Paediatrics: Emergency Med Flashcards
What is overall approach to seriously unwell child? (3)
- Primary ABCDE assessment and resuscitation
- Secondary assessment + emergency treatment
- Stabilise and transfer
What is aim of ABCDE assessment? how long?
to identify life threatening problems to guide resuscitation
- should take less than a min
ABCDE: A?
airway assessent
- look, listen + feel for airway latency (head tilt)
ABCDE: B what 3 things do you assess for?
Breathing assessment
- effort (how much work going into breathing)
- Efficacy (what are they achieving in terms of air movement + gas exchange)
- Effect (of resp inadequacy of rest of body)
Signs of resp distress
- Increased RR
- sob
- grunting
- flaring nostrils
- tracheal tug
- use of accessory muscles
- gasping (late sign of sever hypoxia)
When might child not show signs of increased resp effort?
- when severe resp problem for some time (=> fatigued)
- neuromuscular disease
- central resp depression
what could cause central resp depression (3)
- raised ICP
- hypoventilation
- opiates
How does hypoxia affect HR?
tachycardia (when prolonged => Brady)
ABCDE: what do you look for in C? (4)
circulation assessment
- HR, pulse vol, cap refill, BP
name some effects of circulatory inadequacy
affects other organs
- increased RR (driven by metabolic acidosis (lactic acid))
- decreased urine output
- mottled skin with pale/cool peripheries
ABCDE: what do you do for D?
Disability )neurological) assessment
- AVPU or GCS
What does AVPU start for?
- Alert
- Voice (responds to)
- Pain (responds to)
- Unresponsive
what GCS score would a patient have if they only responded to pain on AVPU scale?
GCS 8
ABCDE: what is E? what do you look out for?
Exposure
- swift head tot toe examination to look for clues of underlying pathology
- Fever, rash, bruising
Resp rate trend in kids? when does it reach adult level? what?
RR decreases with age
- by 12 it is like adult (12-20)
Resp: child found to have bubbling sound. what is diagnosis? emergency treatment?
excessive secretions
- suctioning
Resp: child found to have harsh stridor and a barking cough. what is diagnosis? emergency treatment?
Croup
- oral dexamethosone (and adrenaline in severe cases)
Resp: child found to have soft stridor, drooling and a fever in a sick looking child. what is diagnosis? emergency treatment?
Bacterial tracheitis or epiglottitis
- intubation by anaesthetist followed by IV Abx
Resp: child found to have sudden onset stridor with Hx of inhalation. what is diagnosis? emergency treatment?
inhaled foreign body
- Laryngoscopy for removal
Resp: child found to have stridor following ingestions or injection of a known allergen. what is diagnosis? emergency treatment?
anaphylaxis
- IM adrenaline
Resp: child found to have wheeze. what is diagnosis? emergency treatment?
Acute asthma
- Bronchodilators
Resp: child found to have bronchial breathing. what is diagnosis? emergency treatment?
pneumonia
- IV Abx
what is (paediatric) shock?
life threatening condition caused by systemic failure of circulatory system => inadequate perfusion => ischaemia => multi-organ failure
(failure of circulatory system to adequately perfuse major organs)
Do kids show medical signs earlier or later than adults. why?
show fewer signs (die to high physiological reserves)