Structured Approach To The Sick Child Flashcards
T or F: the most common cause of cardiac arrest in children is secondary to cardiac arrhythmia
F. Rarely due to cardiac arrhythmia. Most commonly sequelae of hypoxaemia and/or shock with associated organ damage & dysfunction
Average weights for M or F children at:
1) Birth
2) 1 year
3) 2 years
4) 5 years
5) 10 years
6) 14 years
1) Birth 3.5kg
2) 1 year 9-10kg
3) 2 years 12kg
4) 5 years 18kg
5) 10 years 31kg
6) 14 years 50kg
Normal resp rate range at:
1) Birth - 3 months
2) 3 months
3) 6-12 months
4) 18 months
5) 2-7 years
6) 8-11 years
7) 12 years - adult
1) 25-50
2) 25-45
3) 20-40
4) 20-35
5) 20-30
6) 15-25
7) 12-24
Normal HR range for:
1) Birth - 1 month
2) 3 months
3) 6 -12 months
4) 18 months
5) 2 years
6) 3 years
7) 4 - 5 years
8) 6-7 years
9) 8 - 11 years
10) 14 years
1) 120 - 170
2) 115 - 160
3) 110 - 160
4) 100 - 155
5) 100 - 150
6) 90 - 140
7) 80 - 135
8) 80 - 130
9) 70 - 120
10) 60 - 110
Normal systolic BP range for:
1) Birth - 6 months
2) 12 - 18 months
3) 2 - 4 years
4) 5 - 11 years
5) 12 years - adult
1) 80-90
2) 85-95
3) 85-100
4) 90-110
5) 100-120
Name - anatomical features that need to be taken into account when managing a child’s airway?
- Large occiput + short neck (in young child)
- can result in neck flex ion and airway narrowing when laid supine - Small face + mandible
- Teeth or orthodontic appliances can be loose
- Large tongue
- tends to obstruct airway in unconscious child
- can impede laryngoscope view - Floor of mouth easily compressible
- need to pay attention when positioning fingers on jaw
Why is an infant < 6 months old at greater risk of airway compromise when they have an URTI compared to older children?
Infants < 6 months are primarily nasal breathers, so narrow nasal passages are easily obstructed by mucus secretions in URTI
How does the shape of the epiglottis in children differ from adults?
Horseshoe shaped and projects posteriorly at 45 degrees (can make intubation more difficult)
How does the position of the larynx in children differ from adults and how does this affect intubation?
Larynx is high & anterior
- sits at level of 2nd + 3rd cervical vertebrae in children, but 5th + 6th cervical vertebrae in adults
Can often be easier to intubate children with straight blade laryngoscope
Name 3 differences affecting a child’s breathing compared to adults?
- Small upper and lower airways
- greater resistance to airflow due to smaller radius of airways
- therefore more easily obstructed - Horizontal ribs
- ribs are more horizontal compared to adults so contribute less to chest expansion - Diaphragmatic breathing
- infants mainly rely on diaphragmatic breathing
- therefore tire more easily as they have fewer Type 1 muscle fibres (highly oxidative, fatigue resistant fibres)
What is a child’s circulating blood volume?
70-80 ml / kg
How does the body surface area to weight ratio differ with increasing age?
BSA to weight ratio decreases with increasing age.
- Means that smaller children with a higher ratio lose heat more rapidly and are relatively more prone to developing hypothermia
Why do infants desaturate more rapidly than adults?
Combination of:
- high metabolic rate and oxygen consumption
- low lung volumes
- limited respiratory reserve
How does the oxygen dissociation curve appear at birth?
Shifted to the left with reduced P50.
- Because 70% of baby’s Hb is HbF
What is cardiac output principally related to in infants: HR or SV?
HR - stroke volume in infants is relatively fixed
Explain the standardised triage scale
1 - RED - immediate care - max time to clinician 0 min
2 - ORANGE - very urgent care - max time to clinician 10 min
3 - YELLOW - urgent care - max time to clinician 60 min
4 - GREEN - standard care - max time to clinician 240 min
5 - BLUE - non-urgent care - max time to clinician N/A
What are the 5 steps in the triage system?
- Identify the problem
- Gather and analyse information related to the solution
- seek discriminators to allow differentiation between patients
- life threat, pain, haemorrhage, conscious level, temperature - Evaluate all alternatives and select one for implementation
- Implement the selected alternative
- Monitor the implementation and evaluate outcomes
In which situation is the Alder Hey Triage Pain Score a useful tool?
When the child is experiencing anxiety associated with a sudden and unexpected presentation in pain that impedes self-assessment of pain
Elements of the Alder Hey Triage Pain Score
- Cry/voice
- Facial expression
- Posture
- Movement
- Colour
Scoring of Cry/Voice in the Alder Hey Triage Pain Score
0 - no crying, able to have normal conversation
1 - crying but is distractible, on direct questioning says it is painful
2 - inconsolable, crying persistently and complaining of pain
Scoring of Facial Expression in the Alder Hey Pain Triage Score
0 - normal
1 - short grimace < 50% of time
2 - long grimace > 50% of time
N.b. Grimace = open mouth,lips pulled back at corners, furrowed forehead
Scoring of Posture in the Alder Hey Pain Triage Score
0 - normal
1 - increased awareness of affected area, touching, rubbing, limping
2 - affected area held tense and defended e.g. non weight bearing
Scoring of Movement in the Alder Hey Pain Triage Score
0 - normal
1 - reduced or restless
2 - immobile or thrashing
Scoring of Colour in the Alder Hey Triage Pain Score
0 - normal
1 - pale
2- extreme pallor ‘green’
