Pediatric Flashcards
What are the differences with a child’s airway
<6 months they breath through slight nostrils so their risk of airway obstruction goes up
Large head means flex soon can obstruct airway
Short soft trachea hyperextension can obstruct airway
Small mouth so easily obstructed
Compressible floor of mouth- difficult access for suctioning
Increased risk of soft tissue damage from airway management techniques
Neck is short and stubby
Airway is much smaller
Tongue is disproportionately large
What is the difference in a child’s head
Bigger
More surface area for heat loss
More mass relative to the rest of the body
What is the difference in paediatric breathing
Children breathe faster
Lungs are immature
Long volume and alveoli increase during childhood therefore less physiological reserve
Premature babies have insufficient surfactant and increased risk of alveolar collapse
Children have higher metabolic rates and higher consumption of oxygen than adults
Greater risk of hypoxia
Children have soft chest walls that are not supported in respiratory distress and so recess
Do not breath well against obstruction
Ribs do not fracture easily. If a rib fracture is present suspect a serious underlying injury to the organs bellow.
The ribs are more horizontal and compliant
The diaphragm is the main muscle of respiration and so children tire easily
Small thorax so breath sounds are transmitted giving misleading findings on auscultation.
Easy to hear heart and lungs sounds
What are the differences with cardiovascular in children
Higher heart rates and smaller hearts
Circulating blood volume per body weight much greater than adults so small volume losses are more serious
Children have healthy hearts so are unlikely to develop life threatening arrhythmias. Bradycardia is usually associated with hypoxia
Cardiac arrest due to hypoxia and acidosis. Less likely to respond to resuscitation as the body is metabolically abnormal
Children compensate well for hypovoleamia with increased heart rate and extreme vasoconstriction.
By the time hypotension occurs these mechanisms are failing.
What other differences than airway breathing and cardiovascular do children have
Prone to hypoglycaemia as glycogen stores are used more rapidly than adults and are exacerbated in illness or trauma
More susceptible to infection due to low immunity (falling maternal derived antibody)
Meeting organisms for the first time
Liver and spleen are less well protected as they extend bellow the costal margin
Blades extends higher than the pelvis
Abdominal thrusts contraindicated in <1 year
Organs are more susceptible to damage
What are the noticeable characteristics at each age
2 months - can recognise familiar faces, able to track objects with eyes
3 months- can bring objects to mouth, can smile and frown
4 months- reaches out to people, drools
5 months- sleeps through the night, can tell family from stranger
6 months- teething begin, sits upright in a chair, one-syllable words spoken
7 months- afraid of strangers
8 months- responds to “no” can sit alone and play peek-a-boo
9 months- pulls himself or herself up, places objects in mouth to explore them
10 months- responds to his or her name, crawls efficiently
11 months- starts to walk without help, frustrated with restrictions
12 months- knows his or her name, can walk
How is a paediatric assessment performed
The key aim is to rapidly identify actual or potential life threatening illness or injury and maintain a high level of suspicion throughout.
ABCD from doorway on approach including paediatric triangle for assessment
Serous airway, breathing circulation problem = time critical= life saving interventions on scene. Do not delay transport continue treatment on route.
Do I need back up. (Am I managing? Will assistance delay treatment at hospital? Meet back up on route?)
Secondary survey systematic top to toe and toe to top.
What is the paediatric assessment triangle. And how does it work
Appearance of airway
Breathing and circulation
Uses appearance and TICLS Tone Interactiveness Consolability Look or gaze Speech or cry
Describe the phases of ticls
Tone
Is the child moving or resisting examination vigorously? Does the child have good muscle tone? Is the child lip, listless or flaccid
Interactiveness
How alert is the child? How easily does a person, object, or sound distract the child or draw the child’s attention? Will the child reach for, grasp, and play with a toy or examination instrument. Is the child uninterested in playing or interacting with the parent or ambulance clinician
Consolability
Can the child be consoled or comforted by the parent or ambulance clinician? Is the child’s crying or agitation relieved by gentle reassurance.
Look or gaze
Does the child fix his or her gaze on a face, or is there a glassy eyed stare
Speech or cry
Is the child’s cry strong and spontaneous or weak or high pitched? Is the content of speech age-appropriate or confused and garbled?
What are you looking for with a child’s breathing?
Reflects child’s attempts to compensate.
Abnormal airway sounds
Snoring, muffled or hoarse speech, stridor, grunting or wheezing.
Abnormal posturing
Sniffing position, tripod position, refusing to lie down.
Recession
Supraclavicular, intercostal, subcostal, or substernal recession of the chest wall, head bobbing in infants
Flaring
Flaring of the nares inspiration
What do you look at to work out circulation and why
To determine adequacy of cardiac output and core perfusion.
Skin reflects overall status of the core circulation
Pallor- white or pale skin or mucous membranes- sign of poor circulation, reflex peripheral Vasoconstriction, may also indicate hypoxia or anaemia
Mottling- patchy skin dis colour action due to vasoconstriction or vasodilation, reflects vasoinstability in capillary beds, physiological response to a cold environment.
Cyanosis- bluish discolouration of skin and mucous membrane, extreme visual indicator, acrocyanosis, late finding of respiratory failure or shock
Why is physical examination more important in adults
Children have vague, nonspecific symptoms such as fever and/or pyrexia
What should you remember when assessing a child
It is unlikely that the child will have a serious condition but normal physiology
A child who looks well may be compensating well. It is important to spot tachycardia, tachypnoea, and hypoxia
Beware of exhausted child as they may look undistressed as respiratory rate falls and becomes shallow
Remember expose and examine
Estimate the child’s weight early
What examinations should be performed on a child
Airway
Check for mucus, blood or foreign body
Tongue or soft tissue obstruction
Breathing
Calculate the respiratory rate
Auscultating breath sounds
Check sp02 for oxygen saturation
Circulation
Pulse rate and quality, skin CTC, and blood pressure.
What are the normal ova for children
Term baby
-resp 40-60 p 100-170 systolic minimum 50
3 month
-resp 30-50 p 100-170 systolic minimum 50
6 month
-resp 30-50 p 100-170 systolic minimum 60
1 year
-resp 30-40 p 110-160 systolic minimum 70-90
1-2 year
-resp 25-35 p 100-150 systolic minimum 80-95
2-5 year
-resp 25-30 p 95-140 systolic minimum 80-100
5-12 years
-resp 20-25 p 80-120 systolic minimum 90-110
> 12 years
-resp 15-20 p 60-100 systolic minimum 100-120
