SPOPs Paediatrics Flashcards
AEIOU TIPS Mnemonic for ALOC - What to Look For
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
AEIOU TIPS - Alcohol - What to Look For
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
AEIOU TIPS - Electrolytes - What to Look For
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)
AEIOU TIPS - Epilepsy - What to Look For
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
AEIOU TIPS - Infectious - What to Look For
febrile and/or extremely cold
Any obvious signs of infection
Any history around recent sickness?
Think….could this be sepsis?
AEIOU TIPS - Insulin - What to Look For
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
AEIOU TIPS - Overdose (drugs/poisons/toxins) - What to Look For
dangerous substances
AEIOU TIPS - Oxygen - What to Look For
respiratory distress
Auscultate the chest
SP02 values
Don’t look at one of these in isolation
AEIOU TIPS - Psychiatric - What to Look For
potential mental, emotional and/or behavioural disorder?
Be aware of surroundings
Is there a history of same
What are preceding events/triggers?
AEIOU TIPS - Stroke/Shock - What to Look For
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
AEIOU TIPS - Trauma - What to Look For
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
AEIOU TIPS - Ureamia - What to Look For
Any potential issues with kidneys
History taking around all things toileting
ALOC is associated with conditions such as…
Inadequate brain perfusion
Hypoxia or increased carbon dioxide levels
Metabolic disturbances
Drugs or toxins
Primary CNS disorder
Asthma Risk Factors
Genetics
Boys
Early exposure to environmental irritants
Asthma Signs and Symptoms
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
Why are paediatrics more prone to respiratory failure?
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
At what age can children generally begin to participate in communication about their health care?
3 years
At what age do children reach the comprehension abilities of an adult?
12 years
Bronchiolitis Symptoms
runny nose
low grade fever
nasal congestion
coughing
wheezing
no appetite/poor feeding
Causes of Epilepsy
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)
Causes of Seizures
high fever
high or low blood sugar
alcohol or drug withdrawal
brain concussion
Characteristics of Asthma
Bronchospasm
Mucosal oedema
Airway inflammation
Characteristics of Croup
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
Characteristics of Epiglottitis
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
Childhood Risk Factors for Ischemic Stroke
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)
Chronic Hypertension
Long-standing - present prior to pregnancy; or
hypertension in first 20 weeks with SBP >140mmHg or DBP >90mmHg
Clinical Features of Button Battery Ingestion
Choking or gagging (sometimes overheard)
Hoarse voice
Dyspnoea
Stridor
Drooling
Painful swallowing
Vomiting
Unexplained intestinal bleeding
Food refusal
Clinical features of mild/moderate asthma
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%
Clinical features of severe asthma
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%
Clinical Presentations of ALOC
confusion
disorientation
agitation
lethargy
obtundation
coma
GCS_<_14
Communication Tips for Paediatric Patients
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
Complications of RSV
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
Components of paediatric breathing assessment
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?
Components of paediatric circulation assessment
Assess skin colour (pallor, mottling and cyanosis)
Any obvious bleeding
Components of the appearance arm of the paediatric assessment triangle
tone
interactiveness
consolability
look and gaze
speech and cry
Components of the circulation arm of the paediatric assessment triangle
skin colour
early signs of shock
Components of the work of breathing arm of the paediatric assessment triangle
nasal faring
retractions
posturing
breath sounds
Language at different ages of paediatric patients
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
Do all pts suffering from anaphylaxis have erythema and urticaria?
no - skin changes do not always occur if hypotensive
Extracranial causes of ALOC
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)
Features of Absent Generalised Seizure
brief loss of awareness and responsiveness (usually <10 secs)
no post-ictal phase
Features of Atonic Generalised Seizure
Sudden loss of muscle tone (usually <2 seconds) resulting in sudden fall
Features of Myoclonic Generalised Seizure
brief, sudden jerking action of a muscle group (lasting milliseconds)
Features of Simple Febrile Seizures
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)
Features of Tonic Clonic Generalised Seizure
abrupt sudden loss of consciousness and involuntary muscular contractions (tonic phase) followed by jerking movements (clonic phase)
Features of Tonic Generalised Seizure
Sudden increased muscle tone (lasts seconds to mins)
History Taking (questioning) in Stroke Patients
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?
