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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
Q

What are the anatomical differences of a childs airway?

A
  • infants are nose breathers
  • tonsils can enlarge and block airways
  • airway is narrower and shorter
  • large tongue, small mouth
  • loose teeth
  • soft palate
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26
Q

What are the anatomical differences in a child cardiovascular system?

A
  • 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)
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27
Q

What are the anatomical differences in a child’s respiratory system?

A
  • 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
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28
Q

When is a childs respiratory system similar to an adult?

A

8 years old

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29
Q

What are signs of respiratory distress in a child? as per paed RSA?

A
  • tachypnoea
  • grunting
  • wheezing
  • chest wall retraction
  • use of accessory muscles
  • pallor
  • cyanosis (late sign)
  • abdominal protrusion
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30
Q

As per the paediatric RSA, what are signs of hypoxia in an infant?

A
  • pallor
  • hypotension
  • lethargy
  • apnoea
  • bradycardia
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31
Q

As per the paediatric RSA what are signs of hypoxia in children?

A
  • restlessness
  • tachypnoea
  • tachycardia
  • bradycardia (late sign)
  • cyanosis (late sign)
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32
Q

How do you complete a GCS on a <4 year old?

A
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33
Q

How do you complete a GCS on a > 4 year old?

A
  • Hint* its the same as an adult
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34
Q

Recite the paediatric cardiac arrest CPG

A
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35
Q

Recite the paediatric pain relief CPG

A
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36
Q

Recite the paediatric upper airway obstruction CPG

A
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37
Q

Recite the paediatric asthma CPG

A
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38
Q

Recite the paediatric nausea and vomiting CPG

A
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39
Q

Recite the paediatric hypoglycaemia CPG

A
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40
Q

Recite the paediatric seizures CPG

A
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41
Q

Recite the paediatric anaphylaxis CPG

A
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42
Q

Recite the paediatric anaphylaxis (part 2 - alternate therapies) CPG

A
43
Q

Recite the paediatric meningococcal septicaemia CPG

A
44
Q

Recite the paediatric overdose (opioids) CPG

A
45
Q

Recite the paediatric overdose (Psychostimulants) CPG

A
46
Q

Recite the paediatric overdose (TCA) CPG

A
47
Q

Recite the paediatric hypovolaemia CPG

A
48
Q

Recite the paediatric chest injuries CPG

A
49
Q

Recite the paediatric chest injuries (TPT) CPG

A
50
Q

Recite the paediatric burns CPG

A
51
Q

How do you assess paediatric burn TBSA?

A
52
Q

Recite the paediatric hypothermia CPG

A
53
Q

Recite the paediatric environmental hyperthermia CPG

A
54
Q

What is the wong baker pain scale?

A
55
Q

What is the QUESTT pain scale?

A
  • 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
Q

What is the FLACC pain scale?

A
57
Q

What are some common signs of pain in children?

A
  • 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
Q

How can you treat mild pain in a paediatric?

A
  • paracetamol (PO liquid or 500mg tablet)
  • 15mg/kg
  • splinting
  • icepack as appropriate
59
Q

How do you treat moderate to severe pain in a paediatric?

A
60
Q

What can fentanyl cause in children?

A
  • respiratory depression
61
Q

When should IM morphine be used in children?

A
  • as a last resort
62
Q

What is a paediatric patient most likely to go into cardiac arrest from?

A
  • hypoxia
  • congenital cardiac cause
63
Q

What rhythms do paediatrics commonly present in in an arrest?

A
  • PEA
  • Asystole
64
Q

How do you correctly size an OPA for a child?

A
  • from the middle incisor to the angle of the jaw
65
Q

When can you rotate the OPA?

A

> 8 yrs old
< 8 DO NOT ROTATE (to avoid damage to the soft pallate)

66
Q

What are some paediatric considerations for airway managment?

A
  • 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
Q

what does the infant sniffing position look like?

A
68
Q

When do you commence CPR on a paediatric?

A
  • HR <60 in infants (<1 year)
  • HR <40 in children (up to 11 years)
69
Q

What are the metrics of CPR for a paediatric?

