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GAP 2018 > Paediatrics CPGs > Flashcards

Paediatrics CPGs Flashcards

1
Q

Paediatric Assessment Triangle

A

Appearance - Tone, Interactiveness, Consolability, Look/gaze, Speech/cry
Work of breathing - abnormal posturing, abnormal breath sounds, retraction, nasal flaring
Circulation - pallor, mottling, cyanosis

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2
Q

Anatomical differences to adults - head

A
  • larger in proportion to body
  • greater heat loss, heavier, larger occiput
  • falls headfirst
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3
Q

Anatomical differences to adults - airway

A
  • 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
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4
Q

Anatomical differences to adults - ribs/chest

A
  • ribs more horizontal and more compliant
  • diaphragmatic breathers
  • full stomach impairs breathing
  • blunt trauma without # therefore # ribs indicate severe injury
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5
Q

Anatomical differences to adults - abdo

A
  • protruberant
  • organs relatively larger, not protected by fat
  • prone to infections, obstructions, constipation, malapsorption
  • smaller stomach capacity
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6
Q

Anatomical differences to adults - musculoskeletal

A
  • softer bones, more likely to bend

- fractures involve growth plate

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7
Q

Anatomical differences to adults - cardiovascular

A
  • 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
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8
Q

Anatomical differences to adults - respiratory

A

-higher RR
-greater metabolic rate and higher o2 consumption
-TV 5ml/kg
little fatigue resistant muscle fibers therefore tire easily

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9
Q

Causes of cardiopulmonary arrest in paeds

A

hypoxaemia or hT or both

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10
Q

Causes of cardiac pulmonary arrests in paeds

A
  • trauma
  • SIDs
  • drowning
  • asthma
  • septicaemia
  • UAO
  • congenital abnormalities
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11
Q

Paed resus is directed at

A
  • adequate airway control
  • ventilations
  • compressions
  • adrenaline
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12
Q

Airway positioning of infants

A

head and neck neutral position

padding beneath shoulders to prevent neck flexion and head extension

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13
Q

Airway positioning of children

A

use neck flexion and extension with caution

as child gets older, less need for padding

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14
Q

Starting CPR for infants and children

A

Infants (less than 1 yr) HR less than 60

Children (1-4yrs) HR less than 40

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15
Q

Croup definition

A

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

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16
Q

Patho of croup

A

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

17
Q

Signs and sypmpoms of croup

A

mild/mod:
-Barking cough, Urti, Retraction and resp distress, Stridor, Temp/tachycardia
Severe:
-Cyanosis, Lethargy, Altered conscious and agitation, Marked accessory use, Stridor reduces

18
Q

Causes of croup

A
  1. viral
  2. spasmodic: sudden nocturnal onset, part asthma
  3. bacterial tracheitis: susp, with febrile croup with purulent secretions
19
Q

Epiglottits definition

A

severe bacterial airway infection of supra-glottic portion of larynx and epiglottis

20
Q

Signs and symptoms of epiglottits

A 
Septic fever
No cough
Rapid onset
Exp snore/low insp stridor 
Drool - mouth open tongue out
21
Q

Upper airway obstruction symptoms

A

coughing, distressed, difficulty breathing, stridor, red or cyanosed, increased RR

22
Q

Management of mild pain in paeds

A

Paracetamol 15mg/kg oral if no admin in 4 hours

23
Q

Management of moderate pain in paeds

A

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)

24
Q

Management of severe pain in paeds

A

Fentanyl IN or Methoxy
IM Morphine as last resort if pain not controlled by above
0.1mg/kg IM (single dose)

25
Q

Upper airway obstruction management

A

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

26
Q

Croup management

A

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

27
Q

Management of mild or mod asthma in paeds

A

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

28
Q

Management of severe asthma in paeds

A 
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
29
Q

Management of critical asthma in paeds

A

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)

30
Q

Management of paed asthma unconscious

A

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

31
Q

Management of paed asthma loses CO

A

Apnoea 30s

  • exclude TPT
  • gentle lateral chest pressure
  • prepare for resus
32
Q

Nausea and vomiting management paeds

A

Ondansetron ODT
small 2mg
medium 4mg

33
Q

Hypoglycaemia management for paeds

A

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)

34
Q

Seizures management of paeds

A

-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

35
Q

Anaphylaxis management for paeds

A
  • 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
36
Q

Meningococcal Manegement for paeds

A

Ceftriaxone 50mg/kg IM (max 1000mg)

  • dilute 1000mg with 3.5ml Lignocaine 1%
  • admin into upper lateral thigh
37
Q

Opioid overdose for paeds

A
  • assist and maintain airway/ventilation
  • Naloxone 10mcg/kg (max 400mcg) IM
  • repeat after 10mins
38
Q

Chest injuries management for paeds

A
  • supp o2
  • pain relief
  • position pt upright if possible unless: inadequate perfusion, altered consciousness, associated barotrauma, potential spinal injury
39
Q

Burns management for paeds

A
  • 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

GAP 2018 (13 decks)

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