Pg 5 - Flashcards
How do you measure Cap refill?
5 secs of blanching pressure. Prolonged if > 2 secs to return
What is AVPU scale?
• Assesses the level of consciousness in children.
• A= Alert, V= responds to Voice, P= Responds to Pain, U=
Unresponsive
What is the most common cause for CPR in children?
Hypoxia secondary to respiratory or neurogenic shock.
In the seriously injured child what are the additional steps to ABC?
• Cervical spine: manual in-line stabilisation, followed by head blocks
and straps (no routine collar anymore)
• Deal with catastrophic haemorrhage before ABC
What are the underlying mechanisms in respiratory failure?
• Decreased alveolar ventilation, diffusion impairment, intra-pulmonary
shunting, and ventilation-perfusion mismatch.
• Causes hypoxemia, tissue hypoxia and hypercapnia => CO2 narcosis.
• Severe respiratory distress may lead to exhaustion and respiratory
arrest.
What are the indicators of respiratory distress in a child?
Moderate:
- Tachycardia
- Tachypnea; RR>50
- Nasal flaring
- Use of accessory muscles
- Sternal and subcostal recessions
- Head retraction
- Inability to feed.
What are the indicators of respiratory distress in a child?
Severe:
- Cyanosis
- Getting tired
- Reduced level of consciousness
- Sat <92 despite O2 therapy
- Rising PCO2
What are the steps of supportive measures in respiratory distress child?
- O2 needed if sats below 92%
- Nasal cannula or face mask
- CPAP or BiPAP with NIV
- Intubation and mechanical ventilation in ICU
What are the indications of intubation and mechanical ventilation in
respiratory failure?
- Severe respiratory distress
* Progressive NM weakness. E.g. GBS
What are the clinical signs of shock?
Early compensated:
• Tachypnea
• Tachycardia
• Dehydration (Pale mottled cold skin, decreased skin turgor, sunken
eyes and Fontanelles, Core-peripheral T gap > 4, decreased urinary
output)
What are the clinical signs of shock?
Late decompensated:
- Acidotic (Kaussmal breathing).
- Bradychardia
- Severe dehydration (Absent urine output)
- Hypoxemia: Blue peripheries
- Hypercapnia: Confusion
Outline fluid resuscitation in shock, both initial and maintenance?
v• 20 mls/ Kg of 0.9% IV crystalloid saline, repeat twice to transfer to
PICU
• Maintenance 100ml/ 10 Kg/ 24 hrs. (First 10), 50 ml/ 10 Kg (Next 10).
So anyone above 15 already has 1500 mls. 20 mls/ Kg for subsequent
Kg.
What is sepsis and what are its clinical features?
• SIRS+ Infection focus
Sx
Signs
• Symptoms: Fever, poor feeding, irritability, lethargy+ infection focus.
• Signs: Tachypnea, tachycardia and hypotension, Rash, shock and
multi-organ failure
What is sepsis 6?
- Take 3 (Blood cultures, lactate, urine output)
* Give 3 (IV Antibiotics, IV fluids, O2 to keep stats > 94%)
What is the ER management of anaphylaxis?
• Adrenaline auto injector
• Call ambulance (High flow O2, resuscitation fluids, IM or slow IV
Chorphenamine and hydrocortisone +/- salbutamol. Monitor: Sats and
BP, ECG.
What are the management steps for status epilepticus?
- Buccal midazolam
- IV lorazepam
- Re-assess diagnosis and call for help
- Iv phenytoin
- IV phenobarbital
- PR paraldehyde
- Induction of anaesthesia via thiopental
What are the neuroprotective measures if there is raised ICP?
• Tilt head 20-30 • Intubate and ventilate, monitor CO2 and Oximetry, Hypothermia and keep BP normal high. • Restrict fluids • Mannitol
What are the components of GCS?
• Eye (4): Open, demand, pain, None
• Verbal (5): Speaks, words, sounds, cry, mute.
• Motor (6): Move, localisepain, flex to pain, Decorticate, decerebrate,
none
What are the pupillary signs in coma?
• Unilateral dilatation: Expanding lesion, pontine herniation, 3rd nerve
palsy.
• Bilateral dilatation: Severe hypoxia, hypothermia, and post-ictal.
What is BRUE and how it is managed?
One or more of the following that happens and resolve suddenly in previously
well child.
• Cyanosis or pallor
• Absent, decreased or irregular breathing
• Change in tone (increased or decreased)
• Altered level of responsiveness.
When does SIDS peak and what are its risk factors?
• 2-4 months
• Infant (Small prem boy who was sick yesterday, environmental
(Sleeping prone, swaddled on a billow, near mother in a hot room,
Parents (young couple with low education and income who smoke and
drink in an overcrowded house).
What are the main congenital infections?
What are their clinical
features?
How are they diagnosed?
o TORCH.
o Growth restriction, Microcephaly, CHD and PDA, eye and ear
defects, hepatosplenomegaly and haematological, Blueberry
muffin rash.
o Maternal serconversion, Fetal: CVS, amniocentesis, PCR, baby:
fluid samples.
What is the most common congenital infection?
What is the most
common complication?
o CMV
o Sensorineural hearing loss and other neurodevelopmental
disabilities
What are the main steps for intra to extra uterine life
transmission?
o Lung expansion => reduced pulmonary vascular resistance =>
Increased Left atrial filling => Closure of foramen ovale, DA =>
Establishment of adult circulation
What are the main components of Apgar score?
Heart rate > 100 Respiratory effort = strong cry Muscle tone: Well flexed, active Reflex irritability: Cry and cough Colour: Pink
What are the main steps in neonatal resuscitation and what are the extra measures taken for preterm babies?
o Clock, dry, stimulate, o Assess and REASSESS: o Tone, breathing and HR (The most important; check each 30 secs; should be above 60) o Airway: o Breathing: Failed intubation? DOPE: • Displaced, Obstructed, Patient, Equipment o Circulation: CPR (3:1); 90 compressions: 30 ventilations. o Disability: Avoid hypothermia: o Drugs: Centrally (Umbilical venous catheter); Adrenaline, Volume supports.
