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Bachelor of Paramedic Science > SPOPs Paediatrics > Flashcards

SPOPs Paediatrics Flashcards

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1
Q

AEIOU TIPS Mnemonic for ALOC - What to Look For

A

Alcohol - too much/too little
Epilepsy/electrolytes
Insulin - (Overdose/underdose/diabetes
Overdose/oxygen - (Drugs/poisons/toxins or hypoxia)
Uremia – Renal failure

Trauma – History and/or evidence of
Infection – sepsis
Psychiatric - behavioural, mental health disorders
Stroke/shock - Aneurysm, subarachnoid bleed, hypovolemia, MI

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2
Q

AEIOU TIPS - Alcohol - What to Look For

A

Is their evidence on scene suggestive of alcohol ingestion?

Previous hx of same

If suspected – What type of alcohol, how much, what time frame etc

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3
Q

AEIOU TIPS - Electrolytes - What to Look For

A

Paediatrics with any acute illness or condition affecting the input, distribution or output of electrolytes and/or fluid in the body are at risk of electrolyte imbalance

(vomiting diarrhoea, decreased food intake, recent illness)

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4
Q

AEIOU TIPS - Epilepsy - What to Look For

A

Look for any signs of seizure activity

Could this be post-ictal behaviour?

Manage appropriately with any active or ongoing seizure activity.

Look for key signs: Incontinence, injury around face areas, nystagmus

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5
Q

AEIOU TIPS - Infectious - What to Look For

A

febrile and/or extremely cold

Any obvious signs of infection

Any history around recent sickness?

Think….could this be sepsis?

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6
Q

AEIOU TIPS - Insulin - What to Look For

A

Hypoglycemia and hyperglycemia

Is there a known history of diabetes

Consideration for first presentation type 1 diabetes in DKA

Any recent vomiting and or diarrheoa?

Recent sickness

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7
Q

AEIOU TIPS - Overdose ​(drugs/poisons/toxins) - What to Look For

A

dangerous substances

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8
Q

AEIOU TIPS - Oxygen - What to Look For

A

respiratory distress

Auscultate the chest

SP02 values

Don’t look at one of these in isolation

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9
Q

AEIOU TIPS - Psychiatric - What to Look For

A

potential mental, emotional and/or behavioural disorder?

Be aware of surroundings

Is there a history of same

What are preceding events/triggers?

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10
Q

AEIOU TIPS - Stroke/Shock - What to Look For

A

Control any haemorrhages, assess for signs of internal bleeding

Rule out MI through 12 lead ECG

Always perform a FAST assessment in any patient that is altered level of consciousness

Consider anaphylactic shock

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11
Q

AEIOU TIPS - Trauma - What to Look For

A

Evidence of visible trauma

History is key in ruling out any trauma

Thorough head to toe assessment

paediatrics aren’t well protected through the abdominal region, so small impacts an result in large trauma

They compensate well

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12
Q

AEIOU TIPS - Ureamia - What to Look For

A

Any potential issues with kidneys

History taking around all things toileting

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13
Q

ALOC is associated with conditions such as…

A

Inadequate brain perfusion

Hypoxia or increased carbon dioxide levels

Metabolic disturbances

Drugs or toxins

Primary CNS disorder

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14
Q

Asthma Risk Factors

A

Genetics

Boys

Early exposure to environmental irritants

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15
Q

Asthma Signs and Symptoms

A

Frequent coughing that worsens with viral infection, occurs while asleep or triggered by exercise or cold air

whistling/wheezing when breathing out

Shortness of breath

Chest congestion or tightness

Trouble sleeping due to shortness of breath, coughing or wheezing

Delayed recovery or bronchitis after a respiratory infection

Trouble breathing that hampers play or exercise

Fatigue, which can be due to poor sleep

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16
Q

Why are paediatrics more prone to respiratory failure?

A

Poor accessory muscle development

Less rigid, more horizontal thoracic cage

Increased metabolic and oxygen requirements

Decreased respiratory reserves

Less fatigue resistant twitch fibres

The younger the child the less able to compensate

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17
Q

At what age can children generally begin to participate in communication about their health care?

A

3 years

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18
Q

At what age do children reach the comprehension abilities of an adult?

A

12 years

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19
Q

Bronchiolitis Symptoms

A

runny nose

low grade fever

nasal congestion

coughing

wheezing

no appetite/poor feeding

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20
Q

Causes of Epilepsy

A

60% idiopathic

Brain abnormalities that occur in utero

Low oxygen during birth

Brain injury (TBI)

Brain infection
(meningitis or encephalitis)

Stroke

Brain tumour
(benign or malignant)

Neurodegenerative diseases
(Alzheimer’s disease)

Conditions that increase the likelihood of developing epilepsy
(Cerebral Palsy or Down syndrome)

