Sick Child II Flashcards
What is the mot common avoidable factor in child deaths?
Failure to recognise severe illness
What are some symptoms of severe illness in children?
Difficulty breathing, poor feeding, fever, rash, dehydration, lethargy/depressed conscious level
How is the systolic blood pressure calculated in children?
85 + (age in years x 2)
How is paediatric sepsis diagnosed?
Child with suspected/proven infection AND at least two of = temperature <36 or >38, tachycardia, altered mental state, reduced peripheral perfusion
What are some high risk groups for paediatric sepsis?
Immunosuppressed/compromised, chemotherapy, long course steroids, infant <3 months old, recent surgery, indwelling lines, complex neurodisability, high index of clinical concern, significant parental concern
How quickly should treatment for sepsis be delivered?
Within 1 hour = ideally within 15mins
What are the sepsis 6 for the treatment of paediatric sepsis?
High flow oxygen
Give IV/IO antibiotics = broad spectrum
Obtain IV/IO access and take bloods
Consider fluids = 20ml/kg isotonic fluid if shocked
Consider early inotrophic support = adrenaline
Involve seniors early
What are the bloods taken from a child with sepsis used for?
To carry out blood culture
To measure blood glucose and lactate
What may be the underlying reasons for cardiac arrest?
Circulatory failure or respiratory failure (respiratory arrest)
What may cause circulatory failure?
Fluid loss = blood loss, gastroenteritis, burns
Fluid maldistribution = septic shock, CV disease, anaphylaxis
What may cause respiratory failure?
Respiratory distress = foreign body, croup, asthma
Respiratory depression = convulsions, raised ICP, poisoning
What should be done at the end of a primary and secondary assessment?
Primary assessment = resuscitation
Secondary assessment = emergency treatment
What is used to assess breathing?
Effort of breathing = rate, recession, accessory muscle use, grunting, nasal flaring
Efficacy of breathing = expansion, additional noises (wheeze, stridor), pulse oximetry, effect on end organs
How may end organ involvement due to breathing difficulties manifest?
Altered consciousness, pallor, tachycardia
How are airways and breathing managed?
Assess if airway patent = perform airway manoeuvres
High flow oxygen, give rescue breaths if not breathing
Reassess = airway support and ventilation necessary?
perform secondary assessment and give specific disease treatment
How is circulation assessed?
Heart rate, rhythm, pulse volume, capillary refill, blood pressure, effects on other organs (conscious level, skin perfusion, urine output)
Why is hypotension important in assessing circulation?
It is a pre-terminal sign
How is circulation managed?
20ml/kg of 0.9% saline, reassess and repeat if still shocked
May need blood if trauma or haemorrhage
What may need to be given if more than 20ml/kg fluids is being administered?
Inotropes
Who should be made aware if a child is receiving 60ml/kg of fluid?
The paediatric intensive care unit should already be aware at this point
Why is 20ml/kg the dose that is administered?
This is 25% of circulating volume = point at which clinical shock is detected
What areas are looked when assessing if a patient is dehydrated?
Mucous membranes, fontanelles/eyes, skin turgor, urine output, shock, conscious level
How is level of consciousness assessed?
AVPU, GCS, pupillary response, posture (decorticate/decerebrate), always measure glucose
What are some ways of assessing exposure?
Temperature, presence of rash or bruising
