PRRAPID

Question 1

In the ABCDE assessment of a child where are you more likely to find problems?

Answer 1

A and B are more likely to be the cause of problems in children - in part this is due to their smaller airways - Foreign body aspiration or some other form of airway obstruction is more common in children

Question 2

What airway manoeuvres/adjuncts are used in children with airway obstruction?

Answer 2

Different for different ages I

NFANT = neutral, face parallel to surface

1-5yo = sniffing the morning air

>5 = Head tilt chin lift OP tubes are still useful (measure angle of mandible to front incisor) - inserted differently (following the curvature of airway no rotation needed)

Question 3

How do we assess breathing in children?

Answer 3

3Es (effort, efficacy, effect)

EFFORT = increased RR, subcostal, intercostal or sternal recession, accessory muscle use, head bobbing, grunting, nasal falring

EFFICACY = equal air entry, Spo)2, chest movement

EFFECT = HR (tachy or bradycardia), CRT, Concious level

Question 4

What type of respiratory failure is more common in children and what are some common causes?

Answer 4

T1RF more common because children are very unlikely to be CO2 retainers Bronchiolitis, Pneumonia, asthma, pneumothorax, pulmonary oedema T2RF is very worrying because it shows the children are starting to tire and retain CO2

Question 5

What is a very concerning sign when assessing circulation

Answer 5

LOW BLOOD PRESSURE / BLOOD PRESSURE CHANGES - children are very good at compensating their blood pressure so any BP drop is deemed a pre-terminal sign

Question 6

PHYSIOLOGICAL RANGES FOR DIFFERENT AGES

Answer 6

TERM HR=110-170, RR=25-60, Sys BP=60-105

3 MONTH OLD HR=105-165, RR=25-55, Sys BP=65-115

6 MONTH OLD HR=105-165, RR=25-55, Sys BP=65-115

1 YEAR OLD HR=85-150, RR=20-40, Sys BP=70-120

6 YEAR OLD HR=70-135, RR=16-34, Sys BP=80-130 ***Normal adult ranges acheived by age 12y

Question 7

What are some features of assessing disability in children that are different?

Answer 7

There is a MODIFIED GCS for use in children under the age of 5 (difference is response to voice) Main difference is POSTURE decorticate posture (elbow flexion)and decerebrate posture (elbow extension) are two important pathological signs of brain injury in children

Question 8

What is the choking algorithm?

Answer 8

1. ask them if they are choking
2. encourage them to cough
3. deliver 5 back blows
4. deliver 5 abdominal thrusts
5. if not successful and pt looses conciseness begin paediatric CPR

Question 9

What is different about paediatric CPR

Answer 9

BEGIN WITH 5 RESCUE BREATHS Then do compression and breaths in a ratio of 15:2 Should only give CPR for 1 minute before going for help (if you are on your own)

Question 10

How will an inhaled foreign body appear on a CXR?

Answer 10

• The side of the lung that the inhaled foreign body is on will usually appear blacked out (hyper lucency)
• there will usually be mediastinal shift away from the affected side