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21
Q

Causes of Seizures

A

high fever

high or low blood sugar

alcohol or drug withdrawal

brain concussion

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22
Q

Characteristics of Asthma

A

Bronchospasm

Mucosal oedema

Airway inflammation

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23
Q

Characteristics of Croup

A

Appearance - well looking

Onset - viral prodrome, slower onset

Fever - <38.5 moderate

Stridor - usually mild - moderate

Cough - barking, seal-like quality

Speech - hoarse voice

Secretions - able to swallow

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24
Q

Characteristics of Epiglottitis

A

Appearance - toxic and unwell

Onset - abrupt 4-6 hrs

Fever - >38.5

Stridor - usually moderate - severe

Cough - minimal or absent

Speech - unable to speak

Secretions - unable to swallow, drooling of saliva

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25
Q

Childhood Risk Factors for Ischemic Stroke

A

Vasculitis

Autoimmune conditions and infections
(chickenpox can lead to vasculitis)

Focal Cerebral Arteriopathy (FCA)
(Can cause narrowing of blood vessels)

(blood vessel nflammation causing narrowing or weakness)

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26
Q

Chronic Hypertension

A

Long-standing - present prior to pregnancy; or

hypertension in first 20 weeks with SBP >140mmHg or DBP >90mmHg

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27
Q

Clinical Features of Button Battery Ingestion

A

Choking or gagging (sometimes overheard)

Hoarse voice

Dyspnoea

Stridor

Drooling

Painful swallowing

Vomiting

Unexplained intestinal bleeding

Food refusal

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28
Q

Clinical features of mild/moderate asthma

A

Conscious state - alert

General Appearance - mildly anxious

Speech - sentences

RR - <30 min (>5yrs)
<40 min (<5yrs)

Rhythm - prolonged expiratory phase

Effort - accessory muscle use

Skin - pale

HR - <120 (>5 yrs)
<140 (2-5yrs)

Breath Sounds - expiratory wheeze

Sats - 90-94%

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29
Q

Clinical features of severe asthma

A

Conscious state - altered (GXD 13-14)

General Appearance - distressed/agitated

Speech - words

RR - >30 min (>5yrs)
>40 min (<5yrs)

Rhythm - marked prolonged expiratory phase

Effort - accessory muscle use/intercostal retraction/TT

Skin - pale, sweating

HR - >120 (>5 yrs)
>140 (2-5yrs)

Breath Sounds - expiratory and inspiratory wheeze

Sats - <90%

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30
Q

Clinical Presentations of ALOC

A

confusion

disorientation

agitation

lethargy

obtundation

coma

GCS_<_14

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31
Q

Communication Tips for Paediatric Patients

A

Ask closed-ended questions:
“were you coughing at school yesterday?”
“do you have trouble breathing when you try to run?”

give them ample time to respond

talk the through what you are going to do before doing it

let them assist you if possible

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32
Q

Complications of RSV

A

a serious RSV infection in young children increases their risk of developing asthma

has been linked to an increase risk of sensitization to allergens and development of allergies

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33
Q

Components of paediatric breathing assessment

A

Body position

Visible movements of chest/abdomen and breathing pattern

Listen for abnormal audible airway sounds (snoring, hoarse speech, grunting and wheezing)

Airway adequacy, oxygenation and ventilation. Obstructed airways? Shortness of breath?

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34
Q

Components of paediatric circulation assessment

A

Assess skin colour (pallor, mottling and cyanosis)

Any obvious bleeding

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35
Q

Components of the appearance arm of the paediatric assessment triangle

A

tone

interactiveness

consolability

look and gaze

speech and cry

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36
Q

Components of the circulation arm of the paediatric assessment triangle

A

skin colour

early signs of shock

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37
Q

Components of the work of breathing arm of the paediatric assessment triangle

A

nasal faring

retractions

posturing

breath sounds

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38
Q

Language at different ages of paediatric patients

A

3 months - cooing and gurgling

6 monthes - babbling

12 months - first words

18 months - 5-40 words

2 years - 15-300 words, 2-3 word sentences

3 years - 900-1000 words, asks short questions

4 years - 2000 words, 5+ word sentences

5 years - identifying letters, longer sentences

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39
Q

Do all pts suffering from anaphylaxis have erythema and urticaria?

A

no - skin changes do not always occur if hypotensive

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40
Q

Extracranial causes of ALOC

A

Cardiovascular

Metabolic
(Hyper/hypoglycemia, hepatic or renal failure, disorders of electrolytes - sodium,
potassium, magnesium)

Endocrine
(Thyroid or pituitary disorders)

Toxins
(Sedative/hypnotics, ETOH, TCA’s, anticonvulsants, opiates)

Other
(Hypo/hyperthermia, Hypoxia/hypercarbia, infection, psychiatric, trauma)

(Arrhythmia)

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41
Q

Features of Absent Generalised Seizure

A

brief loss of awareness and responsiveness (usually <10 secs)

no post-ictal phase

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42
Q

Features of Atonic Generalised Seizure

A

Sudden loss of muscle tone (usually <2 seconds) resulting in sudden fall

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43
Q

Features of Myoclonic Generalised Seizure

A

brief, sudden jerking action of a muscle group (lasting milliseconds)

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44
Q

Features of Simple Febrile Seizures

A

occur in the setting of viral illnesses

occur at the beginning of an illness with the seizure often the first sign that a child is unwell

Generalised, brief, lasting less than a few minutes

Child returns to normal (<30 mins) post-ictal

generally tonic clonic, clonic or atonic

(URTI’s, gastroenteritis, pharyngitis)

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45
Q

Features of Tonic Clonic Generalised Seizure

A

abrupt sudden loss of consciousness and involuntary muscular contractions (tonic phase) followed by jerking movements (clonic phase)

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46
Q

Features of Tonic Generalised Seizure

A

Sudden increased muscle tone (lasts seconds to mins)

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47
Q

History Taking (questioning) in Stroke Patients

A

Time of onset?

