Paediatrics

Question 1

Why do children lose more heat than adults?

Answer 1

Increased surface area to volume ratio

Question 2

Why are children more prone to getting head injuries?

Answer 2

Large head to body ratio

Question 3

What is always important to remember about children when they are experiencing illness?

Answer 3

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

Question 4

How would you calculate weight in a child that is aged 0-1?

Answer 4

(Age (months)/2) + 4

Question 5

How would you calculate the weight of a child aged 1-5?

Answer 5

(Age (years) x 2) + 8

Question 6

How would you calculate the weight of a 6-12 year old?

Answer 6

Age (years) x3 ) + 7

Question 7

What is important to remember when managing a childs airway who is < 1 years old?

Answer 7

Using the “sniffing the air” position is all that is normally required - Triple airway manouvres are often innapropriate and can cause further obstruction

Question 8

What is important to do when managing the airway of a child who is < 8 years but > 1 year old?

Answer 8

Slight extension is used, but care taken not to hyper extend

Question 9

Why should any obstruction of the nasal passages be alleviated if possible?

Answer 9

Children are obligate nose breathers - blockage can have significant impact on airway and increases respiratory effort

Question 10

When inserting a guedel in a child, how does the technqiue differ from inserting it into an adult airway?

Answer 10

Curve is inserted downwards instead of upwards towards hard palate. It is also preferable to depress the tongue due to its relatively large size

Question 11

What are characteristic signs of increased breathing effort in a child?

Answer 11

• Supraclavicular, substernal and intercostal recession
• Nasal flaring
• Seesaw breathing
• Grunting
• Tracheal tug
• Use of accessory muscles

Question 12

When would you consider giving oxygen therapy to a child?

Answer 12

Repiratory or airway difficulties

Question 13

How would you deliver oxygen to a child?

Answer 13

Facemask + Reassurance

Question 14

If a child was showing signs of respiratory exhaustion, what intervention could you adopt?

Answer 14

Bag valve mask - 8-10 breaths per minute given at a volume to fill the chest - avoid gastric inflation

Question 15

When do signs of shock tend to present in a child with cirulatory issues?

Answer 15

LAte sign - can compensate for approximately 25-30% blood loss

Question 16

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)?

Answer 16

• Pulse rate
• Pallor
• Central CRT
• Cool extremities
• Decreased pulse volume
• Dehydration status

Question 17

What would indicate dehydration in a child?

Answer 17

• Decreased urine output
• Absent tears
• Dry mucous membranes
• Generally ill appearance

Question 18

What is the lowest acceptable blood pressure for a neonate?

Answer 18

0-28 days

Question 19

What is the lowest acceptable blood pressurefor an infant (1 month - 1 year)?

Answer 19

70 mmHg

Question 20

What is the lowest acceptable blood pressure for children (1-10 years)?

Answer 20

70 mmHg + (2x age in years)

Question 21

What is the lowest acceptable BP in a child over the age of 10?

Answer 21

90 mmHg

Question 22

How would you manage a child in shock?

Answer 22

• Two wide bore IV cannulas - if fails use IO access
• Fluid therapy

Question 23

What volume of fluid would you give a child in a trauma situation?

Answer 23

10 ml/kg 0.9% saline

Question 24

What volume of fluid bolus would you give a child in shock due to a medical emergency?

Answer 24

20 ml/kg

Question 25

What can a floppy child indicate?

Answer 25

Exhaustion or severe illness

Question 26

What can a stiff neck and arched back indicate in a child?

Answer 26

Meningisim - arched back is opisthotonus

Question 27

What does legs and arms held rigidly in extension indicate in child?

Question 28

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?

Answer 28

Decorticate posturing - severe brain injury

Question 29

What would the following posturing indicate?

Answer 29

Decerebrate posturing - severe brain injury

Question 30

What would the following posturing indicate?

Answer 30

Decorticate posturing - severe brain injury

Question 31

What should you consider starting in a child with decreased consciousness?

Answer 31

High flow O2 therapy

Question 32

What non-medical measures could you use to manage pain in a child?

Answer 32

• Reassurance
• Splinting

Question 33

What are option for pain relief in children?

Answer 33

• Paracetamol
• Ibuprofen
• IV morphine

Question 34

What loading dose of paracetamol would you give a child in pain?

Answer 34

20 mg/kg

Question 35

What loading dose of ibuprofen would you give a child in pain?

Answer 35

10 mg/kg

Question 36

What dose of IV morphine would you give a child in pain?

Answer 36

0.1 mg/kg

Question 37

What approach should you take when administering anaglesia to children in a pre-hospital setting?

Answer 37

Start low and go slow