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Clinical Care Year 3 > Paeds > Flashcards

Paeds Flashcards

1
Q

What’s is the PAT

A

Paed assemenr triangle

Includes
Appearance
Work of breathing
Circulation

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2
Q

What to look for in appearance

A 
TICLS 
T- tone 
I- Interactiveness 
C- consolability
L- look / gaze 
S - speech / cry
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3
Q

What to look for in work of breathing

A 
Abnormal sounds 
Snoring/ hoarse/ stridor 
Grunting 
Wheezing 
Recession 
Sniffing position 
Tripod 
Nasal flaring 
Head bobbing
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4
Q

What to look for in circulation

A

Pallor
Mottling
Cyanosis

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5
Q

Anaphylaxis

A

= severe allergic reaction

Give adrenaline
Salbutamol
Chlorphenamine
Hydrocortisone

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6
Q

What age can be diagnosed with asthma

A

Age 5-6

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7
Q

Mild moderate asthma clinical features

A 
Able to talk in full sentences 
SpO2 above 92 
PERF more than 50% of best 
Pulse less than 140 age 2-5 
Pulse than 125 age 5 and above

Encourage own inhaler use

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8
Q

Severe asthma clinical features

A

Can’t complete sentences in one breath
SpO2 less than 92
PEFR 33%-50%

2-5
Pulse more than 140
Resp over 40

Over 5
Pulse more than 125
Resp over 30

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9
Q

Severe asthma management

A

Salbutamol
Ipratropium bromide
Hydrocortisone

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10
Q

Life threatening asthma clinical features

A 
Silent chest 
SpO2 less than 92 
Cyanosis 
PEFR less than 33 
Poor resp effort 
Hypotension 
Exhaustion 
Confusion
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11
Q

Life threatening asthma management

A

Continuous salbutamol
Administer 1 in 1000 adrenaline
Assess for tension pneumothorax

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12
Q

How big is child’s airway

A

6 months - 3mm
4 years - 4.5mm
10 years - 6mm

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13
Q

What to do in choking

A

If can cough encourage to cough

If can’t cough - 5 back slaps
5 abdo thrusts
Continue till Able to cough or out

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14
Q

What to do in choking if loss of consciousness

A

Open airway
Laryngoscope
If see remove with mag ills or suction

Nothing visible 5 rescue breaths

15: 2 cpr

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15
Q

What is croup

A

Infection of the upper airway

Most common 6 months to 6 years

Seal like barking cough

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16
Q

Treatment for croup

A

Dexamethasone

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17
Q

What to do in febrile convulsion

A

Temperature
Cool then down
Diazepam

18
Q

Paed pharmacology

A 
Children have different response to drugs 
General rule 
- age based dosing regimen
- weight based rules 
- body surface calculation
19
Q

Adme - how is absorption affects in paeds

A

Intestinal transit time - shorter in younger children affect absorption for poorly soluble drugs

New born gastric ph is neutral, cause greater peak in acid liable drugs e.g. penicillin

Bile secretion - in first 2-3 weeks of life is poor. Decreased drug solubility. Risk in drugs e.g hydrocortisone

Intestinal permeability- higher in Pre term babies becomes more permeable with age

Passive and active transport - full mature by 4 months

20
Q

Adme - how distribution affects paeds

A

Body composition - affects distribution for instance amount of fat

Extracellular water - decreased through development, higher doses of water soluble drugs must be given to obtain the same effect

Protein binding - less in younger children, means drugs can’t bind so free fractions of these drugs are circulating, meaning can penetrate various tissues compartments yielding higher distribution

21
Q

Adme - how metabolism affects paeds

A

Enzymes - less enzyme activity, CYP3A very responsible various studies say increase or decreases with age

Liver has higher blood flow in children, hepatic clearance of drugs quicker, can increase first pass effect

Metabolites may be produced in children than are not in adults

Bacterial colonisation - intestines changed with age.

Gut lumen and wall can decrease bioavailability and the pharmacological effect of some drugs

22
Q

Adme - how elimination affect paeds

A

Predominantly via the kidney

Glomerular filtration rate reached the same as adults at 12 months

Renal excretion - similar or greater with certain drugs, related to kidneys. Children may require extra dose per kg

Urinary ph values can influence the reabsorption of weak acid or bases. So influence drug elimination

23
Q

What SpO2 is likely to cause an arrest in children

A

Less than 90%

24
Q

Fluid for kids in trauma

A

5ml/kg can be repeated till child improves

25
Q

Consideration of airway in paeds

A

Larger occiput may need something under shoulders
Larger tongue more likely to occlude
Any airway needs to be appropriately sized could cause laryngospasm
If occurs gently bvm

26
Q

Consideration of breathing with paeds

A

Assess ventilation - head bobbing, gasping, flares nostrils, chest recession
Ensure right size mask and be gentle around the jaw
Children are more prone to tension pneumothorax, use saline syringe as it will show bubbles

27
Q

Consideration of circulation with paeds

A

A child with haemorrhage can maintain adequate circulatory volume by increasing their peripheral vascular resistance
Peripheral shutdown - mottled, cool extremities, peripheral pallor
Lower threshold for IO

28
Q

Consideration for disability paeds

A

Different gcs for verbal

29
Q

Skin layers

A

Epidermis - first line of defence
Dermis - tough, elastic, connective tissue
Subcutaneous - fatty layer
Muscles/tendons/burns

30
Q

Classifications of burns

A

Superficial - epidermis involvement, blisters may happen after 24 hours, take 3-5 days to heal
Superficial partial thickness - blisters, very painful, few weeks to heal
Deep partial thickness - white and waxy
Full thickness - dry and leathery (may need to cut through burnt skin to relieve pressure)

31
Q

Approach to burns

A

A - consider airway burns

B - apply oxygen as may not have reliable SpO2. Consider salbutamol if there is a wheeze

32
Q

Treatment for burn

A

Cooling/irrigation for 20 minutes maximum, up to 3 hours after, do not irrigate chemical burns

Loose clingfilm, not in chemical burns

33
Q

Trauma centres for children

A

Coventry will accept even though just adult
Nottingham
Birmingham =children only

34
Q

5 key message for paed als

A 
Use ABCDE approach 
15L then do 94/98%
In shock give fluids, blood products 
15:2 bsl 
Search for and treat reversible causes
35
Q

Airway obstruction paed

A

If effective coughing - encourage to cough
If ineffective coughing -
Infant - 5 back blows/ 5 chest thrusts
Child - 5 back blows/ 5 abdo thrusts
Unconscious- open airway remove object do 5 rescue breaths

36
Q

How many newborns have difficulty breathing when born

A

10% of newborns

37
Q

Resus council points for neonatal

A

Leave at least 60 seconds before cord clamping if not possible consider cord milking
Do not suction/ use laryngoscopy
If no response to initial inflation consider extra pressure

38
Q

Important recommendation for neonatal CPR

A 
If after 30 seconds hr slows commence cpr 
3 compressions to 1 ventilation 
Intubate early 
Secure access 
Sats probe right hand
39
Q

Neonatal cpr

A

5 inflation breaths
More pressure
Then 60 secs do cpr 30:1

40
Q

What does the APGAR score look at

A 
Appearance 
Pulse 
Grimace 
Activity 
Respiration

Clinical Care Year 3 (18 decks)

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