The sick child Flashcards

1
Q

how do HR, BP and resp rate change over time from birth to adulthood?

A

HR starts off fast (110-160) and decreases ro 60-100
BP starts off low (70-90 systolic) and increases to 110-120 systolic
resp rate starts off fast ((30-40) and decreases to 15-20

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2
Q

describe the general anatomical differences in infants

A

relatively large heads and prominent occiput
sitting height proportionally more
relatively large surface area compared to volume
high anterior larynx/floppy epiglottis
more flexible ribs
blood volume is 80ml/kg
HbF at birth

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3
Q

what is the most common causative system in presenting children?

A
respiratory
- bronchiolitis
- URTI
- croup
etc
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4
Q

what is the commonest reason for acute illness in children?

A

sepsis

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5
Q

general treatment outline for sepsis?

A

supportive

antimicrobial

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6
Q

what is bronchiolitis?

A

acute inflammatory injury of the bronchioles
usually viral (RSV)
supportive treatment

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7
Q

clinical signs of bronchiolitis?

A

widespread fine crackles all around lung fields due to secretions
struggle with feeding
barking cough
starts off with cold (same as adults) and then progresses into chest

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8
Q

how is bronchiolitis managed?

A

usually viral so no real treatment, just supportive
can insert NG tube for feeding if needed
can need CPAP if severe (forces air up nose so that when you breath out, your lungs don’t collapse)

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9
Q

what is croup?

A

laryngotracheobronchitis
usually viral (parainfluenza)
can narrow upper airway

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10
Q

signs of croup?

A

stridor

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11
Q

management of croup?

A

steroid treatment

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12
Q

noisy breathing in is caused by an obstruction where?

A

upper airway

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13
Q

noisy breathing out (wheeze) is caused by obstruction where?

A

lower airway

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14
Q

other differentials in croup?

A

epiglottitis (ENT emergency)
any upper resp tract obstruction
inhaled foreign body

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15
Q

how can you differentiate for croup?

A

had a cold for a couple of days, barking cough

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16
Q

causes of a wheeze in children?

A
not always asthma
episodic wheeze (more likely to get wheezy in cold weather, if they have a cold/virus etc - due to previous bronchiolitis infection)
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17
Q

how is asthma/episodic wheeze managed?

A

in the same way
steroids, bronchodilators, oxygen
(don’t always give steroids in <2 y/o)

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18
Q

give 2 CNS presentations in children?

A

meningitis (bacterial and viral)

encephalitis (commonly viral)

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19
Q

how are meningitis/encephalitis symptoms investigated?

A

lumbar puncture and imaging

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20
Q

how are meningitis/encephalitis symptoms managed in infants?

A

can be difficult to tell in very young if meningitis is the true diagnosis so antibiotics are given regardless

21
Q

signs of encephalitis?

A

focal neurological deficit

22
Q

signs of meningitis?

A

non-blanching rash (not always present - only a sign on meningococcal meningitis)
- if rash is present, just treat without lumbar puncture

23
Q

general signs on CNS problem?

A

febrile seizures
vasovagal episode (fainting)
reflex anoxic seizures (stops breathing after a shock or knock to the head)
breath holding attacks (breath holding while crying, can cause infant to black out, but harmless)
behavioural episodes
epilepsy
arrhythmias
- all of the above can present similarly to seizures

24
Q

how is a first seizure like episode managed?

A

everyone gets an ECG

don’t treat after the first fit

25
initial approach to management of accidents and trauma in children?
basic life support
26
what is the impact of flexible ribs in children?
means it is difficult to break a child's ribs - therefore if ribs are broken think NAI
27
other common presentations of NAI?
``` retinal haemorrhages (from shaking) rib fractures bruises in different and odd places - behind ear - not on bony prominences ```
28
what can cause GI obstruction in children?
congenital pyloric stenosis volvulus intussusception malrotation (infants)
29
signs of pyloric stenosis
aklalotic skinny vomiting
30
common GI/urogenital presentations in children?
``` viral gastroenteritis GI obstruction acute abdomen (appendicitis) UTI testicular torsion ```
31
common cardiovascular presentations in children?
congenital heart disease (cyanosis, heart failure) arrhythmias (SVT etc) bacterial endocarditis (rare)
32
what is the paediatric sepsis 6?
6 things you should do within an hour when a child has sepsis - high flow oxygen - IV access and blood tests (blood cultures, glucose and lactate) - IV or IO antibiotics if shocked - consider fluid recuscitation - consider inotropic support early - involve senior clinicians/specialists early
33
STOP part of sepsis protocol?
``` recognition child with infection + 2 of the following - temp <36 or >38 - tachycardia - altered mental state - reduced peripheral perfusion ```
34
THINK part of sepsis protocol?
reduce threshold for treatment (some children are at a higher risk so should be treated with fewer signs)
35
what can increase chance of survival after arrest?
if it is caught at respiratory arrest before it becomes a cardiac arrest
36
adult vs child arrest?
adult usually cardio | children usually resp first (then becomes cardio)
37
how is airway (in ABCDE) different in infants to adults?
larynx is higher in infants so don't do head tilt chin lift as this can compress the airway just return to neutral position
38
how can you assess effort of breathing?
``` rate recession accessory muscle use grunting nasal flaring ```
39
how can you assess efficacy of breathing?
expansion additional noises (wheeze, stridor) pulse oximetry effects on end organs (conscious level, pallor, tachycardia)
40
how can circulation be assessed?
``` HR rhythm pulse volume capillary refill BP effects on other organs (conscious level, skin perfusion, urine output) ```
41
jooboobnnoob mcoobwoob?
Joanne McEwan
42
what is a dangerous cardio sign in children and why?
hypotension children are very good at maintaining blood pressure so if its low there must be a cause - pre-terminal sign - need 25+% blood loss before BP control drops
43
how is shock managed (cardio/hypovolaemic shock)?
``` 20ml/kg of 0.9% saline reassess repeat if still shocked may need blood if trauma/haemorrhage - if >20ml/kg of fluid, may need inotropes but still need more fluid - at 60ml/kg, PICU should be aware ```
44
how much blood equates to 25% of circulating volume in children?
20ml/kg | - point at which clinical shock is detected
45
signs of <5% dehydration?
minimal or no clinical signs
46
signs of 5-10% dehydration?
mildly dry mucous membranes slightly decreased skin turgor mildly reduced urine output
47
signs of >10% dehydration?
``` dry, sunken mucous membranes decreased skin turgor significantly reduced urine output shock altered conscious level ```
48
how is conscious level assessed?
``` AVPU GCS pupils posture don't ever forget glucose ```
49
how is disability assessed?
conscious level posture pupils