- THE SICK CHILD - Flashcards
Identify the clinical indications of a neonate in distress
- Less responsive
- Difficulty breathing (grunting, apnoea)
- Poor circulation (cyanosis, mottled skin)
- Decreased UO
- Decreased Activity
- Fever
- T>38 (sepsis)
- Decreased feeding
- vomiting
- seizures
- Jaundice
Discuss the principles of neonatal resuscitation
Aim
To provide adequate resuscitation to ensure the survival of the neonate and prevention of morbidity.
Airway:
To establish and maintain airway by position and suction
Breathing:
To establish and maintain respiratory effort for effective pulmonary gas exchange (through gentle stimulation, neopuff, ETT)
Circulation:
Maintain heart rate and adequate perfusion
(If HR less than 80bpm and unresponsive administer CPR
Drugs:
To reverse the effects of matemal analgesia/anaesthesia.
To correct acidosis.
To correct shock.
Equipment and Environment:
Maintain temperature
Prepare and maintain a warm environment to prevent heat loss following delivery and during resuscitation.
All resuscitative equipment must be available and ready for use.
Followup:
Infants with Apgar scores of <3 at 1 minute or <7 at 5 minutes will need to have follow up observation in Special Care Nursery for first 24 hours.
Parents require explanation and reassurance.
Discuss the pathophysiology of sepsis in the neonate
- Specific microbial factors (infection obtained from mother e.g. group B strep), intrauritine, meningitis, pneumonia
- Host factors predisposing newborn (poor cellular and humeral immunity and barries broken down easily
Discuss the clinical manifestations of sepsis in the neonate
Respiratory: • increased respiratory rate • apnoea • grunting • cyanosis Cardiovascular: • tachycardia • bradycardic episodes • poor perfusion • hypotension Central nervous system: • lethargy • irritability • seizures Other: • jaundice, • temperature instability (1/3 are normothermic), • poor tolerance to handling, • unstable blood glucose levels, and • blood gas derangements.
Discuss the use of an umbilical artery/vein catheter
Umbilical artery/vein catheterisation can be used for:
- acid-base and oxygen monitoring
- blood sampling for other investigations
- continuous arterial blood pressure monitoring.
Discuss the insertion of an umbilical artery/vein catheter
Insertion of an umbilical catheter is a sterile procedure.
- the area is prepared
- the umbilical cord clamped and upward tension applied
- incision is made
- there are two arteries and one vein
- catheter inserted
- fixated
Identify the early signs of deterioration in the unwell child
- less responsive
- tachypnoea
- tachycardia
- increased effort (retractions, nasal flaring, air hunger)
- cyanosis, mottled skin
- decreased UO
- cap refill >2 sec
- weightloss
Discuss the late signs of deterioration in the unwell child
- weak cry
- bradycardia
- apnoeic/gasping/grunting
- poor air entry
- cyanosis
Identify the neonate landmarks for intraosseous insertion
- proximal tibia
- distal tibia
- distal femur
Identify the considerations for insertion of an IO needle
Indications:
- Child shutdown, 2 attempts at IV access
- more than 90 seconds spent on IV in resus
Contra-indications:
- prosthesis
- trauma to bone
- burns
- local infection
- recent IO in same bone
Identify how to secure an ETT in a paediatric pt
- duoderm to the sides of the face
- tie ETT (knot away from nare)
- trouser tape to the opposite side of the ETT
- bottom leg straight
- top leg over nose and around ETT
- 2nd tape placed in opposite process
- same process for oral ETT
Outline the differences in setting up a paediatric arterial/CVC line
- Pressure bag with 500ml NS used in paeds > 10kg
- syringe driver with 0.5 units/ml 45% NS and lectro-cath
- Patency (<10kgs - 1ml/hr, 10-40kg - 1.5mls/hr, >40kgs - 3mls/hr)
Discuss the paediatric considerations in the triage assessment
Predictors of serious illness:
- Decreased feeding (<1/2 normal feeding)
- Breathing difficulty
- <4 wet nappies past 24hrs
- decreased activity
- Drowsiness
- Pale and hot
- Febrile < 3months old
- mechanism of injury
- co-morbidities
- age <3months
- Events preceding arrival to ED
Discuss the management of a child suspected of non-accidental injuries or neglect
The priorities in dealing with child abuse are:
Assessment:
- to diagnose, treat and document the child’s injuries,
- to interpret a pattern of injury or behaviour leading to the suspicion of abuse,
- to notify and involve the Victorian Forensic Paediatric Medical Service (VFPMS),
- to provide, when consent is given, a verbal or written report to Child Protection and the Police.
Management:
- Contact Forensic Paediatric Medical Service
Discuss the management of UTIs in the neonate/paediatric
- Assessment and early and management of sepsis
- Clean catch specimen
- Antibiotics
- Admission <6 months