A
  • 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
Q

What are the compression rates for paediatrics?

A
  • 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
Q

Up to what weight can you use paediatric pads?

A

up to 25kg (8 years old)

72
Q

What pad placement do you use in a small child?

A
  • anterior posterior
  • to avoid pads touching
73
Q

What happens if the defib pads are too close together?

A
  • it can cause an electrical arch
74
Q

How do you calculate the joules for defibrillation?

A

4 joules per kg

75
Q

What is croup?

A
  • 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
Q

Draw and label the upper respiratory tract

A
77
Q

What are some signs and symptoms of upper airway obstruction/croup

A
  • stridor
  • sore, hoarse throat
  • fever
  • harsh barking cough (worse at night)
  • restlessness and irritable
  • distressed
  • previous URTI
  • slow onset
  • signs of respiratory distress
78
Q

How do you assess the severity of croup?

A
79
Q

What is the management for croup?

A
  • 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
Q

When do we give adrenaline in croup and why do we give it?

A
  • severe croup - increasesing respiratory distress, increasing lethargy, decreasing stridor
  • beta 2 effects (bronchodilation)
  • alpha effects (localised vasoconstriction results in decreased upper airway swelling)
81
Q

What is epiglottitis?

A
  • 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
Q

What are signs of an upper airway obstruction - epiglottitis

A
  • fever/septic
  • no cough
  • rapid onset (2-6 hours)
  • stridor/snore on expiration
  • leans forward
  • drooling
  • difficulty swallowing
  • signs of resp distress
83
Q

What is the management of epiglottitis

A
  • 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
Q

What is the management of a FB obstruction?

A
  • 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
Q

Explain the tonic and clonic phase of a seizure

A
  • 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
Q

What is generalised convulsive status epilepticus?

A

Generalised convulsive seizure with continuous seizure activity for >5min or multiple seizures without COMPLETE regain of consciousness between seizures.

87
Q

What is the treatment for continuous generalised seizures?

A
  • 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
Q

What age group do febrile convulsions typically occur in?

A

6 months - 5 years

89
Q

Can you terminate a febrile convulsion with midazolam?

A

Yes, you treat it the same as any other seizure

90
Q

Why do febrile convulsions occur?

A
  • as a result of sudden spike of temperature (over 39 degrees)
  • these occur due to an immature hypothalamus
91
Q

What is anaphylaxis?

A
  • an acute, severe, systemic hypersensitivity reaction. A patient recieves an initial exposure to an antigen resulting in a systemic response
92
Q

What is the pathophysiology of anaphylaxis?

A
  • 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
Q

What is the dose for an Epipen Jnr?

A

0.15mg

94
Q

What makes someone a high risk anaphylaxis?

A
  • expected course (severity of illness)
  • hypotension
  • caused by medications
  • respiratory symptoms
  • history of asthma/co-morbidities
  • no response to initial dose of adrenaline
95
Q

Do you have to transport an anaphylaxis even if symptoms have resolves?

A

Yes, they require minimum of 4 hours monitoring in hospital

96
Q

What is asthma? and what is it caused by?

A
  • A reversible airway disease causing bronchospasm, mucosal oedema and mucosal plugging.
  • it may be triggered by allergens, weather, illness or emotional state
97
Q

Draw the anatomy of the lungs

A
98
Q

When can a child be diagnosed with asthma?

A
  • > 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
Q

If you need to provide assisted ventilations for a paed with asthma, how many do you do and how should you do it?

A
100
Q

Define hypoglycaemia

A
  • Refers to a lack of glucose in the blood
  • <4mmol/L
  • can result in impaired neurological function
101
Q

What are some signs and symptoms. of hypoglycaemia?

A
  • ACS
  • abnormal behavious
  • drowsiness
  • Pallow
  • diaphoresis
102
Q

What is meningococcal septicaemia?

A
  • 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
Q

How is meningococcal transmitted?

A

Droplets

104
Q

What types of burns require special consideration?

A
  • genitals
  • facial
  • circumferential
  • chest
  • joints
  • hands or feet

HCPAR6012 Exam Revision (11 decks)

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