes to be held by parents
  • Place older infants in sitting position
  • Examine from toes to head
  • Have parent remove one clothing item at a time, then replace
  • Distract with a toy, penlight, or stethoscope
  • Speak continuously in soft tones
  • Perform painful procedures last (only take BGL if absolutely necessary - taken on the sole of the foot in pts <1)
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29
Q

List the characteristics typical of an infant during assessment.

A
  • Normally alert
  • Eyes follow examiner
  • Slightly flexed extremities
  • Rolling over by 4 to 6 months
  • Can sit unaided by 4 to 8 months
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30
Q

The term ‘toddler’ spans what age range?

A

1 to 3 years

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31
Q

What is the normal HR range for a toddler (1 to 3 years)?

A

80 - 140bpm

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32
Q

What is the normal RR range for a toddler (1 to 3 years)?

A

25 - 30

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33
Q

List some physiological features of a toddler (1 to 3 years)

A
  • Small and short trachea
  • Thin chest walls (breath sound transmission - may hear obstruction in lower lobes when it’s located near the epiglottis, etc)
  • High centre of gravity (prone to falls and TBI)
  • Larger percentage of fat and cartilage (less likely to suffer serious injury than older children - energy sustained from trauma will dissipate)
  • Poor thermoregulation
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34
Q

List some keys to assessing a toddler (1 to 3 years).

A
  • Have parent remove clothing as necessary
  • Use appropriate language (“ouchie”)
  • Distract with a toy or penlight if necessary
  • Avoid needles is possible
  • Consider using assessment equipment on parents or other sibling
  • Consider early analgesia where injuries are obvious
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35
Q

What are the characteristics typical of a toddler during assessment?

A
  • Normally alert/active
  • Does not like to sit still
  • May grab at penlight or push hands away
  • Can walk by 18 months
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36
Q

What is the age range of a pre-schooler?

A

4 - 5 years

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37
Q

What is the normal HR range for a pre-schooler?

A

80 - 140bpm

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38
Q

What is the normal RR range for a pre-schooler?

A

20 - 30

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39
Q

Pre-schoolers cannot sustain rapid RR for extended periods due to…

A

Immature intercostal muscles.

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40
Q

What is the difference in oxygen requirement between pre-schoolers and adults/adolescents?

A

Pre-schoolers have twice the oxygen requirement as adults/adolescents.

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41
Q

Do children have a larger or smaller functional residual capacity (FRC)?

A

Smaller

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42
Q

Why do children have smaller oxygen reserves?

A

They have a smaller functional reserve capacity (FRC).

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43
Q

What is the risk of smaller functional reserve capacity (FRC) and therefore smaller oxygen capacity in children?

A

Hypoxia can develop rapidly.

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44
Q

List some keys to interaction when assessing pre-school children.

A
  • Be honest
  • Tell child just before procedure if it will hurt
  • Avoid needles if possible
  • Keep wounds covered
  • Allow child to hide their face
  • Distract child with a story (discuss TV show/daycare/school/friends/activities)
  • Praise good behaviour and bravery
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45
Q

What are some characteristics typical of pre-school children during assessment?

A
  • Normally alert/active
  • Can sit still on request
  • Can cooperate with examination
  • Understands speech
  • Will make up own explanations for anything not understood
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46
Q

What is the age range of primary school children?

A

6 - 12

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47
Q

What is the normal HR range for primary school age children?

A

70 - 120bpm

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48
Q

What is the normal RR range for primary school age children?

A

15 - 25

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49
Q

Around what age do bones lose cartilaginous flexibility?

A

6

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50
Q

At what age is a child’s airway size and flexibility equal to that of an adult?

A

10

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51
Q

List some keys to interaction when assessing primary school age children (6 - 12)

A
  • Speak directly to the child
  • Explain in simple terms what is wrong
  • Always be truthful
  • Allow child to participate in examination
  • Explain procedures immediately before performing them
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52
Q

What is the age range of an adolescent?

A

13 - 18

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53
Q

What is the normal HR range of an adolescent?

A

60 - 100bpm

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54
Q

What is the normal RR range of an adolescent?

A

15 - 20

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55
Q

At what age is cardiac output equal to that of an adult?

A

15

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56
Q

List some keys to interaction when assessing adolescents.

A
  • Speak directly to the pt
  • Obtain hx from the pt
  • Explain the process as to an adult and gain consent
  • Interview privately when appropriate
  • Be honest
  • Encourage questions
  • Reassure pt regarding disfiguring injury when possible
  • Respect modesty
  • Ask friends to comfort pt when needed
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57
Q

What are some characteristics typical of adolescents during assessment?

