Paediatrics CPGs Flashcards
Paediatric Assessment Triangle
Appearance - Tone, Interactiveness, Consolability, Look/gaze, Speech/cry
Work of breathing - abnormal posturing, abnormal breath sounds, retraction, nasal flaring
Circulation - pallor, mottling, cyanosis
Anatomical differences to adults - head
- larger in proportion to body
- greater heat loss, heavier, larger occiput
- falls headfirst
Anatomical differences to adults - airway
- soft laryngeal cartilage
- nose breathers
- large head, short neck
- trachea diameter smaller and shorter
- cricoid narrow
- epiglotis large
- smaller oral cavity
- delicate mucosa
- large tongue
- small jaw
- loose teeth
Anatomical differences to adults - ribs/chest
- ribs more horizontal and more compliant
- diaphragmatic breathers
- full stomach impairs breathing
- blunt trauma without # therefore # ribs indicate severe injury
Anatomical differences to adults - abdo
- protruberant
- organs relatively larger, not protected by fat
- prone to infections, obstructions, constipation, malapsorption
- smaller stomach capacity
Anatomical differences to adults - musculoskeletal
- softer bones, more likely to bend
- fractures involve growth plate
Anatomical differences to adults - cardiovascular
- bradycardic arrest - hypoxia
- poor sympathetic innervation therefore poor tachycardic response to shock
- left ventricle underdeveloped therefore fixed SV , increased BP relies on increased HR and SVR
- higher HR
- hT indicates greater than 40% blood loss
Anatomical differences to adults - respiratory
-higher RR
-greater metabolic rate and higher o2 consumption
-TV 5ml/kg
little fatigue resistant muscle fibers therefore tire easily
Causes of cardiopulmonary arrest in paeds
hypoxaemia or hT or both
Causes of cardiac pulmonary arrests in paeds
- trauma
- SIDs
- drowning
- asthma
- septicaemia
- UAO
- congenital abnormalities
Paed resus is directed at
- adequate airway control
- ventilations
- compressions
- adrenaline
Airway positioning of infants
head and neck neutral position
padding beneath shoulders to prevent neck flexion and head extension
Airway positioning of children
use neck flexion and extension with caution
as child gets older, less need for padding
Starting CPR for infants and children
Infants (less than 1 yr) HR less than 60
Children (1-4yrs) HR less than 40
Croup definition
A viral infection of the larynx, trachea and bronchi which leads to airway obstruction that can cause stridor - inflammation and oedema of mucosa and submucosa causing narrowing of subglottic area - obstruction, resp distress, hypoxia
Patho of croup
URTI - migrates into and infects the glottis and subglottic regions - inflammatory oedema accumulation - narrowing of the airway causing partial airway obstruction - child devlops a hoarse barking cough caused by a decrease in mobility of the vocal cords due to the oedema
Signs and sypmpoms of croup
mild/mod:
-Barking cough, Urti, Retraction and resp distress, Stridor, Temp/tachycardia
Severe:
-Cyanosis, Lethargy, Altered conscious and agitation, Marked accessory use, Stridor reduces
Causes of croup
- viral
- spasmodic: sudden nocturnal onset, part asthma
- bacterial tracheitis: susp, with febrile croup with purulent secretions
Epiglottits definition
severe bacterial airway infection of supra-glottic portion of larynx and epiglottis
Signs and symptoms of epiglottits
Septic fever No cough Rapid onset Exp snore/low insp stridor Drool - mouth open tongue out
Upper airway obstruction symptoms
coughing, distressed, difficulty breathing, stridor, red or cyanosed, increased RR
Management of mild pain in paeds
Paracetamol 15mg/kg oral if no admin in 4 hours
Management of moderate pain in paeds
Fentanyl IN
-small child (10-17kg) 25mcg
-large child (18-39kg) 25-50mcg
repeat initial dose every 5-10mins titrated to pain and side effects (max 3 doses)
-consult for children under 10kg
OR
Methoxy 3ml, repeat if required (max 6ml)
Management of severe pain in paeds
Fentanyl IN or Methoxy
IM Morphine as last resort if pain not controlled by above
0.1mg/kg IM (single dose)
Upper airway obstruction management
Partial obstruction - encourage cough, utilise gravity, BLS
Partial obstruction - utilise gravity, back slaps alternating with chest thrusts - if becomes unconscious: chest compression, suction, magill’s, forced ventilation - if loss of CO mx as cardiac arrest
Susp. epiglottitis - BLS and tx
Croup management
Moderate: Dex 600mcg/kg oral (max 12mg) , tx
Severe: increasing resp distress, increasing lethargy, decreasing stridor - Adrenaline 5mg in 5ml neb, Dex 600mcg/kg oral (max 12mg)
-repeat adrenaline at 5 min intervals until improvement
Management of mild or mod asthma in paeds
Salbutamol pMDI
6 or older: 4-12 doses
2-6yrs: 2-6 doses
pt take 4 breaths per dose, repeat at 20 min intervals is required
Management of severe asthma in paeds
Salbutamol neb -small children (2-4): 2.5mg (1.25ml) -medium child (5-11): 2.5-5mg (1.25-2.5ml) -repeat every 20 mins if required Ipratropium Bromide 250mcg (1ml) neb
Management of critical asthma in paeds
Salbutamol all children (2-11): 10mg (5ml) neb, repeat every 5 mins if required
Ipratropium Bromide: 250mcg (1ml) neb
If unable to gain IV: Adrenaline 10mcg/kg IM repeat every 5-10 mins as required (max 30mcg/kg)
Dexamethasone 600mcg/kg oral (max 12mg)
Management of paed asthma unconscious
small child - 12-15 ventilations per min
medium child - 10-14 ventilations per min
use Vt sufficient to achieve visible chest rise and fall
moderately high resp pressures
allow for prolonged expiratory phase
gentle lateral chest pressure during expiration
Management of paed asthma loses CO
Apnoea 30s
- exclude TPT
- gentle lateral chest pressure
- prepare for resus
Nausea and vomiting management paeds
Ondansetron ODT
small 2mg
medium 4mg
Hypoglycaemia management for paeds
BGL less than 4: Glucose 15g oral
BGL less than 4 no response: under 25kg Glucagon 0.5 IU IM (0.5ml)
25kg or more Glucaon 1 IU IM (1ml)
Seizures management of paeds
-mx airway and ventilation as required
-if airway patent, admin high flow o2
-Midaz IM
Medium child (5-11yrs) 2.5-5mg IM
Small child (1-4yrs): 2.5mg
Small and Large child (under 12 months): 1mg
Newborn: 0.5mg
-continue to monitor airway, ventilation, conscious state, BP
-repeat after 10mins once only, consult for further
Anaphylaxis management for paeds
- Monitor cardiac rhythm
- Adrenaline 10mcg/kg IM - repeat at 5 mins until satisfactory results or side effects
- provide high flow o2
- mx respiratory distress as indicated
- where possible do not allow pt to stand or walk
Meningococcal Manegement for paeds
Ceftriaxone 50mg/kg IM (max 1000mg)
- dilute 1000mg with 3.5ml Lignocaine 1%
- admin into upper lateral thigh
Opioid overdose for paeds
- assist and maintain airway/ventilation
- Naloxone 10mcg/kg (max 400mcg) IM
- repeat after 10mins
Chest injuries management for paeds
- supp o2
- pain relief
- position pt upright if possible unless: inadequate perfusion, altered consciousness, associated barotrauma, potential spinal injury
Burns management for paeds
- cool the burn, warm the pt
- cool burn area
- protect remainder of pt from heat loss where possible
- provide analgesia
- cover cooled burn area with cling wrap
