Paediatrics Flashcards
Anatomical features of paediatrics
- 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)
Immune system:
- Less developed = more prone to infection
- Immature T cells, more susceptible to viral respiratory infections
Respiratory:
Large epiglottis
Large tonsils and adenoids
Large tongue
Small jaw
Higher larynx and more anterior than adult
Higher metabolic demand = higher respiratory rate.
Cardiovascular:
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
Gastrointestinal:
More prone to infection, obstruction, constipation, malabsorption.
Smaller stomach capacity but large in comparison to body
Musculoskeletal:
Bones are more soft and pliable = bond likely to bend than break.
Tissue healing better than adults
Metabolic:
Lack of amylase for 2-4 months
Temperature:
Susceptible to wide range of temperature
CNS not fully matured
Prone to febrile convulsions
Newborn and small infant values: (<3 months)
HR: 110-170bpm
BP: >60mmHg
RR: 25-60 breaths/minute
Large infant: (3-12 months)
HR: 105-165bpm
BP: >65mmHg
RR: 25-55
Small child: (1-4 years)
HR: 85-150bpm
BP: >70mmHg
RR: 20-40
Medium child: (5-11 years)
HR: 70-135bpm
BP: >80
RR: 16-34
Upper Respiratory Tract Infections (URTI’s)
Usually viral
Children experience these often (6-8 times a year)
URTI signs and symptoms:
- Runny nose
- Pharyngitis
- Fever
URTI treatment:
Paracetamol for discomfort
Ambulances are likely called for SOB
Tonsilitis:
Usually viral
Sometimes so severe that upper airway obstruction occurs
Recurrent tonsilitis may require removal.
Signs and symptoms: (tonsilitis)
Swelling of tonsils and pharynx
May have white exudate on tonsils
Treatment: (tonsilitis)
Paracetamol
Otitis Media:
Commonly caused by pneumonia or influenza
Especially common in Eustachian Tube dysfunction
Signs and symptoms: Otitis Media
Fever
Deafness and pain in one ear
Irritable child
Bulging red tympanic membrane
Treatment: otitis media
Most will resolve spontaneously
Symptomatic treatment
Antibiotics if bacterial
Croup:
Acute Laryngotracheobronchitis
Common in children from 6 months to 6 years
85% viral
Causes narrowing of the pharnyx
Risk factors: croup
Late autumn and winter
Males>females
Recurrent episodes
Signs and symptoms: croup
Usually preceded by a URTI Seal like barking cough Stridor Pale/lethargic Slower onset than epiglottitis
Treatment: croup
Oral steroid therapy (dexamethasone 600mcg/kg)
Nebulized adrenaline 5mg in 5ml
Paracetamol for pain
Epiglottitis:
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)
Signs & symptoms: epiglottitis
High fever (unwell looking) Sore throat Inspiratory stridor Drooling and dysphagia Severe respiratory distress NO cough Septic and flushed
Treatment: epiglottitis
Avoid examination of airway as this may cause laryngospasm and respiratory arrest
Limit anxiety
Expedient transport
In hospital may intubate/surgical airway/antibiotics
Respiratory Distress Syndrome (RDS)
Aka Hyaline Membrane Disease (HMD)
Leading cause of death in newborns - primarily preterm infants.
50-70& survival rate with treatment
