Paeds Flashcards
What’s is the PAT
Paed assemenr triangle
Includes
Appearance
Work of breathing
Circulation
What to look for in appearance
TICLS T- tone I- Interactiveness C- consolability L- look / gaze S - speech / cry
What to look for in work of breathing
Abnormal sounds Snoring/ hoarse/ stridor Grunting Wheezing Recession Sniffing position Tripod Nasal flaring Head bobbing
What to look for in circulation
Pallor
Mottling
Cyanosis
Anaphylaxis
= severe allergic reaction
Give adrenaline
Salbutamol
Chlorphenamine
Hydrocortisone
What age can be diagnosed with asthma
Age 5-6
Mild moderate asthma clinical features
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
Severe asthma clinical features
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
Severe asthma management
Salbutamol
Ipratropium bromide
Hydrocortisone
Life threatening asthma clinical features
Silent chest SpO2 less than 92 Cyanosis PEFR less than 33 Poor resp effort Hypotension Exhaustion Confusion
Life threatening asthma management
Continuous salbutamol
Administer 1 in 1000 adrenaline
Assess for tension pneumothorax
How big is child’s airway
6 months - 3mm
4 years - 4.5mm
10 years - 6mm
What to do in choking
If can cough encourage to cough
If can’t cough - 5 back slaps
5 abdo thrusts
Continue till Able to cough or out
What to do in choking if loss of consciousness
Open airway
Laryngoscope
If see remove with mag ills or suction
Nothing visible 5 rescue breaths
15: 2 cpr
What is croup
Infection of the upper airway
Most common 6 months to 6 years
Seal like barking cough
Treatment for croup
Dexamethasone
What to do in febrile convulsion
Temperature
Cool then down
Diazepam
Paed pharmacology
Children have different response to drugs General rule - age based dosing regimen - weight based rules - body surface calculation
Adme - how is absorption affects in paeds
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
Adme - how distribution affects paeds
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
Adme - how metabolism affects paeds
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
Adme - how elimination affect paeds
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
What SpO2 is likely to cause an arrest in children
Less than 90%
Fluid for kids in trauma
5ml/kg can be repeated till child improves
Consideration of airway in paeds
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
Consideration of breathing with paeds
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
Consideration of circulation with paeds
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
Consideration for disability paeds
Different gcs for verbal
Skin layers
Epidermis - first line of defence
Dermis - tough, elastic, connective tissue
Subcutaneous - fatty layer
Muscles/tendons/burns
Classifications of burns
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)
Approach to burns
A - consider airway burns
B - apply oxygen as may not have reliable SpO2. Consider salbutamol if there is a wheeze
Treatment for burn
Cooling/irrigation for 20 minutes maximum, up to 3 hours after, do not irrigate chemical burns
Loose clingfilm, not in chemical burns
Trauma centres for children
Coventry will accept even though just adult
Nottingham
Birmingham =children only
5 key message for paed als
Use ABCDE approach 15L then do 94/98% In shock give fluids, blood products 15:2 bsl Search for and treat reversible causes
Airway obstruction paed
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
How many newborns have difficulty breathing when born
10% of newborns
Resus council points for neonatal
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
Important recommendation for neonatal CPR
If after 30 seconds hr slows commence cpr 3 compressions to 1 ventilation Intubate early Secure access Sats probe right hand
Neonatal cpr
5 inflation breaths
More pressure
Then 60 secs do cpr 30:1
What does the APGAR score look at
Appearance Pulse Grimace Activity Respiration
