Physiological Differences

Question 1

Airway

Answer 1

More prone to obstruction as smaller in diameter,
The narrowest part of the airway occurs at the level of the cricoid cartilage, rather than at the vocal cords
When intubating remember = larger tongue, airway positioned more anteriorly, flexible trachea that can be easily compromised, larynx sits higher and epiglottis u shaped and floppy -
difficult to view the vocal cords.
loose teeth, narrow nostrils

Question 2

Breathing

Answer 2

less than 6mths breath through the nose - obstruction of mucus leads to resp. arrest,
upper + lower airway are smaller + easier obstructed,
Lungs are immature alveolar numbers increase with age, breath mainly on diaphram, muscles tire easily.
Higher metabolic rate + O2 consumption

Question 3

Circulation

Answer 3

Cardiac Output is rate dependent in infants and young children, circulating blood volume is higher, but actual blood volume is smaller, - faster heart rate, poor ability to increase stroke volume, heart ventricles are the same size until they develop, ECG - QRS elongated

Question 4

Other Differences

Answer 4

ABDO - Distension = weak muscles and solid organs, liver extends below the ribcage - more valnerable to injury
MUSCULOSKELETAL SYSTEM - The cartilage in the childs bones are relatively weak, weaker than the ligaments and easily fractured. Because children’s bones are more elastic, when they do have fractures they tend to be different. Children also have growth plates at the end of their bones - areas of growing bone - which may sometimes be damaged.
BRAIN + NERVOUS SYSTEM - Continues to develop once the baby is born.
HEAD - Large head - more surface area to lose heat from, carries more weight when they fall more likely to fall on head.
NECK - Short necks - difficult to feel a corotid pulse, or see jugular veins
HYPOGLYCEAMIA - poor glycogen stores and rapid metabolic rate (75mins- childs golden hour, treat all hypoglycemic shock until proven otherwise
SPINAL CORD INJURY - A childs vertibray can easily dislocate and quickly relocate, although an x-ray may show no obvious fracture, it will not tell if the cord itself has been damaged (caroline)

Question 5

Paediatric Formulae

Age for Page = Table guides for vital signs
airway sizes
defib jules
drugs
( accurate figures quicker rather than working using Paed Formulae )

Answer 5

W = WEIGHT - if the childs age is known (Age+4x2=KG)
E = ELECTRICITY/SHOCK - 4 jules per KG
T = TUBE ETT - (AGE/4+4 = mm in diameter)
OPA (AGE/2+12=cm)
F = FLUIDS - Medical/cardiac arrest = 20ml/kg repeat 3 times
Trauma - initial bolus 5ml/kg repeat continually
A = ADRENALINE - 1mlg in 1ml 1/10,000
G = GLUCOSE -5ml/kg of 10% dextrose