How are a child’s lungs different to that of an adult?
less capacity
How are a child’s vocal cords different to that of an adult?
upwards slant
(horizontal in adult)
How is a child’s cricoiddifferent to that of an adult?
narrowest part of the airway
How is a child’s epiglottis different to that of an adult?
floppier
U shaped
shorter
How is a child’s larynx different to that of an adult?
more anterior and superior
How is a child’s tongue different to that of an adult?
larger in proportion to mouth
How is a child’s trachea different to that of an adult?
narrow and less rigid
How many joules per kilo are paediatrics administered?
4
How to Interact with Paediatric Patient’s Parents
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
How to Perform Back Blows
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
How to Perform Chest Thrusts
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
How to promote safe drug administration practice
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
Implication of Less Cartilage in the Airways
floppy and more compressible airways
Implication of More Mucous Cells in the Airways
more secretions and mucous production
Implication of Smaller Airways
increased resistance
(any swelling or congestion quickly leads to compromise)
Infant signs of congenital heart defect
SOB
cyanosis
difficulty with feeding
peripheral cyanosis
Intracranial causes of ALOC
CVA
subarachnoid haemorrhage
intracerebral haemorrhage
diffuse axonal injury
meningitis/encephalitis
post ictal states
epilepticus
space occupying lesion
febrile seizures
Key Information Needed if Overdose/poison/toxicity Suspected in Paediatric Patient
Age, gender and weight of the child
Agent involved
Time of ingestion or exposure.
Possible dose ingested and potential maximum possible
Symptoms
Key Questioning Around Perceived Asthma Risk
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
Magnesium Sulphate Pharmacology
triggers cerebral vasodilation, reducing ischemia generated by cerebral vasospasm
Management of Bronchiolitis
Position appropriately
Don’t agitate or further inflate situation
Provide oxygen requirement if needed
Transport
Management of Button Battery Ingestion
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
Management of Epiglottitis
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
Symptoms of Mild Foreign Body Airway Obstruction (FBAO)
Effective cough
Crying or verbal response
Able to take a breath before coughing
Fully responsive
Management of Life Threatening Asthma
Oxygen Adrenaline Salbutamol Ipratropium bromide Hydrocortisone Magnesium If RR less than 10 commence IPPV with NEB CPAP
Management of Mild Foreign Body Airway Obstruction (FBAO)
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
Management of Seizures
rest and reassurance
Pt assessment and Hx taking
Midazolam
Pt positioning and safety
Consider reversible causes
Oxygen
IPPV
CCP backup for Levetiracetam (Keppra)
Management of Severe Asthma
Oxygen Adrenaline Salbutamol Ipratropium bromide Hydrocortisone Magnesium CPAP
Management of Strokes in Paediatrics
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
Management of Unsconscious Foreign Body Airway Obstruction (FBAO)
Consider:
Removing obstruction under direct visualisation
(laryngoscopy/magills)
Oxygen
Gentle IPPV
LMA/ETT
Commence CPR if the patient deteriorates further
Mild Croup (WCS <2) Treatment
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
Mild Persistent Asthma Presentations
presents with one of following:
Daytime symptoms more than once a week but not everyday
Nightime symptoms more than twice a week
Mild/Moderate Asthma Management
Oxygen
Salbutamol
Ipratropium bromide (atrovent)
Hydrocortisone
Moderate Croup (WCS 3-7) Treatment
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
Moderate Persistent Asthma Presentations
presents with one of following:
Daily daytime symptoms
Nightime symptoms more than once per week
Symptoms sometimes restrict activity or sleep
Non-fatal Choking Statistics
Food at approx. 60%
Non-food items (coins, marbles, balloons) at approx. 30%
Remaining 10% unknown
Paediatric Age Classifications
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
Paediatric Age Range
1 yr - 12 yrs
Paediatric Assessment Triangle cardiorespiratory failure components
appearance
breathing
circulation
Paediatric Assessment Triangle cns/metabolic components
appearance
Paediatric Assessment Triangle resiratory failure components
appearance
breathing
Paediatric Assessment Triangle respiratory distress components
breathing
Paediatric Assessment Triangle shock components
appearance
circulation
Paediatric Glascow Coma Scale (PGCS) 0 - 12 months
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
Paediatric Glascow Coma Scale (PGCS) 13 - 23 Months
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
Paediatric Glascow Coma Scale (PGCS) 2 - 5 years
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
Paediatric Glascow Coma Scale (PGCS) >5 yrs
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
Paediatric Pain Assessment Mnemonic
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?
