Recognising the sick child Flashcards
What is the more common cause of cardiac arrest in children, circulatory failure or respiratory failure?
Respiratory failure
What symptoms present in unwell children?
6
Difficulty breathing Poor feeding Fever Rash Lethargy/ depressed conscious level Dehydration
What is the structured approach for an acutely unwell child?
Primary assessment (ABCDE)
–> Resuscitation
Secondary Assessment
–> Emergency Treatment
If unsure about whether a sick child is in respiratory failure or shock, and on exposure of the child, you can see non-blanching rash, what does this suggest?
SHOCK
rash –> meningococcal meningitis –> sepsticaemia–> sepsis –> shock
What five things do you look for in a child when assessing EFFORT OF BREATHING during ABC assessment?
Rate of breathing Recession Accessory muscle use Grunting Nasal Flaring
What four things do you look for in a child when assessing EFFICACY OF BREATHING during an ABC assessment?
Chest expansion
Additional noises (inspiratory stridor, expiratory wheeze)
Pulse oximetry
Effects of end organs - conscious level, palor, tachycardia
What is the name for the additional sound made on inspiration?
Stridor
What is the name for the additional sound made on expiration?
Wheeze
How do you work out what a child’s sytolic BP should be (normal parrameters) based on their age?
Systolic BP = 85+(age in years x2)
e.g. age 7 –> 85+(7x2) = 85+14 = 99
What is the main difference, in terms of airway management, between infants and children?
Infants (>1 year old) –> don’t extend neck as far as children over 1.
Babies have high anterior larynx. If you over-extend their necks, you may risk shutting off their airway,
If you do not know the age, make a judgement based on size etc.
What does CPAP stand for?
Continuus Positive Airway Pressure
What signs may you see in a child with croup?
Stridor and barking cough
Stridor breathign sounds due to inflammation of upper airways
What (6) things are you assessing when doing assessment of circulation in ABCDE examnation of child?
Heart Rate Rhythm Pulse Volume Capillary Return Blood Pressure Effects on other organs (conscious level, skin perfusion (temperature, colour), urine output)
What volume and concentration of saline would you give if circulatory management required?
20mls/kg of 0.9% saline
- -> (reassess)
- -> (repeat if still shocked)
- -> (reassess)
20mls/kg = 25% of circulating volume = point at whch clinical shock detected
If >20mls/kg of fluid required, may need inotropes but may still need MORE fluid
At 60mls/kg, PICU should already be aware
At what level of dehydration may the patient be shocked?
> 10% dehydrated
