Paeds Flashcards
1
Q
Baby BLS <1yr
A
- SSS (safe stimulate shout)
- Air way opening manoeuvres
- Look listen feel for breathing
- If not breathing 5 initial breaths. Mouth over nose and mouth
- Pulse check 5-10 secs (brachial/femoral)
- 15 Chest compression with correct finger/ hand technique. Two thumbs on lower 1/3 of sternum with hand round thorax or two fingers on lower 1/3 of sternum.
- 15:2 ratio
- Call emergency services
2
Q
Child/adolescent BLS >1yr
A
- SSS (safe stimulate shout)
- Air way opening manoeuvres
- Look listen feel for breathing
- If not breathing 5 initial breaths. Pinch nose and cover mouth only.
- Pulse check 5-10 secs (carotid/femoral)
- 15 Chest compression with correct finger/ hand technique. Heel of 1 hand over lower 1/3 of sternum (younger child). Both hand for older child. Compress at least 1/3 chest for both.
- 15:2 ratio
- Call emergency services
3
Q
Choking
A
- Coughing Y/N
- If yes - encourage to cough and check for deteriation
- If no - consciouss/unconsciouss
- If Consciouss - 5 back blows:5 chest thrusts (<1yr) 5 abdo thrusts (child)
- If unconsciouss - BLS
Chest thrust
- Two fingers on sternum pushing up and in
Abdo thrust
- One hand in fist above umbilicus and below xiphisternum
- One hand on top
- Thrust in and up
4
Q
General paeds Hx
A
- Introduction + consent
- Patient details
- Relationship of adult
- PC
- SOCRATES
- HPC
- DH
- Allergies
- Immunisations
- PMH
- ObHx
- Development Hx
- PSH
- FHx/SHx
- Family trees
- Housings, Education, Smoking, Pets
- HHEADS (if adolescent)
- ?Consanguinity
- ICE
- Feeding/Nutrition
- breast/formula
- nappies
- stools/wee’s
Summary
DD
Management
5
Q
Respiratory History exam DD management
A
Resp symptoms:
- Cough
- Describe the cough: moist/dry, barking, blood?
- Time of day? early morning, middle of night (disturbs sleep) = asthma
- SoB
- Dysopnoea
- Wheeze
- Chest pain
- Blue breath holding
- Intermitent (sp) symtpoms (between wheeze attacks)
- Coryzal sx
Systemic sx
- FTT (weight loss and growth stunting)?
- Syncope
- Blue breath holding
- fever
- lymphadenopathy
PMH: atopy
SH: exposure to cigarette smoke, recently abroad, foriegn body exposure
6
Q
Respiratory Exam
A
1. Introduction, confirm patient details & consent
2. Wash hands
3. End of bed examination & General Appearance
- Chest wall
- Scars
- Lines
- Shape (assymetry)
- noises/ask to cough (see attached picture)
- Signs of resp distress: intercostal/subcostal recession, trachael tug, nostral flaring, using accessory mm
- Cyanosis
- Energetic/apathetic/tired
- Comment on anything round bed (inhalers, sats monitors)
4. Inspect peripheries
Hands:
- Clubbing: CF, chronic lung disease, IBD
- Peripheral cyanosis
- Older children: CAP refill
RR
Eyes:
- pallor of conjunctiva: anaemia
Mouth:
- central cyanosis
- dry mucosal surfaces
5. Palpation
Trachea position
- deviation = tension pneumothorax
Lymph nodes
- signs of infection
- metasteses
Central CAP refill
- press on sternum for 5 seconds
Chest expansion
- poor: asthma
- asymetrical: pneumothorax?
Hepatomegaly
Oedema
- pretibial
Apex beat
- check medisatinal shift
- tension pneumothorax
6. Auscultate (first as percussion is unsettling for child)
16 areas - front(6), back(6), axilla (4)
Noises (see image + see below)
- harsh breathing sounds - upper airway problem (foreign body, allergic rxn, viral/bacterial URTI)
- crackles
- fine: bronchiolitis
- indicates small airway collapse due to loose secretions
- coarse: pneumonia
- excess fluid in lungs
- fine: bronchiolitis
- Dullness: consolidation
7. Further investigations/exams:
- ENT
- Peak flow
- Sats
- BP
- CVS
- Abdo
7
Q
pGALS
A
- Introduce, patient details, check relation of accompanying adult, consent, wash hands.