Paramedic Management of Pre-Eclampsia and Eclampsia
empathy and reassurance
manage symptomatically
consider magnesium if seizure activity and midazolam if no CCP
Prenatal Stroke Risk Factors
pregnancy complications
difficulties during birth
infections
clotting disorders in mother or baby
cardiac issues and arrhythmias
Risk Factors for Haemorrhagic Stroke
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)
Risk Factors for Stroke at Any Age
Head or neck trauma
Moyamoya disease
(progressive narrowing and blockage of blood vessels)
(Dissection - injury to blood vessels causing blood clot or leakage)
Seizure Definition
a transient disturbance of cerebral function caused by abnormal neuronal activity in the brain
Seizure Signs and Symptoms
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
Sequence of Assessments in ALOC Pts
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
Severe Croup (WCS _>_8) Treatment
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
Severe Persistent Asthma Presentations
presents with one of following:
Continual daytime symptoms
Frequent nighttime symptoms
Frequent flare ups
Symptoms frequently restrict activity or sleep
Should respiratory assessments be conducted on all paediatric patients irrespective of type of complaint?
Yes
Signs and Symptoms of Croup
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
Signs and Symptoms of Epiglotttitis
High fever
Sore throat/difficulty swallowing
Stridor/respiratory distress
Difficultly swallowing
Drooling
Signs and Symptoms of Reflux and GERD
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
Signs and Symptoms of Stroke in Babies
seizures
extreme sleepiness
using only one side of body
Signs and Symptoms of Stroke in Toddlers, Children and Teenagers
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
Signs of perinatal OCD
significant fear of harm coming to the infant
over estimation of apparent threats
Signs of Respiratory Distress in a Paediatric
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
Social and emotional questions for obstetric patients
Ask about their current mental health
Do they have support around them?
Is their partner around?
Steps in the approach to a paediatric patient
The Paediatric Assessment Triangle (PAT)
Primary survey
Secondary survey (cardiovascular, respiratory, neurological)
SAMPLE and pain assessment
Head to toe assessment
Symptoms of Severe Foreign Body Airway Obstruction (FBAO)
Absent or ineffective cough
Unable to vocalise
Worsening stridor
Quiet or silent chest
Cyanosis
Decreasing LOC
The first rhythm analysis in a paediatric pt 1 year or older is performed in what mode?
AED
The three key components of the paediatric assessment triangle
apearance
work of breathing
circulation
Note: Any observed abnormality within an arm of the triangle qualifies the entire component as abnormal
Tx for suspected congenital heart defects
hi flow oxygen
transport
Tx of reflux and GERD
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.
Types of congenital heart issues
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
Types of Generalised Seizures
absent
atonic
tonic
myoclonic
tonic clonic
Westley Croup Score Air Entry Variables and Scores
Markedly decreased - 2
Decreased - 1
Normal - 0
Westley Croup Score Chest Wall Retractions Variables and Scores
Severe - 3
Moderate - 2
Mild - 1
None - 0
Westley Croup Score Components
Level of consciousness
Cyanosis
Stridor
Air entry
Chest wall retractions
Westley Croup Score Cyanosis Variables and Scores
At rest - 5
With agitation - 4
None - 0
Westley Croup Score LOC Variables and Scores
Disorientated - 5
Normal, including sleep - 0
Westley Croup Score Results
MILD CROUP: <2
MODERATE CROUP: 3 to 5
SEVERE CROUP: 6 to 11
SEVERE RESPIRATORY FAILURE: >12
Westley Croup Score Stridor Variables and Scores
At rest - 2
With agitation - 1
None - 0
What 2 conditions must always be considered in Complex Febrile Seizures/Status Epilepticus
meningitis
encephalitis
What age does QAS define a paediatric patient?
12 years of age or less
What age group does croup usually affect?
children between six months and five years old
it can affect older children
some children get croup several times
What ages do febrile seizures typically occur in?
6 mths - 6 years
What ages does childhood stroke occur?
1 month to 18 years
What are Complex Febrile Seizures?
frequent cause of status epilepticus
What are our pulse points to start resuscitation in the unresponsive paediatric pt?
Newborn: HR <60
1-12 yrs: HR <40
What are the 2 main categories of ALOC?
intracranial
extracranial
What are the 4 key categories of paediatric assessment?
