Paeds - A-E assessment

Question 1

What should be examined when assessing Airway & Breathing?

Answer 1

• Effort of breathing
• Resp rate and rhythm
• Stridor/ wheeze
• Auscultation (silent chest = SERIOUS)
• Skin colour

Question 2

What is assessed in circulation?

Answer 2

• Heart rate
• Pulse volume
• Cap refill
• Skin temperature

Question 3

What is assessed in disability?

Answer 3

• Conscious level
• Posture
• Pupils (size and response to light)
• Blood sugar testing

Question 4

What is assessed in exposure?

Answer 4

• Fever
• Rash
• Bruising

Question 5

What should be done if the child’s airway is compromised?

Answer 5

Seek anaesthetic help urgently

Question 6

What are potential causes of raised respiratory rate?

Answer 6

• Airway pathology
• Lung pathology
• Metabolic acidosis (DKA)

Question 7

What are the normal resp rates for each age group?

Answer 7

• > 1, 30-40
• 1-2, 25-35
• 2-5, 25-30
• 5-12, 15-25
• > 12, 12-20

Question 8

What other signs of respiratory distress are there?

Answer 8

• Grunting
• Flaring nostrils
• Tracheal tug (movement of the trachea downwards during inspiration)
• Accessory muscle use
• Gasping is a late sign of hypoxia

Question 9

In which hypoxic patients will there not be signs of increased respiratory effort?

Answer 9

• Those who have become fatigued due to severe respiratory problems for some time
• Neuromuscular disease eg. muscular dystrophy
• Central respiratory depression (raised ICP, poisoning, encephalopathy)

Question 10

How can hypoxia affect the heart?

Answer 10

Tachycardia initially, leading to bradycardia if this is prolonged

Question 11

How should children with respiratory difficulties or hypoxia be treated?

Answer 11

Give high flow O2 (15L/ minute) through an O2 mask with a reservoir bag

Question 12

How should children with respiratory difficulties/ hypoxia and inadequate respiratory effort be treated?

Answer 12

Use a bag-valve mask to deliver 15L/min of O2 and consider intubation and ventilation if needed

Question 13

What are the effects of circulatory inadequacy on a child’s organs?

Answer 13

• Increased resp rate (metabolic acidosis)
• Reduced urine output
• Mottled skin with pale, cool peripheries
• Altered mental state

Question 14

What should be done if there are signs of circulatory compromise?

Answer 14

Establish venous or intraosseous access and give 20ml/kg bolus of 0.9% NaCl

Question 15

When would inotropic support be considered?

Answer 15

If more than two boluses are needed

Question 16

What is the initial bolus for a child with DKA?

Answer 16

10ml/kg due to the risk of cerebral oedema

Question 17

What should be done if venous access is unsuccessful?

Answer 17

Intraosseous access is rapid and effective and should be considered early

Question 18

Which scores can be used to assess the child’s conscious level?

Answer 18

• AVPU (alert, responds to voice, responds to pain, unresponsive), response to pain only corresponds with a GCS score of 8
• GCS

Question 19

What does stiff posturing suggest in a child?

Answer 19

Decorticate or decerebrate posture which indicates serious brain dysfunction

Question 20

How is hypoglycaemia treated in a child?

Answer 20

Bolus of 2ml/kg 10% glucose IV or IO, followed by a glucose infusion to prevent recurrence

Question 21

How is DKA managed in a child?

Answer 21

10ml/kg 0.9% saline, followed by replacement 5-10% for dehydration, maintenance with 0.45% saline and adequate K+ replacement

Insulin should be infused after initial fluid resuscitation in 0.1U/kg/hr

Question 22

What is the most common complication of DKA?

Answer 22

Cerebral oedema, careful neurological and vital sign monitoring and early intervention with mannitol or hypertonic saline infusion