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HCPAR6012 Exam Revision > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are the age classifications?

A
  • Newborn: born that day
  • Small infant: < 3 months old
  • Large infant: 3-12 months old
  • Small child: 1-4 yrs old
  • Medium child: 5-11 yrs old
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2
Q

When do you treat a child under the adult guidelines?

A

12 years or older

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3
Q

What are child weights/calculations?

A
  • Newborn = 3.5kg
  • 3 month old = 6kg
  • 6 month old = 8kg
  • Child 1-9 yrs (age x 2) + 8
  • Child 10-11 yrs (Age x 3.3)
  • always ask the parent if they know how much the child weights
  • Don’t be afraid to approximate if you feel the child weighs more or less than the calculated weight
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4
Q

How much should a newborn weigh?

A

3.5kg

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5
Q

How much should a 3 month old weigh?

A

6kg

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6
Q

How much should a 6 month old weigh?

A

8kg

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7
Q

How do you calculate a weight for a 1-9 year old?

A

(age x 2) + 8 = weight

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8
Q

How do you calculate the weight for a 10-11 year old?

A

Age x 3.3 = weight

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9
Q

What are normal vital signs for all paeds 0-11 (HR, BP, RR)

A
Re
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10
Q

What does the paediatric assessment triangle consist of?

A
  • Appearance
  • Work of breathing
  • Circulation
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11
Q

What do you assess for in APPEARANCE of the paediatric triangle?

A
  • Tone
  • Interactiveness
  • Consolability
  • Look/Gaze
  • Speech/Cry
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12
Q

What do you assess for in WORK OF BREATHING of the paediatric triangle?

A
  • Abnormal breath sounds
  • Abnormal positioning
  • Retractions
  • Nasal flaring
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13
Q

What do you assess for in CIRCULATION of the paediatric triangle?

A
  • Pallor
  • Mottling
  • Cyanosis
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14
Q

How do you assess a child?

A
  • Tone
  • Interactivity
  • Consolability
  • Look/gaze
  • Speech/cry
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15
Q

How do you identify a “well child”

A
  • Tone = active, reaching, moving, strong grip
  • Interactivity = interested in the environment, looking, smiling
  • Consolability = easily comforted/consoled
  • Look/gaze = looks at caregivers or items of interest
  • Speech/cry = cries
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16
Q

How do you identify an “unwell child”

A
  • Tone = still, floppy, quiet
  • Interactivity = not interested in their surroundings
  • Consolability = inconsolable
  • Look/gaze = staring, not engaging in eye contact
  • Speech/cry = moaning, grunting or quiet
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17
Q

What are some signs of illness in a child

A
  • feeding less than half of normal intake over 24 hours
  • lethargy/less responsive than usual
  • less active than normal
  • less than 4 wet nappies in 24 hours
  • pale and hot skin
  • laboured breathing
  • vomiting bile stained fluid
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18
Q

What are the anatomical differences of a childs head?

A

Head
- large and heaving in proportion to the body
- large area for heat loss. accounts for almost 20% of BSA in infants compared to 9% by age 15
- soft skulls - fontanels

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19
Q

What are the anatomical differences of a childs neck?

A
  • weak muscles and ligaments
  • short and fat neck
  • prone to neck flexion and extension
  • difficult to apply cervical collar
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20
Q

What are the anatomical differences in a childs chest?

A
  • soft pliable ribs = fracture indicates severe force
  • rib cage does not expand easily for breathing
  • chest muscles weaker and tire earily. Less ability to assist breathing
  • The sternum is soft
  • The ribs are placed horizontally
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21
Q

What are the anatomical differences of a childs abdomen?

A
  • protruding
  • less fat and muscle protecting internal organs. Prone to seatbelt injuries
  • smaller stomach capacity
  • distension with air is morelikely to cause vomiting
  • liver and spleen less protected by ribs and abdominal wall
  • marked movement with normal respiration
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22
Q

What are the anatomical differences of a childs musculoskeletal system?

A
  • bones are softer and more likely to bend than break
  • green stick fractures are common
  • dislocations are common
  • ligaments are stronger, breaks occur rather than sprain
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23
Q

What are the anatomical differences in a childs skin?

A
  • thinner and more sensitive
  • bruise and burn more easily (and at lower temperatures)
  • generally heal better than adults
  • less fat for insulation
  • more sensitive to allergens
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24
Q

What are the anatomical differences temperature regulation in a child?

