Paeds emergencies Flashcards
What do you give as fluid resus bolus
20ml/kg over 10 mins if in shock
10ml/kg over 10 mins if not in shock /DKA or circ overload of HF
what do you give as routine maintenance fluids?
0.9% NaCl/Plasmalyte + 5% dextrose
ALWAYS add dextrose other than in DKA as children become hypoglycaemic very quickly
how much maintenance fluid do you give to a child
o 100ml/kg/day for each first 10 kg
o 50ml/kg/day for next 10kg (10-20)
o 20ml/kg/day for every further kg
what is maintenance fluid requirement in neonates
day 1: 50-60ml/kg/day day 2: 70-80ml/kg/day day 3: 80-100 day 4: 100-120 day 5-28: 120-150
why must you NOT replace fluid deficit too quicklyu
because it can cause a rapid reduction in plasma sodium > osmolality causes shift of water into cerebral cells > cerebral oedema > seizures
SO AIM TO REDUCE PLASMA SODIUM SLOWLY (i.e. over 48h)
what are the three types of fluid that you must give in dehydratyion
bolus
maintenance
rehydration
how do you calculate rehydration fluid requirement
10 x weight x % dehydration
What is AVPU
Measures cognitive state rapidly
Alert
responds to Voice
responds to Pain
Unresponsive
Explain what you are looking for in Airway and Breathing of A-E
Check for airway obstruction, respiratopry distressù
Look:
- pallor/cyanotic
- Work of breathing? (inspiratory effort - grunting, nasal flaring, head bobbing, tracheal tug, intercostal/subcostal recession)
- Resp rate
- O2 monitor
Listen:
- stridor, wheeze
- ascultate for air entry
Explain what you are looking for in Circulation
Central and peripheral perfusion
Cap refill
HR, pulse volume, BP
Explain what yoy are looking for in disability
Note level of consciousness, AVPU
Note posture (hypotonic, decorticate, decerebrate)
Pupil - size and reactivity
How do you perform CPR on child
15 chest compressions : 2 rescue breaths
- infant: use two thumbs
- small child: heel of one hand
- large child: both hangs
What are the two shockable cardiac rhythms
VF
VT
What are the two non shockable rhythms
pulseless electical activity (PEA)
asystole
List the reversible causes of cardiac arresty
4Hs and 4Ts
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia
Tension pneumothorax
Tamponade
Thromboembolism
Toxins
What is T1 resp failure
Hypoxaemia with normo/hypocapnoea
oxygen is low but CO2 is normal
This is OXYGENATION failure due to V/Q mismatch
there is poor oxygenation of the lung, but the lung is still able to work and excrete CO2
What kind of NIV can you give for T1RF
CPAP
What is T2 Resp Failure
Hypoxaemia with Hypercapnoea
due to VENTILATION failure
List causes for T2 RF in children
increased airway resistance
decreased breathing effort (very tired)
decreased lung area available (bronchiectasis)
neuromuscular problem (GBS)
Why do children do head bobbing when struggling tro breathe
due to SCM involvement
What is the function of grunting when struggling to.breathe
it is essentially physiological CPAP
as child tries to maintain alveoli open after exhalation
Why should you weane children off steroids gradually
because they suppress the adrenal gland
so will have lowered endogenous cortisol production
what are features of moderate/severe resp distress in infant=
tachycardia RR >60 nasal flaring head bobbing grunting tracheal tug use of accessory muscles (IC, SC recession) reduced conscious levels saturation < 92 rising pCO2
What are the three increasing steps to ventilation in an emergency
Oxygen (if O2<92)
Non invasive ventilation (CPAP/BiPAP)
Invasive ventilatory support (endotracheal intubation and mechanical ventilation)
why are children so susceptible to fluid loss?
HIGHER REQ
EASIER DEHYDRATION
- high surface area-volume ration
- high basal metaboli rate
- may become to take oral fluids
- additional fluid loss if vomiting, diarrhoea, increased insensible losses
What are early compensated features of dehydration
tachypnoea, tachycardia (maintains BP) decreased skin turgor sunken eyes, fontanelles mottled, pale, cold skin delayed cap refill core-peripheral temperature gap >4 decreased UO
What are late decompensated features of dehydration
Kussmaul breathing
bradycardia, hypotension
blue peripheries
absent urine output
What is shock?
The condition that arises when the body is unable to meet the metabolic demands of tissue
what 2 key features occur with shock
10% decrease in body weight
Metabolic acidosis
Explain the picture of a high risk sepsis child
Behaviour: no response to social cues, appears ill, does not wake, weak high pitched crying
HR: tachycardic / <60bpm
RR: tachypnoea, grunting, apnoea, SpO2<90% on air
Mottled/ashen appearance
Cyanosis of skin, lips, tongue
Non-blanching rash
Age <3m with >38 deg temp
Temp <36 degrees
what lactate level makes you consider a child as high risk, and what is the immediate mx
> 2 mmol/L
give fluid bolus without delay
What is SIDS
death with no identifiable cause even after autopsy after 1 month of age
what is advice to prevent SIDS
sleep on back
avoid overheating (no headwrapping, blanket no higher than shoulders, no high room temp)
feet to foot position
no one should smoke near infant
have baby in parents bedroom for first 6m
avoid bringing the baby into their bed when they are tired /have had alcohool or drugs
avoid sleeping with baby on sofa
breastfeed if possible