- Screening questions
- Do you have any pain/stiffness in your joints, muscles or back
- Do you have any difficulty dressing yourself (buttons/zips)
- Do you find it hard to go up and down stairs
- Ask to undress, need to fully expose arms and legs,
- Posture and gait
- Observe arms, legs and back from all angles
- Observe walking: normally, tip toe, heel walk
- Arms
- Ask them to put their hands straight out in front of them fingers spread palms down
- Ask them to turn their hands over and make a fist
- Ask them to touch each of their fingers to their thumb
- Gently squeeze the outside of their knuckles, looking for tenderness
- Put your hands in prayer position
- Put your hands in prayer position but back of hands touching
- Reach hands up to the sky
- Then also look at the ceiling
- Put hands behind your head like Dr. Cox
- Legs
- Put on bed
- Feel for knee effusion
- Ask to bend and straighten knee, whilst feeling for crepitations
- Then passively do all hip movement, up down and rotation (hold knee up and move foot from left to right)
- Temporomandibular joint
- Open your mouth wide enough to put 3 fingers in
- Kneck and spin
- Touch your ear to your shoulder (observe the neck)
- Touch your toes (watch spine)
Throughout observe for: pain, limb alignment, swelling, asymmetry, deformity
8
Q
Baby check
A
- Introduce confirm patient introcude wash hands consent
- Questions
- Pregnancy: prenatal complications, birth type, perinatal complications, gestation, birth wgt, how long ago was birth
- FHx: hip problems, eye problems, heart, kidney, ear problems
- What’s going in and out: current feeding, meconium, peeing, pooping
- Any other parental concerns
- Weight baby
- Ask parents to undress baby to nappy or do it yourself
- General inspection: colour, cry, posture
- Passively move all babies limbs checking for tone: shouldn’t feel like rag doll
- Head
- Circumference
- Shape
- Fontanel (should be flat)
- Sutures
- Skin
- Face
- Dysmorphic features: low nasal bridge, epicanthal folds, widely spaced eyes
- Skin
- Assymetry
- Trauma
- Nose and nostril patency
- Eyes
- Discharge
- Sclera for jaundice
- Ptosis epicanthal folds?
- Red reflex
- Subconjunctival haemorrhage
- Ears
- Size
- Shape
- Location
- Symmetry
- Mouth
- VISUALLY and manually check for cleft
- Central uvula
- Check if tongue ties
- Sucking relfex
- Neck + clavicles
- Neck length (short turners)
- Webbed (turners)
- Swelling
- Clavicle fracture
- Upper limbs
- Symmetry
- Digits
- Palmar crease
- Brachial pulses
- Check grip and head lag (warn parents)
- Chest
- Inspect
- Ausculate lungs
- Auscultate heart
- Abdo
- Inspect for distention, colour, hernia
- Inspect umbilicus: discharge, signs of infection, hernia
- Palpate: liver, spleen, kidney,
- Genitalia
- Boys: check hypospadias, check both testicles
- Girls: check all labia, clitorus
- Patent anus
- Lower limbs
- Femorals
- symmetry
- tone
- movement
- odema
- Bend knees checking if they hypo/er extend or dislocate
- Ankle deformities
- Digits
- Hips
- Barlows test (adduct hips and gently apply pressure posteriorly)
- Ortolani’s test (flex hips and knees, place index fingers on posterior joint aspect and gently abduct knees)
- Back and spine
- Scolisos
- Skin
- Morrow reflex
- Support baby head and back in arm and drop back
9
Q
CN exam
A
Introduce wash hands consent confirm patient
CNI Have you noticed any changes in smell
CNII
- size, shape and symmetry of pupils
- Actuity
- Pupil reflexes: direct consensual swinging accomodation
- Visual fields
- Fundoscopy incl red reflex and back fundus (optic disc) colour cup and contour
CNIII+IV+VI
- Ptosis
- Eye movements
- Cover test
CNV
- Touch face
- Clench teeth
- Open mouth against resistence
- Corneal reflex
CNVII
- Pull faces
CNVIII
- Any hearing changes
- Whisper test
- Rinner and Webbers
CNIX+X+XII
- Stick out tongue
- Push tongue against cheek
- Ahh
- Asymmetry or vesiculations of tongue or uvula
- Gag reflex
- Drink water
- Cough
CNXII
- Shrug shoulders
- Turn head against hand
10
Q
Rinner and webbs interpretation
A
11
Q
Signs of resp distress
A
- Nasal flaring
- Head bobbing
- Tripoding
- Intercostal and subcostal recession
12
Q
Signs of dehydration
A
Dec skin turgour
Dry mucous membranes
Sunken fontanels
Sunken eyes
