paeds misc Flashcards
What three things (acronym) should you do before starting ‘ABC’ on a collapsed child?
SSS
- Safe to approach
- Stimulate pt (verbal, trap squeeze)
- Shout for help
After shouting for help for an unresponsive child, what should you then do? (ie ABC)
at what point should you start compressions and what rate?
AIRWAY
- look (swelling, secretions)
- open (head tilt, chin lift, but not as extended aas an adult)
BREATHING - look - listen - fell (on cheek) for up to 10 secs
deliver FIVE rescue breaths
- ideally with 15L of O2
(nb correct mask size and just squeeze bag enough to see rise + fall - if overinflate can cause vomiting)
if no rise + fall:
- check mask seal
- head tilt chin lift
- look for obstruction
FEEL CAROTID pulse
- for up to 10 secs
- if HR <60bpm (ie less than one a sec) then START COMPRESSIONS
COMPRESSIONS
- 1 or 2 hands, depnding on size of child
- 15:2 breaths
- do at rate of 2 a second (120bpm, ie faster than adults)
nb if a child looks like an adult then do adult CPR
differences when performing BLS on an infant (<1 year) compared to a child? 4
1) neutral position (1/2 a cm head tilt)
2) use smaller bag mask
3) assess circulation with femoral + brachial pulses (instead of carotid)
4) compressions with 2 fingers (still 120bpm 15:2)
nb if there is someone else with you, you can use encircling technique + use thumbs for compressions
When making a crash call, what information do you need to provide? 2
1) type of arrest:
- adult
- child
- neonate
- obstetric
2) location
number is 2222
Describe the management of a choking infant (<1 year)
What do you do differently if it’s a child? 1
ie older than 1
- encourage coughing
- hold baby upside down (on knee)
- 5 firm back blows
CALL FOR HELP
- 5 CHEST thrusts (same place as CPR)
continue alternating between back blows and chest thrusts with reassessing until foreign body dislodged or loose consciousness / colour / tone and then start BLS/CPR
IF CHILD:
- do abdo thrusts instead of chest thrusts (everything else is the same)
nb any child/infant who has chest or abdo thrusts needs checking over for internal injuries afterwards
Four main groups of things that cause anaphylaxis? (ie to ask about in hx)
- food
- insect bites
- medications
- immunisations
Signs / symptoms which can indicate anaphylaxis:
- CNS? 1
- skin? 4
- upper airways? 4
- lower airways? 3
- cardiovascular? 4
- GI? 4
CNS
- altered level of consciousness
SKIN
- urticaria
- pruritis
- angioedema (esp around mouth)
- flushing
UPPER AIRWAY
- new onset hoarseness
- stridor
- sneezing
- rhinorrhoea
LOWER AIRWAY
- cough
- wheeze
- SOB / tachypnoea
CARDIOVASCULAR
- dizzy / lightheaded
- tachycardia (but thready)
- hypotension
- pallor / cyanosis
GI
- nausea
- vomiting
- diarrhoea
- abdo pain
Management of anaphylaxis:
- approach?
- what features are used to make diagnosis of anaphylaxis?
- initial medication to give? paediatric dose? when to repeat?
- three other things to do?
- other medication / things to give? 4
- what to monitor? 3
A-E approach!!!
acute onset of illness
- life-threatening airway and/or breathing and/or circulation problems
- and usually skin changes
IM ADRENALINE - 500mcg if over 12 (ie adult dose) - 300mcg if 6-12y - 150mcg if <6y REPEAT at 5 mins if no improvement
- call for help
- lie patient flat (and raise legs)
- establish airway (or get anaesthetist to)
OTHER MEDICATIONS:
- high flow oxygen
- IV fluid challenge
- chlorphenamine IV
- hydrocortisone IV
MONITOR
- O2 sats
- ECG
- BP
What volume and type of fluid should be used for a paediatric fluid challenge?
20ml/kg
crystalloid (0.9% saline)
AIRWAY
- what looking for on exam? 7
- possible investigations? 1
- possible management? 6
nb investigations incl obs, bedside, bloods, imaging, other
LOOK - chest/abdo movements (see-saw indicates obstruction) - visualise foreign body - misting of O2 mask - swelling around mouth (anaphylaxis) - facial burns / soot around mouth (- cyanosis is late sign)
LISTEN
- gurgling
- stridor
- wheeze
- grunting
- silence (complete obstruction)
FEEL
- for expired air
INVESTIGATIONS
- peak flow
MANAGEMENT
- KEEP CHILD CALM (if conscious)
- call for help (if any signs of airway obstruction)
- head tilt, chin lift (jaw thrust if c-spine issues, neutral if infant)
- airway adjuncts (nasopharyngeal, oropharyngeal)
- suction secretions
- give 15L O2 NRBM (only if can tolerate - can waft near mouth if this keeps them calm)
Main DDx of airway problems in children:
- infective? 2
- non-infective? 3
describe initial management for each
CROUP
- oral dexamethasone
- neb budenoside and adrenaline if severe
EPIGLOTTITIS
- IV abx (cefriaxone)
FOREIGN BODY
- back slaps / abdo/chest thrusts
- suction
- bronchoscopy if far down
ANAPHYLAXIS
- IM adrenaline
- IV/IM hydrocortisone
- IV/IM chlorphenamine
- also oxygen and fluid challenge
BURNS
- analgesia + fluids
- transfer to burns unit
BREATHING
- what looking for / doing on exam? 9
- possible investigations? 4
- possible management? 6
nb investigations incl obs, bedside, bloods, imaging, other
- central cyanosis?
- equal chest expansion
- tracheal tug
- inter/subcostal recessions
- wheezing
- grunting
- nasal flaring
- palpate trachea central
- percuss
- auscultate
INVESTIGATIONS
- RR
- O2 sats
- blood gas (norm capillary or venous)
- CXR
MANAGEMENT
- oxygen
- bag valve mask
- neb salbutamol etc
