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Year 2: Block 4: Paediatrics > the acutely ill child > Flashcards

the acutely ill child Flashcards

1
Q

normal physiological parameters for under 1 year old

A
  • heart rate= 110-160
  • resp rate= 30-40
  • systolic blood pressure= 70-90
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2
Q

normal physiological parameters for a 1-2 year old

A
  • heart rate= 100-150
  • resp rate= 25-35
  • systolic blood pressure= 80-95
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3
Q

normal physiological parameters for 2-5 year old

A
  • heart rate= 95-140
  • resp rate= 25-30
  • systolic blood pressure= 80-100
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4
Q

normal physiological parameters for 5-12 year old

A
  • heart rate= 80-120
  • resp rate= 20-25
  • systolic blood pressure= 90-110
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5
Q

normal physiological parameters for 12+ year old

A
  • heart rate= 60-100
  • resp rate= 15-20
  • systolic blood pressure= 100-120
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6
Q

children have a

A

larger surface area compared to their volume and their glottis is located more superior and anterior

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7
Q

children blood volume

A

80mls/ kg

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8
Q

meningitis

A

inflammation of the meninges

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9
Q

meninges

A

3 protective membranes covering the brain and spinal cord

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10
Q

meningitis more specifically refers to

A

inflammation of the 2 inner membranes called the arachnoid and pia matter known as leptomeninges

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11
Q

in meningitis WCC of CSF

A

is above 5

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12
Q

bacterial causes of meningitis

A
  • 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
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13
Q

viral causes of meningitis

A
  • enterovirus (particularly cocksackie)
  • Herpes simplex virus
  • HIV
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14
Q

symptoms of meningitis

A

headaches, fever, nucall rigidity, photophobia, phonophobia

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15
Q

diagnosis of meningitis

A

lumbar puncture

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16
Q

treatment of meningitis

A

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

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17
Q

febrile convulsions

A

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

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18
Q

simple febrile convulsion

A

generalised tonic iconic seizure which lasts less than 15 minutes and does not recur within 24 hours or within the same febrile illness

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19
Q

complex febrile seizures

A

one of the following:

  • focal features at onset or during the seizure
  • duration of longer than 15 minutes
  • recurrence within the same febrile illness
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20
Q

febrile status epilepticus

A

febrile seizure which lasts longer than 30 minutes

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21
Q

most common causes of fever in children with febrile convulsions

A

viral infections, otitis media, tonsilitis, gastroenteritis or post-immunisation

22
Q

history taking for a suspected febrile convulsion

A
  • 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
23
Q

febrile convulsions management

A
  • 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
24
Q

treatment of febrile convulsions

A

do not require treatment but if seizure lasts longer than 5 minutes rectal diazepam can be given

25
Q

vasovagal syncope

A

syncope is transient loss of consciousness caused by transient global cerebral hypo perfusion characterised by rapid onset, short duration and spontaneous recovery

26
Q

causes of vasovagal syncope

A
  • postural hypotension
  • emotional stress
  • orthostatic stress e.g prolonged standing in hot crowded places
27
Q

reflex anoxic seizures

A

paroxysmal, spontaneously reversing brief periods of asystole triggered by pain, fear or anxiety due to increased vagal responsiveness

28
Q

during a reflex anoxic seizure

A

child becomes suddenly pale and limp and will fall over if standing, this is followed by stiffening and clonic jerking of the limbs

29
Q

reflex anoxic seizure usually lasts for

A

30-60s does not cause tongue-biting (which is useful to differentiate it from epilepsy)

30
Q

breath holding spells

A

episodes in which a child cries because he is hurt, frightened or upset and turns pale or blue before loosing consciousness

31
Q

sepsis is the

A

commonest reason for acute illness in children

32
Q

sepsis step 1

A

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

33
Q

sepsis step 2

A

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
34
Q

sepsis step 3

A

stop and thick is this sepsis is yes implement SEPSIS 6 within one hour

35
Q

paediatric sepsis 6

A
  1. high flow O2
  2. obtain intravenous or intra-osseous access and take blood cultures, blood glucose and blood lactate
  3. Give IV or IO broad spectrum antibiotics
    if shocked…
  4. Consider fluid rescucitation 20ml/kg isotonic fluid over 5-10
  5. consider inotropic support early 0.3mg/kg of adrenaline in 50mls of 5% dextrose
  6. GET SENIOR HELP
36
Q

causes of paediatric cardiac arrest

A

respiratory failure is most common followed by circulatory failure

37
Q

causes of respiratory failure

A
  1. respiratory distress= foreign body, croup, asthma

2. respiratory depression= convulsions, raised ICP, poisoning

38
Q

causes of circulatory failure

A
  1. fluid loss= blood loss, gastroenteritis, burns

2. fluid maldistribution= septic shock, cardiac disease, anaphylaxis

39
Q

respiratory arrest

A

has much better outcomes than cardiorespiratory arrest but if untreated will progress to cardiorespiratory arrest

40
Q

PAEDIATRIC BLS ALGORITHM

A
  • UNRESPONSIVE
  • SHOUT FOR HELP
  • OPEN AIRWAY
  • NOT BREATHING NORMALLY
  • 5 RESCUE BREATHS
  • NO SIGNS OF LIFE
  • 15 CHEST COMPRESSIONS: 2 RESCUE BREATHS
41
Q

A

A

Airway open airway and listen for breathing

42
Q

B

A

Breathing is evaluated by both effort and efficacy of breathing

43
Q

effort of breathing

A
  • rate
  • recession
  • accessory muscle usage
  • grunting
  • nasal flaring
44
Q

efficacy of breathing

A
  • chest expansion
  • additional noises; inspiratory stridor, expiratory wheeze
  • pulse oximetry
  • effects on end organs
45
Q

C

A

circulation;

  • capillary refill
  • pulse volume, rhythm and rate
  • blood pressure

If shocked 20mls/kg of 0.9% saline repeat if there is no response

46
Q

20mls/kg

A

is 25% of circulating volume and is the point where clinical shock is detected

47
Q

D

A

disability

  • AVPU
  • GCS
  • Pupillary response to light
  • Posture
48
Q

posture

A

decorticate or decerebrate

49
Q

what posture it worse

A

decerebrate but they both indicate severe brain damage

50
Q

DEFG

A

don’t ever forget glucose

51
Q

E

A

Exposure; temperature and rash/ bruising/ bleeding

Year 2: Block 4: Paediatrics (14 decks)

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