What are main concerns?
(signs/symptoms)

What were they doing leading into this?

Have they had this before?

Any recent hits and trauma to the head?

What is their normal functioning level prior to this event?

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48
Q

How are a child’s lungs different to that of an adult?

A

less capacity

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49
Q

How are a child’s vocal cords different to that of an adult?

A

upwards slant

(horizontal in adult)

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50
Q

How is a child’s cricoiddifferent to that of an adult?

A

narrowest part of the airway

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51
Q

How is a child’s epiglottis different to that of an adult?

A

floppier

U shaped

shorter

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52
Q

How is a child’s larynx different to that of an adult?

A

more anterior and superior

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53
Q

How is a child’s tongue different to that of an adult?

A

larger in proportion to mouth

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54
Q

How is a child’s trachea different to that of an adult?

A

narrow and less rigid

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55
Q

How many joules per kilo are paediatrics administered?

A

4

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56
Q

How to Interact with Paediatric Patient’s Parents

A

engage their parents in conversation

ask the parents questions

be tolerant with parents - they are worried about their child

Answer their questions and break down the information for them so they understand

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57
Q

How to Perform Back Blows

A

apply a sharp blow to the centre of the patients back between the shoulder blades, using the heel of one hand

The appropriate force will differ between patients, but care must be taken to not cause injury

Infants may be placed in a head-down position to deliver back blows

After each blow, check to see if the airway obstruction has been relieved

The aim is to relieve the obstruction with each blow, rather than give all five blows

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58
Q

How to Perform Chest Thrusts

A

applied at the same point on the chest as chest compressions

sharper, but at a slower rate than chest compressions

Must be applied with the patients back supported to allow compression of the chest

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59
Q

How to promote safe drug administration practice

A

Work out your doses on the way to scene

Confirm your doses with the DCPM and/or your paediatric pocketbook

Confirm the dose with your partner

NEVER be afraid to double or triple check

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60
Q

Implication of Less Cartilage in the Airways

A

floppy and more compressible airways

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61
Q

Implication of More Mucous Cells in the Airways

A

more secretions and mucous production

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62
Q

Implication of Smaller Airways

A

increased resistance

(any swelling or congestion quickly leads to compromise)

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63
Q

Infant signs of congenital heart defect

A

SOB

cyanosis

difficulty with feeding

peripheral cyanosis

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64
Q

Intracranial causes of ALOC

A

CVA

subarachnoid haemorrhage

intracerebral haemorrhage

diffuse axonal injury

meningitis/encephalitis

post ictal states

epilepticus

space occupying lesion

febrile seizures

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65
Q

Key Information Needed if Overdose/poison/toxicity Suspected in Paediatric Patient

A

Age, gender and weight of the child

Agent involved

Time of ingestion or exposure.

Possible dose ingested and potential maximum possible

Symptoms

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66
Q

Key Questioning Around Perceived Asthma Risk

A

Previous asthma hx

type of asthma

previous admissions in last year (ED, PICU)

Triggers

onset of symtoms

What medication and/or plan they are on

are they compliant with plan

Socio economic status

health literacy

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67
Q

Magnesium Sulphate Pharmacology

A

triggers cerebral vasodilation, reducing ischemia generated by cerebral vasospasm

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68
Q

Management of Bronchiolitis

A

Position appropriately

Don’t agitate or further inflate situation

Provide oxygen requirement if needed

Transport

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69
Q

Management of Button Battery Ingestion

A

Attempt to identify the type of button battery

Take product packaging to hospital if possible

Keep pt nil by mouth

Consider:
IV access
Analgesia
Antiemetic

Transport to hospital

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70
Q

Management of Epiglottitis

A

Calm and reassurance

Avoid ANY unnecessary disturbance of patient

DO NOT attempt to look in throat

Avoid IV access unless resuscitation is required

Consider oxygen

TRANSPORT CODE 1

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71
Q

Symptoms of Mild Foreign Body Airway Obstruction (FBAO)

A

Effective cough

Crying or verbal response

Able to take a breath before coughing

Fully responsive

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72
Q

Management of Life Threatening Asthma

A

Oxygen Adrenaline Salbutamol Ipratropium bromide Hydrocortisone Magnesium If RR less than 10 commence IPPV with NEB CPAP

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73
Q

Management of Mild Foreign Body Airway Obstruction (FBAO)

A

Patients themselves will optimise position (sitting forward)