Weight
Anatomy
Physiology
Psychology
What are the keys of appropriate pain management?
Assessment of pain
Provision of appropriate non pharmacological and pharmacological analgesia based on the pain assessment
Reassessment of pain after analgesia
What are the most common dysrhythmias seen in paediatric arrests?
bradycardia
asystole
What are the two categories of seizures?
focal
generalised
What are the two types of focal seizures?
focal
focal dyscognitive
What causes aspiration?
Dysphagia (difficulty swallowing) – muscles don’t work properly
Abnormal anatomy (cleft palate)
Delayed growth (prematurity)
Brain damage
Cranial nerve issue
Gastroesophageal reflux disease (GERD)
What causes croup?
viral infection, with some caused by bacteria
(parainfluenza, common influenza, rsv)
What causes epiglottitis?
bacteria haemophilus influence
What causes haemorrhagic strokes?
a break in the wall of a weakened vessel
What causes ischaemic stroke?
embolic (clot) or thrombotic (plaque) occlusion of a vessel
Causes of Perinatal Stroke
congenital heart disease
infection
blood clotting disorders
placental disorders
birth trauma
What does TICLS stand for?
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
What happens when a button battery is ingested?
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
What information do we want to find out about the BRUE episode?
description
choking/gagging
breathing
colour
distress
conscious state
tone
movement
What is a coarctation of aorta?
Narrowing of the aorta
What is a febrile seizure?
seizure that occurs in conjunction with a high temperature (>38 degrees)
What is a focal seizure?
abnormal neuronal activity is limited to one hemisphere of the cerebral cortex
What is a generalised seizure?
abnormal neuronal activity rapidly engages both hemispheres of the cerebral cortex
What is a perinatal stroke?
Occurs before or shortly after birth
28 weeks gestation to one-month-old)
also known as fetal, prenatal, neonatal and in-utero stroke
What is a stroke?
blood flow to a portion of the brain is interrupted causing ischemia and if not restored it will eventually lead to permanent brain injury
What is aspiration?
The process of something entering the airway or lungs by accident (food, liquid, other materials)
What is Asthma?
chronic pulmonary disease characterised by recurrent but usually reversible lower airway obstruction
What is bimanual compression?
invasive two-handed technique to manually compress the uterus
wall which is continued through to definitive care (theatre).
What is Brief Resolved Unexplained Event (BRUE)?
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
What is Bronchiolitis?
inflammation of the bronchioles
typically affects infants and children under 2
almost always caused by a respiratory virus
What is choking?
the blockage or hindrance of respiration by a foreign body obstruction in the airway
What is congenital heart disease?
a general term for any defect of the heart, heart valves or central blood vessels that are present at birth
What is croup?
a common viral inflammatory illness of the subglottic structures causing inspiratory stridor and barking cough
What is Epiglottitis?
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
What is Epilepsy?
condition of unprovoked, recurrent seizures
What is frequent intermittent asthma?
shorter intervals (< 6 – 8 weeks)
No symptoms between flare-ups
May have preventative therapy
Accounts for 20% of childhood asthma
What is infrequent intermittent asthma?
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
What is persistent Asthma?
5-10% of paediatric asthma presentations with mild, moderate and severe classifications
What is poisoning?
the process whereby cells are injured or destroyed by the inhalation, ingestion, injection or absorption of a toxic substance
What is reflux and GERD?
The acidic contents of the stomach travel back up the oesophagus
What is Respiratory Distress Syndrome (RDS)?
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
What is Respiratory Syncytial Virus (RSV)?
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
What is status epilepticus?
seizure activity greater than 5 minutes in duration or recurrent seizure activity where the Pt does not recover to GCS15 prior to another seizure
What is tactile stimulation?
vigorous warming, drying and rubbing of the back and soles of the feet in the newborn to stimulate respiratory activity
What is the cause of reflux and GERD?
the lower osephageal sphincter (LES) is weak and underdeveloped and doesn’t close off properly
What is the CPR ratio utilised in paediatric patients?
30: 2 singer officer
15: 2 two officer
reassess every 2 minutes
What is the epiglottis?
thin cartilage structure at the root of the tongue that closes off the windpipe (trachea) when foods or liquids are being swallowed
What is the main cause of bronchiolitis?
