Recognition and initial management of the seriously ill child Flashcards
What is the most common reason for cardiorespiratory arrest?
Hypoxia
How does the ABCDE approach help assess a child?
It is a systematic approach to assess a sick child
How would you treat an upper airway obstruction?
Maintain airway patency
Delivery of supplemental oxygen ASAP to prevent hypoxia
Feeding should be avoided
If there is a decreased level of consciousness airway compromise, must be assumed
Name a basic airway opening manoeuvre
Head tilt and chin lift, or Jaw thrust
What airway adjunct could you use until Experienced help is available
Oronasal pharyngeal airway should be used
What is an advanced emergency airway management?
Insertion of tracheal tube, supraglottic airway such as an i gel, laryngeal mask airway LMA, or cricothyroidotomy 
Name some causes of airway obstruction
Congenital abnormality
Secretion such as vomit and blood
Respiratory tract, infection, swelling and mucus
Pharyngeal swelling, oedema and infection
Epiglottitis
Croup
Nasal feeding tubes,
Oxygen delivery devices
Foreign body
Central nervous system, depression, loss of muscle tone,
Facial or throat trauma 
If a child has increased respiratory rate, what would dare arterial CO2 levels be?
Arterial CO2 levels may initially be normal or even low due to increased respiratory rate, although they will rise stimulating the respiratory centre to increase the rest fruit tree rate further as fail worsens.
What symptoms may you find if a child is arterial CO2 levels are increased
Tachycardia
Vasodilation and bounding pulse
What happens when respiratory decompensation occurs?
The respiratory system is unable to provide sufficient oxygen for tissue requirements, anaerobic metabolism, occurs, and respiratory acidosis is complicated by metabolic acidosis
Name, three kinds of recession
Sternal
Subcostal
Intercostal 
Name some signs of respiratory failure
Increased work of breathing
Recession
Use of accessory muscles head bobbing
Seesaw respiration
Nasal flaring
Inspiritatory expiratory noises
Grunting
May change position
How may you be able to tell how efficient a child’s breathing is?
Pulse oximetry
Chest movement palpitation and percussion
Chest auscultation
What does a quiet chest indicate?
A very quiet owner, silent chest indicates a dangerously reduced tidal volume and is an ominous sign
When should you start oxygen therapy?
If a child’s O2 saturation is 94% and below
When would you expect central cyanosis to appear?
If the child’s SATs are under 80%
What does AVPU stand for?
Alert
Response to voice
Response to the pain
Unresponsive to painful stimuli
What size would you expect for compensated circulatory failure?
Normal blood pressure
Signs of abnormal perfusion, tachycardia, poor skin, perfusion, long cap, refill, time, weak, peripheral, pulse, tachypnoea, and reduced urine output
What size would you see with decompensated circulatory failure?
Hypertension, clinical signs of inadequate tissue perfusion are more apparent
What is circulatory failure and shock?
Shock is the clinical state where the delivery of oxygenated blood and nutrients such as glucose to the body. Tissues is inadequate for metabolic demand. Additionally, the removal of cellular waste such as CO2 and lactic acid may also be impaired circulatory. Failure refers to insufficient blood being delivered to bodies tissues.
Name five categories of shock
Hypovolaemic shock
Distributive shock
Cardiogenic shock
Obstructive shock
Disassociative shock
What are the most common causes of circulatory failure in children?
Hypervolaemia, sepsis, or anaphylaxis
What is hypovolaemic shock?
decreased circulating volume (preload)
It may result from severe fluid loss, such as dehydration or haemorrhage
What is distributive shock?
An inadequate distribution of blood
The blood flow is insufficient for the metabolic demand of the tissues
For example, anaphylaxis, sepsis, or neurogenic
What is cardiogenic shock?
Circulatory failure due to primary cardiac problem, due to congenital or acquired heart disease, for example, cardiomyopathy, myocarditis, or following cardiac surgery
What is obstructive shock?
This is an uncommon cause of circulatory failure, due to obstruction of blood flow to the Heart.
For example, tension, pneumothorax, cardiac tamponade, or constructive pericarditis
What is disassociative shock?
An insufficient oxygen carrying capacity of the blood
For example, anaemia or carbon monoxide poisoning
How do you workout cardiac output?
Heart rate X stroke volume
How can you recognise circulatory failure?
Heart rate
Post volume
Capillary refill time
BP
Filling pressure - liver size in infants or jugular vein, filling in older children
Endorgan perfusion status
Name 4 pulses
Femoral
Carotid
Radial
Brachial
To check a child’s CRT how long would you press the centre of the sternum for?
5 Seconds
In hypovolaemia, what percentage of the child, total circulating volume can be lost before hypertension occurs
40%
How would you treat shock?
10ml/kg bolus with an isotonic crystalloid solution, such as Plasma-Lyte or 0.9% sodium chloride 
What is decorticate?
When a child is arms flexed an extended (posture)
What is decerebrate?
When a child’s arms & legs are extended (posture)
What do decorticate decerebrate indicate?
Both indicate serious, brain dysfunction, and maybe signs of raised intracranial pressure
ABCDE assessment - what are you looking for initially (Airway)?
Is the air way patent?
Is the air way at risk?
Is the airway obstructed?
Suction if indicated
Head positioning
Oropharyngeal airway
Reassess
Someone expert help
When assessing breathing in ABCDE assessment what are you looking for?
Observe conscious level, air movement (look listen, feel) respiratory rate, chest expansion, use of accessory muscles/recession, palpation, percussion, auscultation, SPO2
How would you react to breathing in ABCDE?
Administer high flow, oxygen as indicated
Support breathing with bag mask ventilation as necessary
Re assess
Summon expert help
In the initial ABCDE approach, what are you observing in circulation?
Evidence of haemorrhage or fluid loss
Conscious level
Heart rate
Cap refill time
Presence of distal or central pulses
Pulse volume features
Skin temperature & colour
Blood pressure
Urinary output 
If any issues arise in C (ABCDE) what could you do?
Control any external bleeding
Attach monitoring
Obtain circulatory access (IV or IO)
Estimate weight
Blood samples for lab testing and glucose
Fluid bolus 10ml per kilogram
Reassess
Summon expert help
In ABCDE what is D?
Disability
AVPU score
Child’s Interaction with parent and surroundings
Posture and muscle tone
People size and reactivity
What interventions can be done at D (Abcde assessment)?
Reconsider A B and C management as conscious level dictates
Establish glucose estimation
Establish if any medications have been given or ingested
Reassess
Summon expert help
What are you looking for exposure (ABCDE) and management of assessment?
Reconsider specific management, for example, antibiotics in sepsis
Consider appropriate temperature control measures
Reassess
Summon expert help
How does the structured ABCDE approach help?
It helps to ensure that potentially life-threatening problems are identified and dealt with in order of priority
How does early recognition of the seriously ill child help?
It prevents the majority of cardiorespiratory arrest, therefore reducing morbidity and mortality
