the acutely ill child Flashcards
normal physiological parameters for under 1 year old
- heart rate= 110-160
- resp rate= 30-40
- systolic blood pressure= 70-90
normal physiological parameters for a 1-2 year old
- heart rate= 100-150
- resp rate= 25-35
- systolic blood pressure= 80-95
normal physiological parameters for 2-5 year old
- heart rate= 95-140
- resp rate= 25-30
- systolic blood pressure= 80-100
normal physiological parameters for 5-12 year old
- heart rate= 80-120
- resp rate= 20-25
- systolic blood pressure= 90-110
normal physiological parameters for 12+ year old
- heart rate= 60-100
- resp rate= 15-20
- systolic blood pressure= 100-120
children have a
larger surface area compared to their volume and their glottis is located more superior and anterior
children blood volume
80mls/ kg
meningitis
inflammation of the meninges
meninges
3 protective membranes covering the brain and spinal cord
meningitis more specifically refers to
inflammation of the 2 inner membranes called the arachnoid and pia matter known as leptomeninges
in meningitis WCC of CSF
is above 5
bacterial causes of meningitis
- in neonates= group B strep, e.coli, listeria monocytogenes
- in children and teens= neisseria meningitidis, strep pneumonia
- in adults and elderly= strep pneumonia and listeria monocytogenes
viral causes of meningitis
- enterovirus (particularly cocksackie)
- Herpes simplex virus
- HIV
symptoms of meningitis
headaches, fever, nucall rigidity, photophobia, phonophobia
diagnosis of meningitis
lumbar puncture
treatment of meningitis
depends on the underlying cause but for bacterial causes steroids and then antibiotics to prevent injury to the leptomeninges as the antibiotics destroy the bacteria
febrile convulsions
seizures occurring in children between the ages of 6 months- 5 years associated with a fever without any underlying cause such as a CNS infection or electrolyte imbalance
simple febrile convulsion
generalised tonic iconic seizure which lasts less than 15 minutes and does not recur within 24 hours or within the same febrile illness
complex febrile seizures
one of the following:
- focal features at onset or during the seizure
- duration of longer than 15 minutes
- recurrence within the same febrile illness
febrile status epilepticus
febrile seizure which lasts longer than 30 minutes
most common causes of fever in children with febrile convulsions
viral infections, otitis media, tonsilitis, gastroenteritis or post-immunisation
history taking for a suspected febrile convulsion
- eyewitness account of the seizure including conscious level prior to the seizure, duration of the seizure, focal or generalised and the time take to recover from the seizure
- are there any more sinister symptoms of meningitis or septicaemia
- past medical history or family history of seizures
febrile convulsions management
- generally managed at home, once child comes out of seizure place them in the recovery position
- if seizure lasts more than 5 minutes call an ambulance
treatment of febrile convulsions
do not require treatment but if seizure lasts longer than 5 minutes rectal diazepam can be given
vasovagal syncope
syncope is transient loss of consciousness caused by transient global cerebral hypo perfusion characterised by rapid onset, short duration and spontaneous recovery
causes of vasovagal syncope
- postural hypotension
- emotional stress
- orthostatic stress e.g prolonged standing in hot crowded places
reflex anoxic seizures
paroxysmal, spontaneously reversing brief periods of asystole triggered by pain, fear or anxiety due to increased vagal responsiveness
during a reflex anoxic seizure
child becomes suddenly pale and limp and will fall over if standing, this is followed by stiffening and clonic jerking of the limbs
reflex anoxic seizure usually lasts for
30-60s does not cause tongue-biting (which is useful to differentiate it from epilepsy)
breath holding spells
episodes in which a child cries because he is hurt, frightened or upset and turns pale or blue before loosing consciousness
sepsis is the
commonest reason for acute illness in children
sepsis step 1
recognition: a child with suspected or proven infection and at least 2 of the following
- temperature less than 36 or greater than 38
- inappropriate tachycardia
- altered mental state (sleepiness/ irritability/ leathery/ floppiness)
- reduced peripheral perfusion/ prolonged cap refill/ cool or mottled peripheries
sepsis step 2
reduced your threshold for considering sepsis i.e. some children are at a higher risk of sepsis so they can have it without fulfilling all criteria;
- infants
- immunosupressed/ immunocompromised/ chemotherapy
- recent surgery
- indwelling devices/ lines
- complex neurodisability/ long term condition
- high index of clinical suspicion
- significant parental concern
sepsis step 3
stop and thick is this sepsis is yes implement SEPSIS 6 within one hour
paediatric sepsis 6
- high flow O2
- obtain intravenous or intra-osseous access and take blood cultures, blood glucose and blood lactate
- Give IV or IO broad spectrum antibiotics
if shocked… - Consider fluid rescucitation 20ml/kg isotonic fluid over 5-10
- consider inotropic support early 0.3mg/kg of adrenaline in 50mls of 5% dextrose
- GET SENIOR HELP
causes of paediatric cardiac arrest
respiratory failure is most common followed by circulatory failure
causes of respiratory failure
- respiratory distress= foreign body, croup, asthma
2. respiratory depression= convulsions, raised ICP, poisoning
causes of circulatory failure
- fluid loss= blood loss, gastroenteritis, burns
2. fluid maldistribution= septic shock, cardiac disease, anaphylaxis
respiratory arrest
has much better outcomes than cardiorespiratory arrest but if untreated will progress to cardiorespiratory arrest
PAEDIATRIC BLS ALGORITHM
- UNRESPONSIVE
- SHOUT FOR HELP
- OPEN AIRWAY
- NOT BREATHING NORMALLY
- 5 RESCUE BREATHS
- NO SIGNS OF LIFE
- 15 CHEST COMPRESSIONS: 2 RESCUE BREATHS
A
Airway open airway and listen for breathing
B
Breathing is evaluated by both effort and efficacy of breathing
effort of breathing
- rate
- recession
- accessory muscle usage
- grunting
- nasal flaring
efficacy of breathing
- chest expansion
- additional noises; inspiratory stridor, expiratory wheeze
- pulse oximetry
- effects on end organs
C
circulation;
- capillary refill
- pulse volume, rhythm and rate
- blood pressure
If shocked 20mls/kg of 0.9% saline repeat if there is no response
20mls/kg
is 25% of circulating volume and is the point where clinical shock is detected
D
disability
- AVPU
- GCS
- Pupillary response to light
- Posture
posture
decorticate or decerebrate
what posture it worse
decerebrate but they both indicate severe brain damage
DEFG
don’t ever forget glucose
E
Exposure; temperature and rash/ bruising/ bleeding
