Anatomical respiratory differences in paediatrics
- The trachea is shorter and softer with over extension of the head causing ‘crimping’ or narrowing of this structure if done in excess.
- The Epiglottis is more prominent and could influence endotracheal intubation.
- Infants are nose breathers for the first several months of life. Obstruction of the nose from secretion, blood, or oedema may cause respiratory distress.
- Airway resistance is greater in Paediatrics. A similar degree of airway swelling in a neonate to an adult would result in partial occlusion if not increased airway resistance.
- Neonates are “Belly breathers”. Using the abdominal muscles to support the diaphragm in breathing.
Cardiac anatomical differences in paediatrics
- greater metabolic rate that requires greater oxygen consumption
- increased natural respiratory rate.
- At birth the cardiac ventricles are similar in weight.
- The child’s circulating blood volume is greater than that of an adult (70-80ml/kg), but the actual blood volume is smaller.
- In a neonate, the volume blood pumped with each contraction is uniform with very little impact during a fluid bolus in comparison to an older child or adult.
What does PDA, ASD or VSD stand for
- Patent Ductus Arteriosus
- Atrial septal defect
- Ventricular Septal Defect
Explain the Pathology of PDA
- The PDA should close down after birth and turn into a ligament
- If the Duct stays open after birth this is when its called a PDA
- Causes oxygenated and deoxygenated blood to cross over
- Can cause lower body hypoxia as they get older
- Differences in pressure cause deoxygenated blood to not make the right route
Explain what ASD is
- Atrial septum separates the right and left atrium
- ASD opening in the septum due to not closing after birth
- Causes oxygenated and deoxygenated blood to cross over
Explain what VSD is
- Ventricular septum separates the right and left ventricle
- VSD is a opening in the ventricular septum
How do you calculate the weight of a child
- Weight = (Age+4) x2
Proportion of head % of BSA and what could this effect
- At birth the neonates head accounts for 19% of BSA falling to 9% by 15yrs of age.
- impact on the neonates ability to maintain thermoregulation and could make them prone to hypo and hyperthermia.
Respiration rate for Neonates to 18 years old
Neonate - 1 = 30-40
1-2 = 25-35
2-5 = 25-30
5-12 = 20-25
12-18 = 15-20
Heart rate in Neonates to 18 years old
Neonate - 1 = 110-160
1-2 = 100 - 150
2-5 = 95 - 140
5-12 = 80 - 120
12-18 = 60 - 100
What is the PAT
- Paediatric Assessment Triangle
- It is a initial assessment tool for us to use on first seeing the child
- Its non invasive and non threatening so can be done without even touching the patient, this is good as it will not put a already stressed child under more stress
What are the three parts of the PAT
- Appearance
- Work of Breathing
- Circulation
Explain what we are looking for in Appearance as part of the PAT
Appearance
- T - Tone
- I - Interactiveness, does the child look around at relevant things, do they take notice of you as you enter the room
- C - Consolability, is the family member able to console the crying child
- L - Look/Gaze, Does the child seem vacant
- S - Speech/Cry, Is the child using appropriate words for the childs age.
Explain what we are looking for in Work Of Breathing as part of the PAT
Work of Breathing
- Rate, is it too fast or slow for the age
- Position - Tripodding, using the muscles of the back to open up the chest cavity to get more air in
- Retractivness
- Anxiety
Explain what we are looking for in Circulation as part of the PAT
Circulation
- Skin colour
Pale
Ashen
Cyanosed
When intubating a child what are the factors to look out for
- Shortened trachea
- Enlarged epiglottis
- Attach Capnography
- Secure tube
- Constantly monitor
Why are neonates prone to hypothermia
- Neonate temp can decrease at a rate of 0.1 - 0.3c per minute after birth
- Due to being a wet new born with a large surface area
- Loses heat by evaporation, convection, conduction and radiation
Signs of hypothermia in neonate
- Bradycardia
- Cold to touch
- Lethargic
- Poor feeder
- ## Tachypnoeic