A
  • Has clear concepts of the future
  • Responds positively to respectful attitude
  • Can make decisions about care
58
Q

What is the Luscombe formula?

A

(age x 3) + 7 = estimated weight

59
Q

List some considerations for paediatric airway assessment.

A
  • Larger head (prone to flexion)
  • Larger tongue
  • Nasal breathers <6 months
  • Narrow nasal passages
  • Lack of hyaline cartilage (easily obstructed)
  • Epiglottis more horizontal
  • Larynx is higher and more anterior
  • Cricoid ring is narrowest part of the airway
  • Trachea is short and soft
  • Smaller airway diameter (lower threshold for obstruction; airway is ~the size of their pinky finger)
60
Q

Due to the small diameter of a paed’s airway, minor swelling/oedema can be catastrophic. List four causes of airway swelling in paeds.

A
  • Croup
  • Epiglottitis
  • Burns
  • Inhalational injuries
61
Q

List some reasons for paed-specific airway adjucts.

A
  • Size of oropharynx
  • Large tongue
  • Possibility of trauma when turning an OPA
  • Tonsils
62
Q

List four OPA considerations in paeds.

A
  • Proper sizing
  • Proper positioning
  • If too large, epiglottis becomes obstruction
  • If too small, may push tongue into hypopharynx
63
Q

List some features of paed respiration.

A
  • Increased RR
  • Comparitively poor muscle tone (tire easily)
  • Increased metabolism and oxygen consumption
  • Decreased functional residual capacity
  • Increased chest wall compliance
  • Decreased lung elastic recoil
64
Q

What is the significance of decreased functional residual capacity in paeds?

A
  • More prone to hypoxia
  • Oxyhaemoglobin desaturation occurs quickly
  • Fewer alveoli per surface area
65
Q

What is the significance of increased chest wall compliance in paeds?

A

Leads to prominent sternal recession and rib space indrawing when airway is obstructed or lung compliance decreases.

66
Q

What is the significance of decreased lung elastic recoil in paeds?

A

Allows intrathoracic pressure to be less negative - reduces small airway patency

67
Q

List signs of paediatric respiratory distress.

A
  • Rate (first sign)
  • Increased effort
    • Recession
    • See-saw breathing (severe chest retractions on inspiration with expansion of abdomen - serious sign, fatigues quickly)
    • Inspiratory/expiratory noises
    • Grunting (heard when trying to expire against a closed glottis - increases pulmonary pressure)
    • Accessory muscle use
    • Head bobbing (using neck muscle to assist breathing - neck muscles not strong enough to hold the head)
    • Nasal flaring
    • Efficacy of breathing
    • Pulse oximetry (may be inaccurate as paeds have reduced peripheral circulation)
68
Q

List some provisional diagnoses for expiratory wheezing (lower airway obstruction/bronchoconstriction) in paeds.

A
  • Bronchiolitis
  • “Reactive airways”
  • Asthma in older children
  • Note that inspiratory and expiratory wheeze indicates worsening condition
69
Q

What is a provisional diagnosis for inspiratory wheeze or stridor in paeds?

A

Airway obstruction

70
Q

List the signs of imminent respiratory arrest.

A
  • Bradypnoea
  • Bradycardia
  • Periodic apnoea
  • Diminished air movement/silent chest
  • Low SpO2
  • Decreasing LOC/stupor/coma
  • Poor skeletal muscle tone/extreme lethargy
  • Cyanosis (central and peripheral)
71
Q

What are some anatomical features of paed hearts?

A

Higher in the chest wall with smaller pericardial sack.

72
Q

A smaller pericardial sack in paeds means they are more prone to what two things?

A

Cardiac contusion and cardiac tamponade

73
Q

What is the stroke volume in paeds (mL/kg/beat/min)?

A

1.5mL/kg/beat/min

74
Q

What is the stroke volume in adults?

A

75-90mL/beat

75
Q

What is the circulating blood volume of a neonate?

A

90mL/kg

76
Q

What is the circulating blood volume of a child?

A

80mL/kg

77
Q

What is the circulating blood volume of an adult?

A

70mL/kg

78
Q

List some signs of poor circulation in paeds.

A
  • Tachycardia
  • Bradycardia (late response to hypoxia - pre-terminal)
  • Dysrhythmias (uncommon)
  • Hypotension (very late sign)
79
Q

Should BP be relied upon as an indicator of shock in paeds?

A
80
Q

What is the significance of an increased surface area and a relatively small body mass in paeds?

A

Increased potential for dehydration.

