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LR Child Health > The Sick Child > Flashcards

The Sick Child Flashcards

1
Q 
As a child ages...
- Heart rate increases/decreases
- Respiratory rate increases/decreases
- Systolic blood pressure increases/decreases
?
A
  • Heart rate decreases
  • Respiratory rate decreases
  • SBP increases
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2
Q

Give the normal range of heart rate, respiratory rate and blood pressure in a < 1 year old vs a >12 year old

A

<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

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3
Q

Give an equation that relates SBP and age in children

A

SBP - 85 = (age in years x2)

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4
Q

Why is an infants sitting height proportionally more than an adults?

A

Infants have a relatively large head and prominent occiput

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5
Q

Infants have a relatively (small/large) surface area compared to volume

A

Large

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6
Q

Why is an infants large SA to volume ratio clinically significant?

A

They become dehydrated more easily

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7
Q

In adult emergencies, a curved laryngoscope is used for resuscitation. How does this differ in children <1 year old and why?

A

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

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8
Q

Compare average total blood volume in infants vs adults

A

Adults: ~5 L/kg
Infants: ~80 ml/kg

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9
Q

Why is this difference in blood volume important clinically?

A

Not much blood needs to be lost for an infant to be in serious trauma

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10
Q

What do children most commonly present with? (4)

A
  • Respiratory infection e.g., croup, bronchiolitis, URTI (28%)
  • Gastroenteritis (8.8%)
  • Seizures/epilepsy/febrile seizures (6.6%)
  • Pneumonia/LRTI (6.2%)

**infections!

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11
Q

What is bronchiolitis?

A

Acute inflammation and infection of the bronchioles in babies and young children

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12
Q

When does bronchiolitis usually present?

A

During a baby’s first winter

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13
Q

What is the most common cause of bronchiolitis?

A

Viruses - esp. RSV

respiratory syncytial virus

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14
Q

How is bronchiolitis treated?

A

Supportive

e.g., CPAP/O2, NG tube feeding

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15
Q

What is a possible long-term effect of bronchiolitis?

A

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

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16
Q

How do you treat an individual with a lasting wheeze after bronchiolitis?

A

All wheezes are treated as they would be in asthma - with preventers and relievers e.g., beclomethasone and salbutamol

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17
Q

Suggest a reason why more children end up on inhalers than actually have asthma?

A

Kids can find it hard to breathe out hard and fast into a peak flow meter properly

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18
Q

What is croup?

A

A common URTI in children which results in obstructed breathing and a characteristic barking cough

19
Q

What is the most common cause of croup?

A

Viruses - esp. parainfluenza

20
Q

What is the differential diagnosis of stridor in children?

A
  • Croup
  • Inhaled foreign body
  • Bacterial tracheitis
  • Epiglottitis
  • Allergy
21
Q

How is croup treated?

A

Oral steroid

reduces inflammation

22
Q

Pneumonia in kids is usually viral/bacterial?

A

Bacterial

23
Q

Suggest two CNS infections in children

A

Meningitis

Encephalitis

24
Q

What is the difference between meningitis and meningococcaemia?

A

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

25
Q

What is the Tumbler Test used in investigation of meningitis?

A

Menincoccal skin rash does not blanche when a glass is pressed against it

26
Q

Suggest 8 reasons for fainting and/or fitting in children

A
  • 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
27
Q

What is the most common arrhythmia in children?

A

Supraventricular tachycardia (SVT)

28
Q

What is the most important cause of trauma to consider?

A

Non-accidental injury

29
Q

Name 3 surgical problems that are seen in children

A
  • GI obstruction
  • Acute abdomen/appendicitis
  • Testicular torsion
30
Q

Signs of congenital heart disease include… (2)

A

Cyanosis

Heart failure

31
Q

What is the most common cause of acute illness in children?

A

Sepsis

32
Q

Name 3 measures taken to prevent healthcare workers from missing sepsis in a child

A
  • Paediatric national early warning score (NEWS)
  • Paediatric sepsis 6
  • Septic screen
33
Q

What is the most common cause of cardiac arrest in children vs adults?

A

Children:
Respiratory failure -> respiratory arrest -> cardiac arrest

Adults:
Circulatory failure -> cardiac arrest

34
Q

What structured approach is used when facing an acutely ill child?

A

DR ABCDE

Danger
Response
Airway
Breathing
Circulation
Disability
Exposure
35
Q

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
?

A

<1 y/o = head in neutral position as the anterior larynx is higher in infants

> 1 y/o = chin lift like in adults

36
Q

How are rescue breaths given if a child is not breathing on high flow O2?

A

5 rescue breaths for 1 second each

37
Q

What does ‘grunting’ mean in children who are working hard to breathe?

A

They are forcing air against a closed glottis

38
Q

Why is hypotension a pre-terminal sign in children?

A

Children usually maintain good BP until they’ve lost ~50% of their blood volume, then BP drops dramatically

39
Q

How should a child with circulatory shock be initially managed?

A
  • 0.9% saline

- Blood if trauma/haemorrhage

40
Q

What is assessed in the ‘disability’ section of ABCDE?

A
  • AVPU
  • GCS for kids
  • Pupils (responsive or blown)
  • Posture
  • Glucose (may just be very hypoglycaemic)
41
Q

Describe decorticate posture

A

Stiff with bent arms and clenched fists held to the chest

42
Q

Describe decerebrate posture

A
  • Stiff with straight arms and legs
  • Toes pointed downwards
  • Neck arched back
43
Q

What are decorticate and decerebrate postures a sign of?

A

Severe brain damage

e.g., following a long period of hypoxia

LR Child Health (12 decks)

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