A
  • unable to regulate temperature as well as adults due to immature hypothalamus
  • susceptible to heat loss and over heating
  • temperature spikes rather than increasing gradually (potentially causing febrile convulsions)
  • infants less able to sweat to dissipate heat
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25
What are the anatomical differences of a childs airway?
- infants are nose breathers - tonsils can enlarge and block airways - airway is narrower and shorter - large tongue, small mouth - loose teeth - soft palate
26
What are the anatomical differences in a child cardiovascular system?
- less storage of blood in veins - less muscle mass in heart wall - compromised by smaller loss of blood than adults due to small blood volume - high heart rate - poor ability to compensate with stroke volume - less likely to experience VT/VF arrest due to healthy hearts (less arthersclerotic plaque)
27
What are the anatomical differences in a child's respiratory system?
- RR is higher due to increased demand for oxygen - diaphragm is the main muscle of breathing - a full stomach or abdominal trauma can affect the work of the diaphragm - signs of distress can include chest wall retraction, tracheal tugging, abdominal protrusion, pale skin, abnormal sounds, lethargy or restlessness and sweating - Imparied ability to increase work of breathing due to immature accessory muscles
28
When is a childs respiratory system similar to an adult?
8 years old
29
What are signs of respiratory distress in a child? as per paed RSA?
- tachypnoea - grunting - wheezing - chest wall retraction - use of accessory muscles - pallor - cyanosis (late sign) - abdominal protrusion
30
As per the paediatric RSA, what are signs of hypoxia in an infant?
- pallor - hypotension - lethargy - apnoea - bradycardia
31
As per the paediatric RSA what are signs of hypoxia in children?
- restlessness - tachypnoea - tachycardia - bradycardia (late sign) - cyanosis (late sign)
32
How do you complete a GCS on a <4 year old?
33
How do you complete a GCS on a > 4 year old?
* Hint* its the same as an adult
34
Recite the paediatric cardiac arrest CPG
35
Recite the paediatric pain relief CPG
36
Recite the paediatric upper airway obstruction CPG
37
Recite the paediatric asthma CPG
38
Recite the paediatric nausea and vomiting CPG
39
Recite the paediatric hypoglycaemia CPG
40
Recite the paediatric seizures CPG
41
Recite the paediatric anaphylaxis CPG
42
Recite the paediatric anaphylaxis (part 2 - alternate therapies) CPG
43
Recite the paediatric meningococcal septicaemia CPG
44
Recite the paediatric overdose (opioids) CPG
45
Recite the paediatric overdose (Psychostimulants) CPG
46
Recite the paediatric overdose (TCA) CPG
47
Recite the paediatric hypovolaemia CPG
48
Recite the paediatric chest injuries CPG
49
Recite the paediatric chest injuries (TPT) CPG
50
Recite the paediatric burns CPG
51
How do you assess paediatric burn TBSA?
52
Recite the paediatric hypothermia CPG
53
Recite the paediatric environmental hyperthermia CPG
54
What is the wong baker pain scale?
55
What is the QUESTT pain scale?
- Question the child - Use pain rating scales - Evaluate behaviour and psychological changes - Secure parents involvement - Take cause of pain into account - Take action and evaluate results
56
What is the FLACC pain scale?
57
What are some common signs of pain in children?
- LOA - guarding - pulling at body part - grimacing/frowning - showing rigidity - arching their backs - difficult to console/crying - jerking/kicking - jaw clenching - knees to chest
58
How can you treat mild pain in a paediatric?
- paracetamol (PO liquid or 500mg tablet) - 15mg/kg - splinting - icepack as appropriate
59
How do you treat moderate to severe pain in a paediatric?
60
What can fentanyl cause in children?
- respiratory depression
61
When should IM morphine be used in children?
- as a last resort
62
What is a paediatric patient most likely to go into cardiac arrest from?
- hypoxia - congenital cardiac cause
63
What rhythms do paediatrics commonly present in in an arrest?
- PEA - Asystole
64
How do you correctly size an OPA for a child?
- from the middle incisor to the angle of the jaw
65
When can you rotate the OPA?
>8 yrs old < 8 DO NOT ROTATE (to avoid damage to the soft pallate)
66
What are some paediatric considerations for airway managment?
- newborns and infants should have their head and neck in neutral alignment. No extension/flexion - padding may be required under the shoulders to maintain a neutral alignment
67
what does the infant sniffing position look like?
68
When do you commence CPR on a paediatric?
- HR <60 in infants (<1 year) - HR <40 in children (up to 11 years)
69
What are the metrics of CPR for a paediatric?
- 1/3 depth of chest - 50% time of compression to relaxation - two fingers for newborns/infants - one handed for small children - two hands for larger children
70
What are the compression rates for paediatrics?
- aim 100-120 compressions per minutes with a pause for ventilations - 30:2 - 15:2 when intubated + no pause for ventilations - < 14 ventilations per minute
71
Up to what weight can you use paediatric pads?
up to 25kg (8 years old)
72
What pad placement do you use in a small child?
- anterior posterior - to avoid pads touching
73
What happens if the defib pads are too close together?
- it can cause an electrical arch
74
How do you calculate the joules for defibrillation?
4 joules per kg
75
What is croup?
- a viral infection of the upper respiratory tract (larynx and trachea) that causes swelling of the airway and difficulty breathing - It is usually preceded by an URTI and often occurs at night - it is most common in children aged 6 months to 6 years and is twice as common in boys than girls
76
Draw and label the upper respiratory tract
77
What are some signs and symptoms of upper airway obstruction/croup