RSV
What is the management pathway for febrile seizures?
active cooling
midazolam
What is the maxiumum joulage that can be adminitered through the paediatric pads?
100 joules
What is the Paediatric Assessment Triangle?
an internationally accepted tool for the initial emergency assessment of infants and children
What is the type of focal seizure when awareness or responsiveness is not impaired?
focal
What is the type of focal seizure where the level of awareness or responsiveness is reduced but full consciousness is not lost?
focal dyscognitive
What is transposition of the great vessels?
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.
What respiratory ailments rate in the top 10 of hospital presentations for paediatric patients?
URTI
asthma
croup
bronchiolitis
What should we always consider in a paediatric pt that is unresponsive?
foreign body airway obstruction
What signs and symptoms will you see related to to the integumentary system in anaphylaxis?
urticaria (rash)
angioedema (swelling)
pruritus (itch)
flushed skin
What signs and symptoms will you see related to to the gastrointestinal system in anaphylaxis?
nausea
vomiting
diarrhoea
abdominal pain
What signs and symptoms will you see related to to the cardiovascular system in anaphylaxis?
hypotension
dizziness
bradycardia/tachycardia
collapse
What signs and symptoms will you see related to to the respiratory system in anaphylaxis?
difficultly breathing
wheeze
upper airway swelling
rhinitis
What systems are generally involed in an anaphylactic reaction?
cardiovascular respiratory integumentary gastrointestinal
What systems are generally involed in an anaphylactic reaction?
cardiovascular
respiratory
integumentary
gastrointestinal
What treatment options do we have if the anaphylaxis pt is refractory to 3 IM adrenaline injections?
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
When are seizures diagnosed as epilepsy?
When a child has 2 or more seizures with no known cause
When should foregin body inhalation be strongly suspected?
where the history details sudden onset of choking, coughing, dyspnoea, laboured breathing, dysphagia and gagging
Where is the pad placement for paediatric pts?
anterior and posterior
Which age range get paediatric pads?
5yrs and under
Who are high risk people for RSV?
Premature babies in ft rs year of life
Infants under 6 months
Children with asthma
people with weakened immune system or underlying heart problems
What stages of life is epilepsy more common to develop in?
children
adolescents
people over 60
Why are paediatric patients more susceptible to Respiratory illnesses?
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
Why do anaphylactic patients present as hypotensive?
due to the release of histamine causing widespread vasodilation
Why do we transport Brue pts to hospital?
further assessment and examination
Why does a grunting occur in respiratory distress?
Increase positive end expiratory pressure
Why does a weak cry occur in respiratory distress?
Sign of fatigue and shows the child is prioritising energy expenditure for work of breathing
Why does clammy skin occur in respiratory distress?
high energy expenditure to breathe therefore sweating to regulate
Why does cricoid/tracheal tug occur in respiratory distress?
Increase pull of diaphragm is tugs downwards on the trachea during inspiration
Why does cyanosis occur in respiratory distress?
reduced haemoglobin and peripheral circulation-indicates poor oxygen saturation levels
Why does head bobbing occur in respiratory distress?
high use of sternocleidomastoid and scalene muscles
Why does hypercarbia occur in respiratory distress?
reduced ability to expire carbon dioxide
Why does hypoxemia occur in respiratory distress?
reduced ability to oxygenate
Why does lethargy occur in respiratory distress?
breathless and working hard causes discomfort and agitation
reserved energy for work of breathing
Why does nasal flaring occur in respiratory distress?
To help increase the diameter of the airway
Why does pallor occur in respiratory distress?
Not oxygenating effectively
Why does sternal recession/retraction occur in respiratory distress?
high negative pressures on inspiration
Why does stridor occur in respiratory distress?
partial obstruction of upper trachea
Why does subcostal and intercostal recession occur in respiratory distress?
high negative pressures on inspiration
Why does tachycardia occur in respiratory distress?
to assist in oxygen transport
Why does tachypnoea occur in respiratory distress?
Unable to increase tidal volume
Why does wheeze occur in respiratory distress?
Narrowing or obstruction of the small airways by secretions or inflammation
Why is choking more common in paediatrics?
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
Why is it important that we transport Croup pts to hospital?
There is no definitive treatment for the virus that causes croup and treatment that reduces the eodema can be short lived.
Prevalance of Respiratory Distress Syndrome (RDS)
98% at 24 weeks 5% at 34 weeks \<1% at 37 weeks
