Recognition + management of the sick child Flashcards
Causes of airway obstruction in children
foreign body
asthma
croup
bronchiolitis
Causes of respiratory depression in children
convulsion
sepsis
poisoning
raised ICP
Causes of alveolar/chest wall failure in children
pneumonia
chest trauma
myopathy
bronchiolitis
Causes of fluid loss in children
bleeding
burns
diarrhoea + vomiting
Causes of fluid maldistribution in children
sepsis
anaphylaxis
Causes of heart failure in children
congenital abnormality
myocarditis
What is the structured approach to assessment of acutely unwell children?
3 minute toolkit
What is the most common presentation to acute paediatric services?
fever
What is the most common thing to cause cardiac arrest in children?
respiratory failure
What is PEWS chart?
national paediatric early warning system chart
What to comment on/look for in B of A-E in children
effort of breathing
is breathing effective
are there effects of inadequate breathing on other organs
How to assess capillary refill time in children
press on skin of sternum or a digit at the level of the heart
apply blanching pressure for 5s
measure time for blush to return
prolonged capillary refill if >2s
Phases of shock in children
compensated: completely reversible
uncompensated: may still be treatable with aggressive appropriate management
irreversible: multiple organ failure
Management of shock in children
fluid resuscitation
fluid bolus = 10ml/kg isotonic crystalloid
reassess
Causes of hypovolaemic shock
haemorrhage
gastroenteritis
intussusception
Causes of distributive shock
sepsis
anaphylaxis
Causes of cardiogenic shock
arrhythmias
heart failure
Causes of obstructive shock
congenital cardiac disease
tension pneumothorax
Causes of dissociative shock
profound anaemia
CO poisoning
Meningitis in children immediate management
IV ceftriaxone
Management priorities in meningitis (neisseria meningitiditis)
antibiotics
fluids
circulatory support
management of DIC
Under what age with a fever suggests serious illness?
under 3 months
almost always serious
always take fever seriously in this age group
Kawasaki disease symptoms/signs
fever >5 days
bilateral non-exudative conjunctivitis
oropharyngeal mucous membrane changes (pharyngeal erythema, red/cracked lips, strawberry tongue)
cervical lymphadenopathy with at least one node >1.5cm diameter
peripheral extremity changes (diffuse erythema + swelling of hands + feet)
polymorphous generalised rash - non-vesicular + non-bullous
Complication of kawasaki disease
coronary artery aneurysms
General causes of prolonged fever in children
infection
inflammation
neoplastic
Key points about fever in children
beware in children<3 months
examine fully to find source
height of fever does not correlate with severity of illness (in over 6 months)
use antipyretics sensibly - not needed if child happy
length of fever - >5 days needs further workup
Does meningitis cause a non-blanching rash?
no
non-blanching rash caused by meningococcal septicaemia/other sepsis/DIC
Do you do a lumbar puncture in a child in septic shock?
no
risk of more complications - bleeding, may not cope with being turned, clotting problems
Why do you not do a lumbar puncture in a patient with raised ICP?
risk of coning
(brainstem herniating into foramen magnum)
What is purpura fulminans?
acute purpuric rash characterised by coagulation of the microvasculature, which leads to purpuric lesions and skin necrosis
can be caused by meningococcal septicaemia
often needs amputations due to necrosis
How many ml in an oz?
30ml
Septic screen in children
blood culture
lumbar puncture
urine culture
chest xray
(looking for source of infection)
Kawasaki disease management
high dose aspirin
intravenous immunoglobulin
echocardiogram to screen for coronary artery aneurysms
What fevers do you take seriously in children?
prolonged fever (>5 days)
babies <3 months