81
Q

Are distal pulses an accurate indicator of shock in paeds?

A

No; inaccurate due to the ability to vasoconstrict.

82
Q

True or false: poor capillary refill is an accurate sign of hypovolaemia/hypoperfusion.

A
83
Q

What are the signs of hypoperfusion/shock in paeds?

A
  • Tachypnoea
  • Mottled/cold/pale skin
  • Agitation
  • Inconsolable or lethargic
84
Q

What visual things are checked when assessing cardiovascular state?

A
  • Skin colour
  • Muscle tone
  • EBL (estimated blood loss)
85
Q

Where should the pulse be checked when assessing cardiovascular state of a newborn?

A

Base of the umbilical cord.

86
Q

How should the pulse be checked when assessing cardiovascular state of a neonate?

A

Auscultate

87
Q

Where should the pulse be checked when assessing cardiovascular state of a infant and a toddler?

A

Brachial

88
Q

Where should the pulse be checked when assessing cardiovascular state of a toddler/older child?

A

Radial

89
Q

What is the equation used to calculate the normal BP of a 1 - 10 year old?

A

70mmHg + (age x 2) - systolic BP

90
Q

Are central pulses a good indicator of perfusion in paeds?

A
91
Q

List the components of a paediatric CNS assessment.

A
  • Conscious level
  • Mental status
    • Hypoxic/hypercapnic will be agitated/drowsy
  • Posturing
    • Painful stimulus may be necessary to stimulate posturing
  • Pupils
    • Check dilation, reactivity, and equality
  • Sensation
    • Difficult to assess unless child is verbal
92
Q

What are the three age ranges of the modified GCS?

A
  • Infant (<1)
  • Child (1 - 4)
  • Adult (4+)
93
Q

Is AVPU used in paeds?

A

Yes, used as per adults except may need to make a judgement call for assessing ‘alertness’ in very young paeds.

94
Q

List the values of the infant (<1) GCS.

A
  • Eyes
    • 4 - open
    • 3 - to voice
    • 2 - to pain
    • 1 - no response
  • Verbal
    • 5 - coos, babbles
    • 4 - irritable cry, consolable
    • 3 - cries persistently to pain
    • 2 - moans to pain
    • 1 - no response
  • Motor
    • 6 - normal, spontaneous movement
    • 5 - withdraws to touch
    • 4 - withdraws to pain
    • 3 - decorticate flexion
    • 2 - decerebrate extension
    • 1 - no response
95
Q

List the values of the child (1 - 4) GCS.

A
  • Eyes
    • 4 - open
    • 3 - to voice
    • 2 - to pain
    • 1 - no response
  • Verbal
    • 5 - oriented, speaks, interacts, social
    • 4 - confused speech, disordered, consolable
    • 3 - inappropriate words, inconsolable
    • 2 - incomprehensible, agitated
    • 1 - no response
  • Motor
    • 6 - normal, spontaneous movement
    • 5 - localises pain
    • 4 - withdraws to pain
    • 3 - decorticate flexion
    • 2 - decerebrate extension
    • 1 - no response
96
Q

List the values of the adult (4+) GCS.

A
  • Eyes
    • 4 - open
    • 3 - to voice
    • 2 - to pain
    • 1 - no response
  • Verbal
    • 5 - oriented and alert
    • 4 - disoriented
    • 3 - nonsensical speech
    • 2 - moans, unintelligible
    • 1 - no response
  • Motor
    • 6 - follows commands
    • 5 - localises pain
    • 4 - withdraws to pain
    • 3 - decorticate flexion
    • 2 - decerebrate extension
    • 1 - no response
97
Q

What is the significance of paed’s large volume of cerebral blood?

A

Can lead to cerebral oedema developing rapidly.

98
Q

What is the implication of unfused sutures and patent fontanelles (<18 months) with regard to ICP?

A

May accommodate gradual increase in ICP and delay symptoms.

99
Q

Poor musculature in the neck and back of paeds makes them prone to ____ and ____ injuries.

A

Flexion and extension.

100
Q

What is the significance of the thin-walled abdomen in paeds?

A

Internal organs are not as well protected and prone to injury.

101
Q

What is the significance of paed bones being soft and pliable?

A

Less likely to #

102
Q

Weaker epiphyseal plates of paed bones means…

A

If # occur, they usually occur along these plates.

103
Q

True or false: paeds have underdeveloped renal function.

A
104
Q

List the manifestations of pain in paeds.

A
  • Vocalisations
  • Facial expressions
  • Grimace
  • Protecting
  • Vital sign changes
  • Changes in activity/behaviour
105
Q

True or false: paeds are often under-treated for pain.