Encourage coughing

Provide reassurance

Provide supportive cares

Closely monitor patient for worsening of condition

Consider:
Up to 5 sharp back blows
Up to 5 chest thrusts
Repeat if required

Continue to assess and manage for deterioration

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74
Q

Management of Seizures

A

rest and reassurance

Pt assessment and Hx taking

Midazolam

Pt positioning and safety

Consider reversible causes

Oxygen

IPPV

CCP backup for Levetiracetam (Keppra)

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75
Q

Management of Severe Asthma

A

Oxygen Adrenaline Salbutamol Ipratropium bromide Hydrocortisone Magnesium CPAP

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76
Q

Management of Strokes in Paediatrics

A

Oxygen

Antiemetic

Analgesia

IV fluids

NIHHSS – 8 score (if 8 years or up)

Premorbid MRS
(level of functioning prior to episode today)

Pre-notify hospital and transport code 1

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77
Q

Management of Unsconscious Foreign Body Airway Obstruction (FBAO)

A

Consider:

Removing obstruction under direct visualisation
(laryngoscopy/magills)

Oxygen

Gentle IPPV

LMA/ETT

Commence CPR if the patient deteriorates further

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78
Q

Mild Croup (WCS <2) Treatment

A

Keep patient calm (avoid further distress)

Assess the Westley croup score

If febrile, administer paracetamol

Consider Dexamethasone PO (0.3mg/kg)

Reassess WCS every 15 minutes

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79
Q

Mild Persistent Asthma Presentations

A

presents with one of following:

Daytime symptoms more than once a week but not everyday

Nightime symptoms more than twice a week

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80
Q

Mild/Moderate Asthma Management

A

Oxygen

Salbutamol

Ipratropium bromide (atrovent)

Hydrocortisone

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81
Q

Moderate Croup (WCS 3-7) Treatment

A

Keep patient calm (avoid further distress)

Assess the Westley croup score

If febrile, administer paracetamol

Administer adrenaline NEB 5mg

Consider Dexamethasone PO (0.3mg/kg)

Reassess WCS every 15 minutes

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82
Q

Moderate Persistent Asthma Presentations

A

presents with one of following:

Daily daytime symptoms

Nightime symptoms more than once per week

Symptoms sometimes restrict activity or sleep

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83
Q

Non-fatal Choking Statistics

A

Food at approx. 60%

Non-food items (coins, marbles, balloons) at approx. 30%

Remaining 10% unknown

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84
Q

Paediatric Age Classifications

A

Newborn – first 6 weeks of life

Baby: 0-12 months of life

Toddler: 1 – 3 years

Pre-school: 3 – 5 years

Child: 6 – 12 years

Adolescent: 12 and up

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85
Q

Paediatric Age Range

A

1 yr - 12 yrs

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86
Q

Paediatric Assessment Triangle cardiorespiratory failure components

A

appearance

breathing

circulation

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87
Q

Paediatric Assessment Triangle cns/metabolic components

A

appearance

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88
Q

Paediatric Assessment Triangle resiratory failure components

A

appearance

breathing

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89
Q

Paediatric Assessment Triangle respiratory distress components

A

breathing

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90
Q

Paediatric Assessment Triangle shock components

A

appearance

circulation

91
Q

Paediatric Glascow Coma Scale (PGCS) 0 - 12 months

A

Eye Opening
Spontaneously 4
To shout 3
To pain 2
No Response 1

Verbal Response
Smiles/coos appropriately 5
Cries and is consolable 4
Persistent innappropriate 3
crying and/or screaming
Grunts, agitated, restless 2
No Response 1

Motor Response
Obeys 6
Localises to pain 5
Withdraws from pain 4
Abnormal flexion 3
Abnormal extension 2
No response 1

92
Q

Paediatric Glascow Coma Scale (PGCS) 13 - 23 Months

A

Eye Opening
Spontaneously 4
To verbal command 3
To pain 2
No Response 1

Verbal Response
Smiles/coos appropriately 5
Cries and is consolable 4
Persistent innappropriate 3
crying and/or screaming
Grunts, agitated, restless 2
No Response 1

Motor Response
Obeys 6
Localises to pain 5
Withdraws from pain 4
Abnormal flexion 3
Abnormal extension 2
No response 1

93
Q

Paediatric Glascow Coma Scale (PGCS) 2 - 5 years

A

Eye Opening
Spontaneously 4
To verbal command 3
To pain 2
No Response 1

Verbal Response
Appropriate words/phrases 5
Inappropriate words 4
Persistent cries and screams 3
Grunts 2
No Response 1

Motor Response
Obeys 6
Localises to pain 5
Withdraws from pain 4
Abnormal flexion 3
Abnormal extension 2
No response 1

94
Q

Paediatric Glascow Coma Scale (PGCS) >5 yrs

A

Eye Opening
Spontaneously 4
To verbal command 3
To pain 2
No Response 1

Verbal Response
Oriented 5
Disoriented/confused 4
Inappropriate words 3
Incomprehensible Sounds 2
No Response 1

Motor Response
Obeys 6
Localises to pain 5
Withdraws from pain 4
Abnormal flexion 3
Abnormal extension 2
No response 1

95
Q

Paediatric Pain Assessment Mnemonic

A

W – Where is the pain?
Can you point to the pain for me?