- stridor - sore, hoarse throat - fever - harsh barking cough (worse at night) - restlessness and irritable - distressed - previous URTI - slow onset - signs of respiratory distress
78
How do you assess the severity of croup?
79
What is the management for croup?
- rest and reassurance +++ - oxygen if tolerated - if in severe respiratory distress, administer nebulised adrenaline 5mg in 5ml - request MICA - admin dex 600mcg/kg PO (Max 12mg) - A further 5mg in 5ml may be given every 5/60 if required - notify recieving hospital
80
When do we give adrenaline in croup and why do we give it?
- severe croup - increasesing respiratory distress, increasing lethargy, decreasing stridor - beta 2 effects (bronchodilation) - alpha effects (localised vasoconstriction results in decreased upper airway swelling)
81
What is epiglottitis?
- a bacterial infection of the epiglottis - it causes inflammation and swelling that may cause an obstruction of the trachea and oesophagus - it is caused by influenza B or a member of the streptococcus family
82
What are signs of an upper airway obstruction - epiglottitis
- fever/septic - no cough - rapid onset (2-6 hours) - stridor/snore on expiration - leans forward - drooling - difficulty swallowing - signs of resp distress
83
What is the management of epiglottitis
- these patients require urgent intubation to avoid complete airway obstruction - rest and reassurance - request MICA - oxygen if tolerated - do not inspect airway - keep child as calm as possible - transport urgently - notify recieving hospital
84
What is the management of a FB obstruction?
* Encourage coughing * If unable to cough, but still conscious: * 5 back blows (not for newborns) * Forceful sharp blow with base of hand to centre of back at the level of the base of scapula's, in an upward motion. * 5 chest thrusts * Similar to chest compressions if supine, only slower and sharper. * May be done on standing patient (not infant/toddler) with arms encircling patient from behind and one fist pulled forcefully into sternum. * Continue alternating until obstruction is resolved or patient becomes unconscious. * * If the patient is unconscious (call MICA!) – inspect airway using laryngoscope and remove obstruction with Magill’s forceps if possible. * If unable to remove obstruction, perform 5 chest compressions * If obstruction still present, provide 5 breaths * Continue alternating…
85
Explain the tonic and clonic phase of a seizure
* The Tonic phase of the seizure relates to the loss of consciousness and the whole body becoming rigid. * The Clonic phase relates to rapid tensing and relaxing of muscles, creating a shaking appearance
86
What is generalised convulsive status epilepticus?
Generalised convulsive seizure with continuous seizure activity for >5min or multiple seizures without COMPLETE regain of consciousness between seizures.
87
What is the treatment for continuous generalised seizures?
* Rest and reassurance * Protect patient from injury * OP airway/NP airway (if necessary) * Oxygen via NR mask or * Assist ventilations if required. * Administer Midazolam IMI * Repeat dose once only after 10/60 if required. * Consider MICA
88
What age group do febrile convulsions typically occur in?
6 months - 5 years
89
Can you terminate a febrile convulsion with midazolam?
Yes, you treat it the same as any other seizure
90
Why do febrile convulsions occur?
- as a result of sudden spike of temperature (over 39 degrees) - these occur due to an immature hypothalamus
91
What is anaphylaxis?
- an acute, severe, systemic hypersensitivity reaction. A patient recieves an initial exposure to an antigen resulting in a systemic response
92
What is the pathophysiology of anaphylaxis?
- exposure to an antigen - the antigen binds to IgE antibodies on mast cells causing degranulation (and release of inflammatory mediators - histamines) - This results in vasodilation, increased vascular permeability, relative fluid loss - this can cause signs of allergy as well as circulatory collapse and respiraotry compromise leading to altered conscious state
93
What is the dose for an Epipen Jnr?
0.15mg
94
What makes someone a high risk anaphylaxis?
- expected course (severity of illness) - hypotension - caused by medications - respiratory symptoms - history of asthma/co-morbidities - no response to initial dose of adrenaline
95
Do you have to transport an anaphylaxis even if symptoms have resolves?
Yes, they require minimum of 4 hours monitoring in hospital
96
What is asthma? and what is it caused by?
- A reversible airway disease causing bronchospasm, mucosal oedema and mucosal plugging. - it may be triggered by allergens, weather, illness or emotional state
97
Draw the anatomy of the lungs
98
When can a child be diagnosed with asthma?
- >2 yrs - children under two are often diagnosed with bronchiolitis rather than asthma when they present with a wheeze - bronchiolitis refers to inflammation of the bronchioles and has a viral cause. Bronchospasm does not occur
99
If you need to provide assisted ventilations for a paed with asthma, how many do you do and how should you do it?
100
Define hypoglycaemia
- Refers to a lack of glucose in the blood - <4mmol/L - can result in impaired neurological function
101
What are some signs and symptoms. of hypoglycaemia?
- ACS - abnormal behavious - drowsiness - Pallow - diaphoresis
102
What is meningococcal septicaemia?
- it is characterised by two things, infection of the meninges and infection of the blood - The sepsis refers to the bacterial toxins that rupture blood vessels causing organ failure
103
How is meningococcal transmitted?
Droplets
104
What types of burns require special consideration?
- genitals - facial - circumferential - chest - joints - hands or feet

HCPAR6012 Exam Revision (11 decks)

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