paediatric a&p differences

Question 1

What are the differences in the structure of the airway? 9 things

Answer 1

• Tongue is larger in proportion to mouth
• Pharynx is smaller – airway is much narrower. Choking hazard.
• Epiglottis is larger and floppier/flatter – finding the vallecular space is harder so you change how you use the laryngoscope to view the vocal chords.
• Epiglottis/trachea is positioned significantly more anteriorly.
• Larynx is more anterior and superior
• Narrowest at cricoid – the airway is narrowest at the top.
• Trachea narrow and less rigid
• Soft palate is flatter/less arched
• Heads/skulls are proportionally much larger. The occiput at the back of the skull is much larger. If the child is laid on their back, this can reduce the size of the airway.

Question 2

What are the differences in the respiratory system? 8 things

Answer 2

• Newborns and children up to the age of about 3 are predominate nasal breathers. Nasal flaring can be a sign of respiratory distress.
• Don’t have well-developed muscle fibres in the diaphragm, but they are often belly breathers.
• Have more horizontal ribs. Don’t have as well defined intercostal muscles. Intercostal recession is a very bad sign.
• Ribs are good protectors in children, as well as more flexible tissues make tension pneumothorax more likely.
• Don’t have developed sternocleidomastoid
• Lungs are immature: increased risk of infection
• Terminal bronchioles (lead to alveoli) are much smaller. However, children/infants create the same amount of mucus as an adult, so these can become very obstructed.
• Children may have more audible respiratory sounds due to trapped air.

Question 3

What are the differences in the cardiovascular system? 6 things

Answer 3

• Higher metabolism – faster heart rate: check page for age.
• Infants unable to increase stroke volume. Cannot vasodilate/vasoconstrict to control bp in the same way as an adult. The only compensatory method they have is increasing heart rate.
• ECG changes – the left ventricle is no more defined than the right ventricle. Muscular development insufficient to increase stroke volume.
• Very unlikely that paediatrics will have vt or vf in arrest. Will normally go from bradycardia to pea.
• Children generally develop healthy hearts and do not develop life threatening arrhythmias easily
• Bradycardia most commonly associated with hypoxia. Pre-terminal sign.
• Children can compensate until they can’t, and then go down very quickly.

Question 4

How are reversible causes and the 4 Hs and 4Ts related to children?

Answer 4

• Hypothermia – can lose and gain heat very quickly. Big heads, children need to wear hats. Can’t shiver or sweat well.
• Hypovolemia – children have a lot less blood. Blood loss can have a bit impact on circulatory volume.
• Hyperkalaemia – can deal better with dehydration/electrolyte imbalances by increasing hr.
• Hypoxia – most likely cause of cardiac arrest. Small airways, lots of mucus, small oxygen reserves.
• Tension pneumothorax more likely due to flexible tissues
  Additional differences
• Smaller Glycogen stores: more prone to hypoglycaemia as the stores are used more rapidly.
• Immature immune system: more prone to infection as they are meeting organisms for the first time.

Question 5

What are the parts of the paediatric assessment triangle?

Answer 5

Appearance – TICLES (muscle) tone: level of fatigue
- Interactive, Consolability,
- Look/gaze: should follow interesting objects with their eyes. If they have a glazed look, this is very bad.
- Speech/cry
Work of breathing: audible sounds such as stridor/barking cough.
Circulation to skin: looking at appearance of skin – pink and perfused, pale, mottling.

Question 6

What does APGAR stand for?

Answer 6

• Activity, Pulse, Grimace (response to stimulation), Appearance (skin colour), Respiration
• Used at 1m and 5min after birth