The Sick Child Flashcards
As a child ages... - Heart rate increases/decreases - Respiratory rate increases/decreases - Systolic blood pressure increases/decreases ?
- Heart rate decreases
- Respiratory rate decreases
- SBP increases
Give the normal range of heart rate, respiratory rate and blood pressure in a < 1 year old vs a >12 year old
<1 y/o:
HR: 110-160 bpm
RR: 30-40 breaths/min
SBP: 70-90 mmHg
> 12 y/o:
HR: 60-100 bpm
RR: 15-20 breaths/min
SBP: 100-120 mmHg
Give an equation that relates SBP and age in children
SBP - 85 = (age in years x2)
Why is an infants sitting height proportionally more than an adults?
Infants have a relatively large head and prominent occiput
Infants have a relatively (small/large) surface area compared to volume
Large
Why is an infants large SA to volume ratio clinically significant?
They become dehydrated more easily
In adult emergencies, a curved laryngoscope is used for resuscitation. How does this differ in children <1 year old and why?
In children <1 y/o, a straight laryngoscope is used for resuscitation
This is because they have a higher anterior larynx and a floppy epiglottis
Compare average total blood volume in infants vs adults
Adults: ~5 L/kg
Infants: ~80 ml/kg
Why is this difference in blood volume important clinically?
Not much blood needs to be lost for an infant to be in serious trauma
What do children most commonly present with? (4)
- Respiratory infection e.g., croup, bronchiolitis, URTI (28%)
- Gastroenteritis (8.8%)
- Seizures/epilepsy/febrile seizures (6.6%)
- Pneumonia/LRTI (6.2%)
**infections!
What is bronchiolitis?
Acute inflammation and infection of the bronchioles in babies and young children
When does bronchiolitis usually present?
During a baby’s first winter
What is the most common cause of bronchiolitis?
Viruses - esp. RSV
respiratory syncytial virus
How is bronchiolitis treated?
Supportive
e.g., CPAP/O2, NG tube feeding
What is a possible long-term effect of bronchiolitis?
Increased incidence of wheezing in later years e.g., every time they get a RTI, go out in the cold etc.
They may grow out of this in adulthood
How do you treat an individual with a lasting wheeze after bronchiolitis?
All wheezes are treated as they would be in asthma - with preventers and relievers e.g., beclomethasone and salbutamol
Suggest a reason why more children end up on inhalers than actually have asthma?
Kids can find it hard to breathe out hard and fast into a peak flow meter properly
What is croup?
A common URTI in children which results in obstructed breathing and a characteristic barking cough
What is the most common cause of croup?
Viruses - esp. parainfluenza
What is the differential diagnosis of stridor in children?
- Croup
- Inhaled foreign body
- Bacterial tracheitis
- Epiglottitis
- Allergy
How is croup treated?
Oral steroid
reduces inflammation
Pneumonia in kids is usually viral/bacterial?
Bacterial
Suggest two CNS infections in children
Meningitis
Encephalitis
What is the difference between meningitis and meningococcaemia?
Meningitis: bacteria infects membranes covering the brain and spinal cord
Meningococcaemia: bacteria travels in the blood but does not infect the brain or spinal cord
What is the Tumbler Test used in investigation of meningitis?
Menincoccal skin rash does not blanche when a glass is pressed against it
Suggest 8 reasons for fainting and/or fitting in children
- Febrile seizures
- Functional fits (no obvious cause)
- Vasovagal episode
- Reflex anoxic episode
- Breath holding attacks e.g., after crying
- Behavioural episodes e.g., rubbing on car seat
- Epilepsy
- Arrhythmias
What is the most common arrhythmia in children?
Supraventricular tachycardia (SVT)
What is the most important cause of trauma to consider?
Non-accidental injury
Name 3 surgical problems that are seen in children
- GI obstruction
- Acute abdomen/appendicitis
- Testicular torsion
Signs of congenital heart disease include… (2)
Cyanosis
Heart failure
What is the most common cause of acute illness in children?
Sepsis
Name 3 measures taken to prevent healthcare workers from missing sepsis in a child
- Paediatric national early warning score (NEWS)
- Paediatric sepsis 6
- Septic screen
What is the most common cause of cardiac arrest in children vs adults?
Children:
Respiratory failure -> respiratory arrest -> cardiac arrest
Adults:
Circulatory failure -> cardiac arrest
What structured approach is used when facing an acutely ill child?
DR ABCDE
Danger Response Airway Breathing Circulation Disability Exposure
If a child’s airway is not patent, how would you position the head to open up the airway in children…
<1 y/o
>1 y/o
?
<1 y/o = head in neutral position as the anterior larynx is higher in infants
> 1 y/o = chin lift like in adults
How are rescue breaths given if a child is not breathing on high flow O2?
5 rescue breaths for 1 second each
What does ‘grunting’ mean in children who are working hard to breathe?
They are forcing air against a closed glottis
Why is hypotension a pre-terminal sign in children?
Children usually maintain good BP until they’ve lost ~50% of their blood volume, then BP drops dramatically
How should a child with circulatory shock be initially managed?
- 0.9% saline
- Blood if trauma/haemorrhage
What is assessed in the ‘disability’ section of ABCDE?
- AVPU
- GCS for kids
- Pupils (responsive or blown)
- Posture
- Glucose (may just be very hypoglycaemic)
Describe decorticate posture
Stiff with bent arms and clenched fists held to the chest
Describe decerebrate posture
- Stiff with straight arms and legs
- Toes pointed downwards
- Neck arched back
What are decorticate and decerebrate postures a sign of?
Severe brain damage
e.g., following a long period of hypoxia