H- How long have you had it?
Did you wake up with that pain?

E – Explain the pain?
What does it feel like?

R – any radiation?
Is it just here?

E – Anything exacerbate it?
When you stop moving it, does it feel better?

S – Score the pain
Is it a big pain or a little pain?

96
Q

Paramedic Management of Pre-Eclampsia and Eclampsia

A

empathy and reassurance

manage symptomatically

consider magnesium if seizure activity and midazolam if no CCP

97
Q

Prenatal Stroke Risk Factors

A

pregnancy complications

difficulties during birth

infections

clotting disorders in mother or baby

cardiac issues and arrhythmias

98
Q

Risk Factors for Haemorrhagic Stroke

A

Arteriovenous malformation (AVM)

Cavernous malformation
(cluster of abnormal blood vessels)

Aneurysm
(weak or thin spot on an artery wall)

(tangled mass of blood vessels in the brain)

99
Q

Risk Factors for Stroke at Any Age

A

Head or neck trauma

Moyamoya disease
(progressive narrowing and blockage of blood vessels)

(Dissection - injury to blood vessels causing blood clot or leakage)

100
Q

Seizure Definition

A

a transient disturbance of cerebral function caused by abnormal neuronal activity in the brain

101
Q

Seizure Signs and Symptoms

A

Disorientated movements

Nystagmus

Increase or loss of tone

Localised twitching of muscles without impaired consciousness

Nonsensical speech

Sudden pause in activity or fixed gaze

Incontinence

Post-ictal: confusion, fatigue, headache, nausea

102
Q

Sequence of Assessments in ALOC Pts

A

Paediatric assessment triangle (PAT)

Primary survey (find it, fix it)

then based on above, the following assessments in any order:

Neurovascular/cardiovascular/respiratory

H2T

Sample/pain assessments

103
Q

Severe Croup (WCS _>_8) Treatment

A

Keep patient calm (avoid further distress)

Assess the Westley croup score

If febrile, administer paracetamol

Administer Dexamethasone PO (0.3mg/kg)

Administer adrenaline NEB 5mg

Reassess WCS every 15 minutes

104
Q

Severe Persistent Asthma Presentations

A

presents with one of following:

Continual daytime symptoms

Frequent nighttime symptoms

Frequent flare ups

Symptoms frequently restrict activity or sleep

105
Q

Should respiratory assessments be conducted on all paediatric patients irrespective of type of complaint?

A

Yes

106
Q

Signs and Symptoms of Croup

A

URTI symptoms – 1-2 days prior

Hoarse voice

Barking seal like cough

Inspiratory stridor

Accessory muscle use

Worse at night and in winter

Sudden onset

Low grade fever

symptoms worst around days 3-7

107
Q

Signs and Symptoms of Epiglotttitis

A

High fever

Sore throat/difficulty swallowing

Stridor/respiratory distress

Difficultly swallowing

Drooling

108
Q

Signs and Symptoms of Reflux and GERD

A

Spitting up and vomiting

Refusal to eat or difficulty eating or swallowing

Irritability during feeding

Wet burps or hiccups

Failure to gain weight

Abnormal arching

Frequent coughing

Gagging and choking

Disturbed sleep

109
Q

Signs and Symptoms of Stroke in Babies

A

seizures

extreme sleepiness

using only one side of body

110
Q

Signs and Symptoms of Stroke in Toddlers, Children and Teenagers

A

collapse

changes in behaviour and difficulty concentrating

weakness or numbness in face, arm or leg - especially on one side

dizziness, loss of balance or poor coordination

severe or unusual headaches, nausea or vomiting

seizures with weakness that doesn’t improve

trouble seeing or loss of vision

difficulty talking, understanding reading or writing

difficulty swallowing, including drooling

111
Q

Signs of perinatal OCD

A

significant fear of harm coming to the infant

over estimation of apparent threats

112
Q

Signs of Respiratory Distress in a Paediatric

A

clammy

pallor

cyanosis

lethargy

head bobbing

nasal flaring

weak cry

grunting

cricoid/tracheal tug

sternal recession/retraction

sub costal and intercostal recession

tachypnoea

stridor

wheeze

tachycardia

hypoxemia

hypercarbia

113
Q

Social and emotional questions for obstetric patients

A

Ask about their current mental health

Do they have support around them?

Is their partner around?

114
Q

Steps in the approach to a paediatric patient

A

The Paediatric Assessment Triangle (PAT)

Primary survey

Secondary survey (cardiovascular, respiratory, neurological)

SAMPLE and pain assessment

Head to toe assessment

115
Q

Symptoms of Severe Foreign Body Airway Obstruction (FBAO)

A

Absent or ineffective cough

Unable to vocalise

Worsening stridor

Quiet or silent chest

Cyanosis

Decreasing LOC

116
Q

The first rhythm analysis in a paediatric pt 1 year or older is performed in what mode?