A
106
Q

Describe the paediatric assessment triangle.

A
107
Q

What is the paediatric assessment triangle and what are the main components?

A

A 30 second initial assessment of a paed to assess criticality; main components are appearance, work of breathing, and circulation [to skin].

108
Q

Describe the deciphering of the paediatric assessment table.

A
109
Q

____% of term babies breathe spontaneously within 10 - 30 seconds of birth.

A

85%

110
Q

____% of newborns will require stimulation to breathe.

A

10%

111
Q

____% of newborns will require ventilations.

A

3%

112
Q

____% of newborns will require longer term respiratory support.

A

1.9%

113
Q

____% of newborns will require CPR.

A

0.1%

114
Q

How can ventilations encourage newborns to breathe?

A

Ventilations can cause pressure changes which assist with transition from maternal to neonatal circulation.

115
Q

What two things should infants in CA secondary to hypoxaemia be initially rx with?

A

Positive pressure ventilation and oxygen.

116
Q

When should suction be used in neonate resuscitation?

A

When there are signs of obvious obstruction.

117
Q

True or false: high flow O2 should be given before CPR is commenced in neonates.

A
118
Q

When is neonatal CPR commenced?

A

When HR is recognised as being below 60bpm.

119
Q

What is the compression to ventilation ratio for neonatal CPR?

A

3:1

120
Q

How many compressions per minute should be given in neonatal CPR?

A

90

121
Q

List the benefits of delayed cord clamping.

A
  • Increased placental transfusion
  • Increased cardiac output
  • Higher/more stable BP
  • Improved pulmonary vascular perfusion and closure of DA
  • Improved benefits in pre-term birth
122
Q

If possible, leave the umbilical cord uncut for ____ ____ to ensure passage of oxygenated blood and reduce the risk of hypovolaemia.

A

60 seconds

123
Q

When should only ventilations be given in newborn resuscitation?

A

If not breathing adequately and/or HR is >100

124
Q

Describe the pattern in which ventilations should be given if only ventilations are being provided.

A

Waltz pattern (breath two three, breath two three)

125
Q

After commencement of newborn CPR, do not cease until…

A

HR is >60bpm

Note: ? >100bpm in W4S

126
Q

Should ventilations be continued after newborn CPR has stopped because HR was >60bpm?

A

Yes - maintain ventilations until good respiratory effort is noted.

127
Q

What effects does placing babies prone on their mother’s chest been shown to have?

A
  • Increased oxygenation
  • Improves tidal volume
  • Promotes self soothing
  • Contributes to positive neurobehavioural development
128
Q

At what point should infants be managed as per paediatric CPR guidelines (15:2)?

A

When they are more than a few hours post birth.

129
Q

List some common causes of arrest in paeds.

A
  • Hypoxaemia and/or hypotension
  • Drowning
  • Septicaemia
  • SIDS
  • Asthma
  • UAO (upper airway obstruction)
  • Congenital abnormalities of heart/lungs
130
Q

True or false: VF is a common paed arrest rhythm.

A

Incidence of VF is 10%, though it often occurs initially with congenital heart conditions.

131
Q

What is the minimal age for an LMA according to QAS guidelines?

A

8 years

132
Q

What is the compression rate of paediatric CPR?

A

100 - 120bpm

133
Q

What is the energy level used for paed defibrillation?

A

4j/kg

134
Q

What is the paed dosage of IV adrenaline for CA?

A

10mcg/kg

135
Q

What is the max dosage of adrenaline for paed CA?

A

1mg

136
Q

What is the dose interval for adrenaline in paed resus according to QAS guidelines?

A

Every 3 to 5 minutes.

137
Q

What can be given under consult if hypovolaemia is suspected and at what dosage, according to QAS guidelines?

A

NaCl; 10-20mL/kg, repeated twice according to pts response, max of 60mL/kg.

138
Q

What are the cares provided after ROSC?

A
  • Continue supportive therapy until there is recovery of function of vital organs/arrival at hospital
  • Regular monitoring
  • Notification
  • Avoid further hypoxaemia
  • Maintain normothermia
  • Consider glucose control
  • Assist parents
139
Q

What is the formula for dose in volume drug calculations?

A
140
Q

What is the most common underlying cause of death of children <1 in Australia?

A

Perinatal and congenital issues.

141
Q

What is the most common underlying cause of death for children aged 1 - 14 in Australia?

A

Land transport accidents.

142
Q

What is the most common underlying cause of death for those aged 15 - 24 in Australia?

A

Suicide.

CSB339 (7 decks)

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