Paediatric

Question 1

Paediatric Advanced Life Support Kit

Answer 1

The paramedic may ask you for equipment. Be familiar with the appropriate sized pieces of equipment.

Question 2

BLS ratio for patients aged infant to puberty

Answer 2

15:2 @ 100-120

Question 3

children and infants responses to illness

Answer 3

Severely unwell children can appear well then suddenly collapse.
More respiratory cause than cardiac in arrests.

Question 4

Paediatric assessment triangle

Answer 4

Appearance.
Work of breathing.
Circulation to skin.

Question 5

TICLS

Answer 5

Tone.
Inter-activeness.
Consolability.
Look/Gaze.
Speech/Cry.

Question 6

CLITS

Answer 6

Consolability.
Look/Gaze.
Interactiveness.
Tone.
Speech/Cry.

Question 7

Work of Breathing - assessment - Effort

Answer 7

Respiratory rate.
Recession.
Accessory muscle.
Nasal flare.
Stridor & Wheeze.
Expiratory grunting.

Question 8

Work of breathing - assessment - Efficiency & Effect

Answer 8

Chest expansion.
Air entry.
Pulse rate.
Colour.
Mental status.

Question 9

Circulation to skin

Answer 9

Colour.
Capillary refill.
Warmth of skin.

Question 10

Respiratory Emergencies

Answer 10

Common 30-40% of acute admissions in children.
Potentially life threatening.
Early recognition and treatment saves lives.

Question 11

Respiratory Emergencies - Assessment

Answer 11

Effort of breathing.
Efficiency of breathing.
Effects of respiratory inadequacy.

Question 12

Signs of deterioration

Answer 12

Increasing recession.
Increasing respiratory rate.
Fatigue.
Altered mental status.
Cyanosis.

Question 13

Upper Airway Emergency causes

Answer 13

Croup.
Inhaled foreign body.
Anaphylaxis.
Epiglottitis.

Question 14

Upper Airway Emergencies - Acute upper airway obstructions are:

Answer 14

Infections.
Foreign bodies.
Angiodema (swelling i.e lips).
Trauma.

Question 15

Croup - signs and symptoms

Answer 15

Common.
Not usually life threatening.
Viral infection.
Age 6months - 9yrs.
Gradual onset.
Harsh stridor.
Barking cough.
No drooling.
Temperature <38.5.
Able to drink.

Question 16

Epiglottitis - signs and symptoms

Answer 16

Rare.
Life threatening.
Bacterial infection.
Age 2-6yrs.
Rapid onset.
Soft stridor.
Looks very unwell.
Quiet, sitting up.
Drooling.
Temperature >38.5.
Unable to drink.

Question 17

Upper Airway Emergency - management

Answer 17

Maintain the airway.
Minimise time on scene.
Do not agitate the child.

Question 18

Anaphylaxis - signs and symptoms

Answer 18

Severe allergic reaction.
Respiratory difficulty.
Hypotension.

Question 19

Anaphylaxis - treatment

Answer 19

ABCDE.
IV fluid.
IM adrenaline.
Chlorphenamine.
Hydrocortisone.

Question 20

Acute Asthma - information

Answer 20

Still results in death.
Night/early morning presentation.
Precipitated by infection/pollen.
Acute inflammation of the airways - wheeze, mucus, plugging, hypoxia, dehydration.

Question 21

Complication of Acute Asthma can be…

Answer 21

A Spontaneous Pneumothorax.

Question 22

Acute Asthma - Indicators of severity

Answer 22

Wheeze = poor.
Accessory Muscle = better
SPO2 = poor
Respiratory rate = better
ETCO2 = better

Question 23

Severe Asthma - signs and symptoms

Answer 23

Too breathless to feed or talk.
Recession/use of accessory muscles.
RR >50 (2-5yrs).
RR >30 (5-18yrs).
HR >120BPM.
Peak flow < 50% predicted.

Question 24

Life Threatening Asthma - signs and symptoms

Answer 24

Agitated/altered level of consciousness.
Poor respiratory effort/exhaustion.
Reduced RR.
SPO2 <33%.

Question 25

Asthma Management

Answer 25

Calm. High flow oxygen. Nebulisers: salbutamol 2.5mg & ipratropium bromide 0.125-0.25mg. ``` In hospital: Steroids. Magnesium sulphate. IV salbutamol. Antibiotics. ```

Question 26

Bronchiolitis - information

Answer 26

50% of infants will suffer form it during first 2 years of life. Seasonal. Viral. Wheeze/cough. Respiratory distress. Apnoea (suspension of external breathing).

Question 27

Asthma & Bronchiolitis - treatment

Answer 27

Oxygen. Salbutamol (para) Ipratropium bromide (para) Hydrocortisone (para)

Question 28

Pneumonia - signs & symptoms

Answer 28

``` Fever. Lethargy. SOB. Pleuritic chest pain. Responsible for 150 deaths per annum. ```

Question 29

Inhaled foreign body - signs & symptoms

Answer 29

Inspiratory stridor (creaking or grating noise)/apnoea. Sudden onset. History of coughing/gagging. Unilateral wheezing.

Question 30

Inhaled foreign body - treatment

Answer 30

``` Never perform blind finger sweep. Back blows. infants 1yr = 5 x abdominal thrusts. Check mouth. Repeat. Open airway. 5 x ventilations. BLS. Laryngoscopy (para) ```

Question 31

Convulsing child - Simple Febrile

Answer 31

<15 mins, do not recur within 24 hrs

Question 32

Convulsing child - Complex Febrile

Answer 32

>15 mins, recurs within 1hr-24hrs

Question 33

Convulsing child - Status Febrile

Answer 33

>30 mins

Question 34

Convulsing child - causes

Answer 34

Febrile. Epilepsy Other causes.

Question 35

Convulsing child - treatment

Answer 35

``` Protect patient. ABC. BM measurement. Oxygen. Dextrose 40% gel (para) IM glucagon (para). IV glucose (para) Glucose (para). Diazepam (para). ```

Question 36

Poisoning - assessment

Answer 36

``` Intentional by child. Accidental. Deliberate by adult. Admit all overdoses. Psychiatric involvement. ```

Question 37

Meningococcal septicaemia

Answer 37

``` Respiratory rate and effort increase. Heart rate increase. Capillary refill increase. Skin cool, mottled. SpO2 <95%. Temperature increase. 1 in 10 cases fatal. ```