A

AED

117
Q

The three key components of the paediatric assessment triangle

A

apearance

work of breathing

circulation

Note: Any observed abnormality within an arm of the triangle qualifies the entire component as abnormal

118
Q

Tx for suspected congenital heart defects

A

hi flow oxygen

transport

119
Q

Tx of reflux and GERD

A

Treat symptomatically

Get baby in a position of comfort

Support and reassure mother

Gain key information – feeding, sleeping, weight gain, wet nappies, temperature

Transport to hospital

Both baby and parents may need help and support.

120
Q

Types of congenital heart issues

A

Blockages that prevent blood flow around the heart and arteries

Abnormal blood flow through the heart (holes in heart)

Parts of the heart under develop

babies are often born with a combination

121
Q

Types of Generalised Seizures

A

absent

atonic

tonic

myoclonic

tonic clonic

122
Q

Westley Croup Score Air Entry Variables and Scores

A

Markedly decreased - 2

Decreased - 1

Normal - 0

123
Q

Westley Croup Score Chest Wall Retractions Variables and Scores

A

Severe - 3

Moderate - 2

Mild - 1

None - 0

124
Q

Westley Croup Score Components

A

Level of consciousness

Cyanosis

Stridor

Air entry

Chest wall retractions

125
Q

Westley Croup Score Cyanosis Variables and Scores

A

At rest - 5

With agitation - 4

None - 0

126
Q

Westley Croup Score LOC Variables and Scores

A

Disorientated - 5

Normal, including sleep - 0

127
Q

Westley Croup Score Results

A

MILD CROUP: <2

MODERATE CROUP: 3 to 5

SEVERE CROUP: 6 to 11

SEVERE RESPIRATORY FAILURE: >12

128
Q

Westley Croup Score Stridor Variables and Scores

A

At rest - 2

With agitation - 1

None - 0

129
Q

What 2 conditions must always be considered in Complex Febrile Seizures/Status Epilepticus

A

meningitis

encephalitis

130
Q

What age does QAS define a paediatric patient?

A

12 years of age or less

131
Q

What age group does croup usually affect?

A

children between six months and five years old

it can affect older children

some children get croup several times

132
Q

What ages do febrile seizures typically occur in?

A

6 mths - 6 years

133
Q

What ages does childhood stroke occur?

A

1 month to 18 years

134
Q

What are Complex Febrile Seizures?

A

frequent cause of status epilepticus

135
Q

What are our pulse points to start resuscitation in the unresponsive paediatric pt?

A

Newborn: HR <60

1-12 yrs: HR <40

136
Q

What are the 2 main categories of ALOC?

A

intracranial

extracranial

137
Q

What are the 4 key categories of paediatric assessment?

A

Weight

Anatomy

Physiology

Psychology

138
Q

What are the keys of appropriate pain management?

A

Assessment of pain

Provision of appropriate non pharmacological and pharmacological analgesia based on the pain assessment

Reassessment of pain after analgesia

139
Q

What are the most common dysrhythmias seen in paediatric arrests?

A

bradycardia

asystole

140
Q

What are the two categories of seizures?

A

focal

generalised

141
Q

What are the two types of focal seizures?

A

focal

focal dyscognitive

142
Q

What causes aspiration?

A

Dysphagia (difficulty swallowing) – muscles don’t work properly

Abnormal anatomy (cleft palate)

Delayed growth (prematurity)

Brain damage

Cranial nerve issue

Gastroesophageal reflux disease (GERD)

143
Q

What causes croup?

A

viral infection, with some caused by bacteria

(parainfluenza, common influenza, rsv)

144
Q

What causes epiglottitis?

A

bacteria haemophilus influence

145
Q

What causes haemorrhagic strokes?

A

a break in the wall of a weakened vessel

146
Q

What causes ischaemic stroke?

A

embolic (clot) or thrombotic (plaque) occlusion of a vessel

147
Q

Causes of Perinatal Stroke

A

congenital heart disease

infection

blood clotting disorders

placental disorders

birth trauma

148
Q

What does TICLS stand for?

A

Tone - good muscle tone, moves spontaneously, sits or stands appropriately for age.

Interaction - Appears alert and engaged with caregiver or paramedic, interacts with people/environment

Consolability - Stops crying when comforted or held by caregiver, has different response to caregiver versus paramedic

Look (gaze) - Makes eye contact, tracks objects

Speech (cry) - strong cry, age appropriate speech

149
Q

What happens when a button battery is ingested?

A

They get stuck in esophagus (throat) which triggers an electrical current causing a chemical reaction that can severely burn the oesophagus in as little as two hours

150
Q

What information do we want to find out about the BRUE episode?

A

description

choking/gagging

breathing

colour

distress

conscious state

tone

movement

151
Q

What is a coarctation of aorta?

A

Narrowing of the aorta

152
Q

What is a febrile seizure?

A

seizure that occurs in conjunction with a high temperature (>38 degrees)

153
Q

What is a focal seizure?

