Paediatrics

Question 1

Anatomical features of paediatrics

Answer 1

• Head is larger and heavier in proportion to body
• Skin has greater surface area relative to body weight with thinner skin
• Weak ligaments and muscles (c1-c2 injuries occur more)
• Ribs more horizontal, less intercostal development (diaphragmatic breathers)
• Blunt trauma rarely causes fractures
• Abdomen more protuberant, more prone to distention with gas (cautious when ventilating)

Question 2

Immune system:

Answer 2

• Less developed = more prone to infection

- Immature T cells, more susceptible to viral respiratory infections

Question 3

Respiratory:

Answer 3

Large epiglottis
Large tonsils and adenoids
Large tongue
Small jaw
Higher larynx and more anterior than adult
Higher metabolic demand = higher respiratory rate.

Question 4

Cardiovascular:

Answer 4

Poor sympathetic innervation but good parasympathetic innervation (poor tachy response)

Left ventricle under-developed (Fixed stroke volume)

Different mechanisms of cardiac arrest into bradyarrhythmias and asystole

Cardiac output greater per body weight

Less blood volume

Question 5

Gastrointestinal:

Answer 5

More prone to infection, obstruction, constipation, malabsorption.

Smaller stomach capacity but large in comparison to body

Question 6

Musculoskeletal:

Answer 6

Bones are more soft and pliable = bond likely to bend than break.

Tissue healing better than adults

Question 7

Metabolic:

Answer 7

Lack of amylase for 2-4 months

Question 8

Temperature:

Answer 8

Susceptible to wide range of temperature
CNS not fully matured
Prone to febrile convulsions

Question 9

Newborn and small infant values: (<3 months)

Answer 9

HR: 110-170bpm
BP: >60mmHg
RR: 25-60 breaths/minute

Question 10

Large infant: (3-12 months)

Answer 10

HR: 105-165bpm
BP: >65mmHg
RR: 25-55

Question 11

Small child: (1-4 years)

Answer 11

HR: 85-150bpm
BP: >70mmHg
RR: 20-40

Question 12

Medium child: (5-11 years)

Answer 12

HR: 70-135bpm
BP: >80
RR: 16-34

Question 13

Upper Respiratory Tract Infections (URTI’s)

Answer 13

Usually viral

Children experience these often (6-8 times a year)

Question 14

URTI signs and symptoms:

Answer 14

• Runny nose
• Pharyngitis
• Fever

Question 15

URTI treatment:

Answer 15

Paracetamol for discomfort

Ambulances are likely called for SOB

Question 16

Tonsilitis:

Answer 16

Usually viral
Sometimes so severe that upper airway obstruction occurs
Recurrent tonsilitis may require removal.

Question 17

Signs and symptoms: (tonsilitis)

Answer 17

Swelling of tonsils and pharynx

May have white exudate on tonsils

Question 18

Treatment: (tonsilitis)

Answer 18

Paracetamol

Question 19

Otitis Media:

Answer 19

Commonly caused by pneumonia or influenza

Especially common in Eustachian Tube dysfunction

Question 20

Signs and symptoms: Otitis Media

Answer 20

Fever
Deafness and pain in one ear
Irritable child
Bulging red tympanic membrane

Question 21

Treatment: otitis media

Answer 21

Most will resolve spontaneously
Symptomatic treatment
Antibiotics if bacterial

Question 22

Croup:

Answer 22

Acute Laryngotracheobronchitis

Common in children from 6 months to 6 years

85% viral

Causes narrowing of the pharnyx

Question 23

Risk factors: croup

Answer 23

Late autumn and winter
Males>females
Recurrent episodes

Question 24

Signs and symptoms: croup

Answer 24

Usually preceded by a URTI
Seal like barking cough
Stridor
Pale/lethargic
Slower onset than epiglottitis

Question 25

Treatment: croup

Answer 25

Oral steroid therapy (dexamethasone 600mcg/kg)

Nebulized adrenaline 5mg in 5ml

Paracetamol for pain

Question 26

Epiglottitis:

Answer 26

Severe, life threatening and progressive infection of the epiglottis and surrounding areas.

Children 2-7

Usually caused by haemophilus type B (which we have vaccines for)

Question 27

Signs & symptoms: epiglottitis

Answer 27

High fever (unwell looking)
Sore throat
Inspiratory stridor
Drooling and dysphagia
Severe respiratory distress
NO cough
Septic and flushed

Question 28

Treatment: epiglottitis

Answer 28

Avoid examination of airway as this may cause laryngospasm and respiratory arrest

Limit anxiety

Expedient transport

In hospital may intubate/surgical airway/antibiotics

Question 29

Respiratory Distress Syndrome (RDS)

Aka Hyaline Membrane Disease (HMD)

Answer 29

Leading cause of death in newborns - primarily preterm infants.

50-70& survival rate with treatment