Paediatric Assessment Flashcards
Meningitis
Viral most common or bacterial (septicaemia).
Caused by meningococcal, pneuomococcal, TB.
Meningococcal - 50% fatal, 10% severe (WHO, 2018).
S/S - fever, photophobia, rash, stiff neck, headaches, seizures, fatigue.
90% of deaths w/in 24hrs (Meningitis UK).
What are the two tests for Meningitis?
Kernig’s - flex leg at 90deg, extend knee up, +ve if pain in lower back and leg.
Brudzinski’s - chin to chest, hips/knees flex due to pain.
Describe what is meant by Meningococcal Septicaemia.
Meningococcal bacteria release toxins into the blood.
Attack endothelium of vessels.
-> leak -> red. blood vol -> red. O2 carrying capacity -> circulation shunts centrally -> cold peripheries/pallor/tachypnoea.
Kawasaki Disease.
Affecting <5y/o mainly.
5/7 - fever w/ rash/lymphodenopathy/strawberry tongue/swollen hands & feet/dry lips.
Tx ALWAYS in hosp - IV immunoglobulin & aspirin.
Complications - vasculitis, can affect coronary arteries (1/4 w/out tx).
3% mortality.
(NHS).
Briefly describe the paediatric assessment triangle.
Appearance: TICLS - Tone, Interactiveness, Consolability, Look/Gaze, Speech/Cry.
WOB: nostril flaring, tracheal tug, IC/sternal recess, accessory muscles, abdo breathing, sounds, positioning.
Circulation: CRT, colour, mottling, rashes, pulses, fluid loss (blood/burns/dehyd), cyanosis (sats <85% - Yon et al., 2022).
Paediatric Rashes
Acute or chronic.
Blisters + itchy = urticaria (environment, food, viral).
Blister + yellow crust = impetigo.
Petechial/purpuric - non-blanch = CONCERN.
Check armpits, buttocks, nappy line, groin, legs.
Causes - chick pox, meals, heat, hives, scarlet fever.
Lymphadenopathy in Paediatrics.
Cervical:
Tonsilitis, pharyngitis, sinusitis, glandular fever, TB.
Generalised:
Febrile illness, systemic juvenile chronic arthritis, acute lymphatic leukaemia, dry reaction, Kawasaki.
What are the signs of sepsis in paediatrics?
Tachypnoea.
Seizures.
Mottling/pallor/cyanosis.
Rash.
Lethargy/red. GCS.
Cold.
Red. oral intake.
Vom.
Red. UO/not PO for >12hrs.
List some red flags in paediatrics.
Fever >38.0
Drowsy.
Cold peripheries.
Petechial rash.
Stiff neck.
SOBAR.
Tachycardia.
Tachypnoeic.
Hypotension (terminal sign).
How do you assess pain in paediatrics?
Wong-Baker FACES Pain Rating Scale.
Outline fever in paediatrics
Generally 38.0+.
<3mths - 38.0+ sig.
3-6mths - 39.0+ sig.
Red flags -
+ rash.
+ dehydration.
+ fatigue.
What are the signs of dehydration in infants?
Dark urine.
Red. UO.
Sunken fontanelle.
Pyrexia.
Dry mouth/tongue/skin.
Constipation.
List the signs of physical abuse.
Injuries at diff healing stages.
Freq minor injuries, inadequate explanation.
Other abuse signs - neglect, fail to thrive.
Non-acc sites.
Child discloses.
Unusual behaviour w/ parent.
Child fearful of parents.
0.5m children abused p/a in UK (NSPCC).
List the signs of dehydration in older children.
Dry mouth.
Cracked lips.
Irritable.
Lack of tears when crying.
Dark urine.
Red. UO.
Constipation.
Poor concentration.
Headaches.
Drowsy.
Dizzy.
List some common sites for NAI.
Eyes.
Cheek - bruising/finger marks.
Mouth - torn frenulum.
Ears - pinch/slap.
Neck, shoulder, upper/inner arm, chest - bruising, grab marks.
Skull # - ICH -> Shaken Baby Syndrome - subdural haematoma, SAH - American Association of Neurosurgeons.
Why are observations different in paediatrics?
RR: ^ as ^ metabolic demand, smaller functional residual capacity (Saikia & Mahanta 2019).
HR: ^ metabolic demand, smaller SV so ^ HR to compensate & give adequate CO (BMJ).
BP: red. - red. SVR + smaller vessels.
Important paediatric history to gain.
Maternal:
Ante&postnatal, birth route/complications, pregnancy complications, prem?
Immunisations:
What? When?
Development:
Milestones? Delays?
Drug Hx:
Regular? Prescribed? Recent short courses (abx, steroids), maternal drugs?
FHx & SHx:
Lives w/? Smokers at home? Pets? Similar symptoms in 1st/2nd degree relatives? School? Social services/health visitor?
Paediatric Anatomical Differences in Airway:
Smaller diameter & length.
Large tongue in smaller oropharynx.
Funnel shape.
Young - narrowest just below glottis (cricoid cartilage).
Anterior larynx.
Epiglottis is long, narrow, floppy & horseshoe shape.
Large occiput (+ tongue = easy obstructed).
Paediatric Anatomical Differences in Breathing:
Infants are obligatory nasal breathers.
Faster to exhaustion.
^ RR.
^ Metabolic demand.
Ribs horizontal (only move up in insp).
Ribs flat not arched.
Compliant chest wall allows sternal recess.
Diaphragmatic breathers as most effective resp muscle.
Paediatric Anatomical Differences in Circulation:
SVR lower - NIBP often inaccurate but will be lower.
Greater subcut tissue + small veins = hard to cannulate.
Arrest - usually resp (healthy CVS - PEA/Asys).
Circulatory vol - vol/kg is proportionately larger -> haem is more serious (100ml in 5kg baby = 10% vol).
Hypotension - late, terminal sign.
Topics to cover in paediatric assessment:
Meningitis.
Septicaemia.
Dehydration.
Rash.
Fever & fatigue.
Pain ax.
System ax - Resp/CVS/GI/Neuro.
NAI/Safeguarding/Welfare.
Plan.
Bronchiolitis.
<2y/p - usually viral.
S/S: ^RR, cold symptoms, red. oral intake, cough, crackles, wheeze.
Features: fever, consider pneumonia if 39.0+ or persistent focal crackles.
Tx: DO NOT GIVE abx or salbutamol (NICE 2015) - doesn’t improve LOS in hosp/Sats, side effects (^HR etc) outweigh any benefit of B2-agonists (Cai et al., 2020).
Croup.
6mths - 3yrs.
S/S: seal bark cough, hoarse voice, DIB, rasping on insp, cold-like symptoms, fever.
Red Flags: resp retractions, cyanosis, lethargy, v’ ^T.
Night time symptoms worse.
(NHS).