A

abnormal neuronal activity is limited to one hemisphere of the cerebral cortex

154
Q

What is a generalised seizure?

A

abnormal neuronal activity rapidly engages both hemispheres of the cerebral cortex

155
Q

What is a perinatal stroke?

A

Occurs before or shortly after birth
28 weeks gestation to one-month-old)

also known as fetal, prenatal, neonatal and in-utero stroke

156
Q

What is a stroke?

A

blood flow to a portion of the brain is interrupted causing ischemia and if not restored it will eventually lead to permanent brain injury

157
Q

What is aspiration?

A

The process of something entering the airway or lungs by accident (food, liquid, other materials)

158
Q

What is Asthma?

A

chronic pulmonary disease characterised by recurrent but usually reversible lower airway obstruction

159
Q

What is bimanual compression?

A

invasive two-handed technique to manually compress the uterus
wall which is continued through to definitive care (theatre).

160
Q

What is Brief Resolved Unexplained Event (BRUE)?

A

an event in an infant that is characterised by a marked change in breathing, tone, colour or level of responsiveness, followed by a complete return to a baseline state, and that cannot be explained by a medical cause

161
Q

What is Bronchiolitis?

A

inflammation of the bronchioles

typically affects infants and children under 2

almost always caused by a respiratory virus

162
Q

What is choking?

A

the blockage or hindrance of respiration by a foreign body obstruction in the airway

163
Q

What is congenital heart disease?

A

a general term for any defect of the heart, heart valves or central blood vessels that are present at birth

164
Q

What is croup?

A

a common viral inflammatory illness of the subglottic structures causing inspiratory stridor and barking cough

165
Q

What is Epiglottitis?

A

serious life threatening inflammation and swelling of the epiglottis

can block the airway

can go from being well to having a serious airway blockage in 4-6hours

166
Q

What is Epilepsy?

A

condition of unprovoked, recurrent seizures

167
Q

What is frequent intermittent asthma?

A

shorter intervals (< 6 – 8 weeks)

No symptoms between flare-ups

May have preventative therapy

Accounts for 20% of childhood asthma

168
Q

What is infrequent intermittent asthma?

A

Have isolated episodes and remain symptom free for 6+ week

Management required for individual flare ups

Most cases are mild

Account for 60% of presentations for asthma

169
Q

What is persistent Asthma?

A

5-10% of paediatric asthma presentations with mild, moderate and severe classifications

170
Q

What is poisoning?

A

the process whereby cells are injured or destroyed by the inhalation, ingestion, injection or absorption of a toxic substance

171
Q

What is reflux and GERD?

A

The acidic contents of the stomach travel back up the oesophagus

172
Q

What is Respiratory Distress Syndrome (RDS)?

A

a common cause of respiratory distress in a newborn, presenting within hours after birth, most often immediately after delivery

primarily affects preterm neonates and infrequently, term infants

incidence is proportional to infant’s gestational age

is more severe in smaller and more premature neonates

173
Q

What is Respiratory Syncytial Virus (RSV)?

A

the most common cause of respiratory and breathing infections in children

causes infection of the lungs and breathing passages, and one of the most frequent causes of the common cold

Most children aged under two years have been infected by RSV

possible to get RSV repeatedly

particularly bubs with immature systems and when have just started day care

174
Q

What is status epilepticus?

A

seizure activity greater than 5 minutes in duration or recurrent seizure activity where the Pt does not recover to GCS15 prior to another seizure

175
Q

What is tactile stimulation?

A

vigorous warming, drying and rubbing of the back and soles of the feet in the newborn to stimulate respiratory activity

176
Q

What is the cause of reflux and GERD?

A

the lower osephageal sphincter (LES) is weak and underdeveloped and doesn’t close off properly

177
Q

What is the CPR ratio utilised in paediatric patients?

A

30: 2 singer officer
15: 2 two officer

reassess every 2 minutes

178
Q

What is the epiglottis?

A

thin cartilage structure at the root of the tongue that closes off the windpipe (trachea) when foods or liquids are being swallowed

179
Q

What is the main cause of bronchiolitis?

A

RSV

180
Q

What is the management pathway for febrile seizures?

A

active cooling

midazolam

181
Q

What is the maxiumum joulage that can be adminitered through the paediatric pads?

A

100 joules

182
Q

What is the Paediatric Assessment Triangle?

A

an internationally accepted tool for the initial emergency assessment of infants and children

183
Q

What is the type of focal seizure when awareness or responsiveness is not impaired?

A

focal

184
Q

What is the type of focal seizure where the level of awareness or responsiveness is reduced but full consciousness is not lost?

A

focal dyscognitive

185
Q

What is transposition of the great vessels?

A

The two main heart arteries are switched.

The aorta arises from the right ventricle and receives blue blood whilst the pulmonary artery arises from the left ventricle.

186
Q

What respiratory ailments rate in the top 10 of hospital presentations for paediatric patients?

A

URTI

asthma

croup

bronchiolitis

187
Q

What should we always consider in a paediatric pt that is unresponsive?

