Paediatrics Flashcards
Why do children lose more heat than adults?
Increased surface area to volume ratio
Why are children more prone to getting head injuries?
Large head to body ratio
What is always important to remember about children when they are experiencing illness?
They can compensate much better than adults, but will reach a point where they drop off a cliff and deteriorate rapidly, leading to often fatal outcomes
How would you calculate weight in a child that is aged 0-1?
(Age (months)/2) + 4
How would you calculate the weight of a child aged 1-5?
(Age (years) x 2) + 8
How would you calculate the weight of a 6-12 year old?
Age (years) x3 ) + 7
What is important to remember when managing a childs airway who is < 1 years old?
Using the “sniffing the air” position is all that is normally required - Triple airway manouvres are often innapropriate and can cause further obstruction
What is important to do when managing the airway of a child who is < 8 years but > 1 year old?
Slight extension is used, but care taken not to hyper extend
Why should any obstruction of the nasal passages be alleviated if possible?
Children are obligate nose breathers - blockage can have significant impact on airway and increases respiratory effort
When inserting a guedel in a child, how does the technqiue differ from inserting it into an adult airway?
Curve is inserted downwards instead of upwards towards hard palate. It is also preferable to depress the tongue due to its relatively large size
What are characteristic signs of increased breathing effort in a child?
- Supraclavicular, substernal and intercostal recession
- Nasal flaring
- Seesaw breathing
- Grunting
- Tracheal tug
- Use of accessory muscles
When would you consider giving oxygen therapy to a child?
Repiratory or airway difficulties
How would you deliver oxygen to a child?
Facemask + Reassurance
If a child was showing signs of respiratory exhaustion, what intervention could you adopt?
Bag valve mask - 8-10 breaths per minute given at a volume to fill the chest - avoid gastric inflation
When do signs of shock tend to present in a child with cirulatory issues?
LAte sign - can compensate for approximately 25-30% blood loss
As hypotension is a very late sign of shock in a child, what other factors would you look for as signs of shock (and therefore become more important when examining for signs fo shock)?
- Pulse rate
- Pallor
- Central CRT
- Cool extremities
- Decreased pulse volume
- Dehydration status
What would indicate dehydration in a child?
- Decreased urine output
- Absent tears
- Dry mucous membranes
- Generally ill appearance
What is the lowest acceptable blood pressure for a neonate?
0-28 days
What is the lowest acceptable blood pressurefor an infant (1 month - 1 year)?
70 mmHg
What is the lowest acceptable blood pressure for children (1-10 years)?
70 mmHg + (2x age in years)
What is the lowest acceptable BP in a child over the age of 10?
90 mmHg
How would you manage a child in shock?
- Two wide bore IV cannulas - if fails use IO access
- Fluid therapy
What volume of fluid would you give a child in a trauma situation?
10 ml/kg 0.9% saline
What volume of fluid bolus would you give a child in shock due to a medical emergency?
20 ml/kg
What can a floppy child indicate?
Exhaustion or severe illness
What can a stiff neck and arched back indicate in a child?
Meningisim - arched back is opisthotonus
What does legs and arms held rigidly in extension indicate in child?
What does a child in a posture where the arms are bent into the body with wrists flexed and fingers held on the chest indicate?
Decorticate posturing - severe brain injury
What would the following posturing indicate?
Decerebrate posturing - severe brain injury
What would the following posturing indicate?
Decorticate posturing - severe brain injury
What should you consider starting in a child with decreased consciousness?
High flow O2 therapy
What non-medical measures could you use to manage pain in a child?
- Reassurance
- Splinting
What are option for pain relief in children?
- Paracetamol
- Ibuprofen
- IV morphine
What loading dose of paracetamol would you give a child in pain?
20 mg/kg
What loading dose of ibuprofen would you give a child in pain?
10 mg/kg
What dose of IV morphine would you give a child in pain?
0.1 mg/kg
What approach should you take when administering anaglesia to children in a pre-hospital setting?
Start low and go slow