A

foreign body airway obstruction

188
Q

What signs and symptoms will you see related to to the integumentary system in anaphylaxis?

A

urticaria (rash)

angioedema (swelling)

pruritus (itch)

flushed skin

189
Q

What signs and symptoms will you see related to to the gastrointestinal system in anaphylaxis?

A

nausea

vomiting

diarrhoea

abdominal pain

190
Q

What signs and symptoms will you see related to to the cardiovascular system in anaphylaxis?

A

hypotension

dizziness

bradycardia/tachycardia

collapse

191
Q

What signs and symptoms will you see related to to the respiratory system in anaphylaxis?

A

difficultly breathing

wheeze

upper airway swelling

rhinitis

192
Q

What systems are generally involed in an anaphylactic reaction?

A

cardiovascular respiratory integumentary gastrointestinal

193
Q

What systems are generally involed in an anaphylactic reaction?

A

cardiovascular

respiratory

integumentary

gastrointestinal

194
Q

What treatment options do we have if the anaphylaxis pt is refractory to 3 IM adrenaline injections?

A

glucagon for refractory anaphylaxis nebulised adrenaline (5mg) for persistent wheeze nebulised salbutamol (2.5mg NEB 1-5yrs, 6 yrs and older 5mg) hydrocortisone (4mg/kg) for persistent wheeze

195
Q

When are seizures diagnosed as epilepsy?

A

When a child has 2 or more seizures with no known cause

196
Q

When should foregin body inhalation be strongly suspected?

A

where the history details sudden onset of choking, coughing, dyspnoea, laboured breathing, dysphagia and gagging

197
Q

Where is the pad placement for paediatric pts?

A

anterior and posterior

198
Q

Which age range get paediatric pads?

A

5yrs and under

199
Q

Who are high risk people for RSV?

A

Premature babies in ft rs year of life

Infants under 6 months

Children with asthma

people with weakened immune system or underlying heart problems

200
Q

What stages of life is epilepsy more common to develop in?

A

children

adolescents

people over 60

201
Q

Why are paediatric patients more susceptible to Respiratory illnesses?

A

airways are proportionately smaller than that of an adult

airways are more susceptible to obstruction and swelling

immature immune systems

oxygen requirements are nearly double that of an adult

oxygen requirements just satisfy metabolic demands, with little left in reserve

202
Q

Why do anaphylactic patients present as hypotensive?

A

due to the release of histamine causing widespread vasodilation

203
Q

Why do we transport Brue pts to hospital?

A

further assessment and examination

204
Q

Why does a grunting occur in respiratory distress?

A

Increase positive end expiratory pressure

205
Q

Why does a weak cry occur in respiratory distress?

A

Sign of fatigue and shows the child is prioritising energy expenditure for work of breathing

206
Q

Why does clammy skin occur in respiratory distress?

A

high energy expenditure to breathe therefore sweating to regulate

207
Q

Why does cricoid/tracheal tug occur in respiratory distress?

A

Increase pull of diaphragm is tugs downwards on the trachea during inspiration

208
Q

Why does cyanosis occur in respiratory distress?

A

reduced haemoglobin and peripheral circulation-indicates poor oxygen saturation levels

209
Q

Why does head bobbing occur in respiratory distress?

A

high use of sternocleidomastoid and scalene muscles

210
Q

Why does hypercarbia occur in respiratory distress?

A

reduced ability to expire carbon dioxide

211
Q

Why does hypoxemia occur in respiratory distress?

A

reduced ability to oxygenate

212
Q

Why does lethargy occur in respiratory distress?

A

breathless and working hard causes discomfort and agitation

reserved energy for work of breathing

213
Q

Why does nasal flaring occur in respiratory distress?

A

To help increase the diameter of the airway

214
Q

Why does pallor occur in respiratory distress?

A

Not oxygenating effectively

215
Q

Why does sternal recession/retraction occur in respiratory distress?

A

high negative pressures on inspiration

216
Q

Why does stridor occur in respiratory distress?

A

partial obstruction of upper trachea

217
Q

Why does subcostal and intercostal recession occur in respiratory distress?

A

high negative pressures on inspiration

218
Q

Why does tachycardia occur in respiratory distress?

A

to assist in oxygen transport

219
Q

Why does tachypnoea occur in respiratory distress?

A

Unable to increase tidal volume

220
Q

Why does wheeze occur in respiratory distress?

A

Narrowing or obstruction of the small airways by secretions or inflammation

221
Q

Why is choking more common in paediatrics?

A

child’s airway is much smaller so a small object can drastically affect ability to breathe

children do not generate the same force when coughing, so efforts may not be enough to dislodge a foreign body

children commonly put objects in their mouths, starting in infancy as they discover their environment

222
Q

Why is it important that we transport Croup pts to hospital?

A

There is no definitive treatment for the virus that causes croup and treatment that reduces the eodema can be short lived.

223
Q

Prevalance of Respiratory Distress Syndrome (RDS)

A

98% at 24 weeks 5% at 34 weeks \<1% at 37 weeks

Bachelor of Paramedic Science (19 decks)

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