The sick child Flashcards
how do HR, BP and resp rate change over time from birth to adulthood?
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
describe the general anatomical differences in infants
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
what is the most common causative system in presenting children?
respiratory - bronchiolitis - URTI - croup etc
what is the commonest reason for acute illness in children?
sepsis
general treatment outline for sepsis?
supportive
antimicrobial
what is bronchiolitis?
acute inflammatory injury of the bronchioles
usually viral (RSV)
supportive treatment
clinical signs of bronchiolitis?
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
how is bronchiolitis managed?
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)
what is croup?
laryngotracheobronchitis
usually viral (parainfluenza)
can narrow upper airway
signs of croup?
stridor
management of croup?
steroid treatment
noisy breathing in is caused by an obstruction where?
upper airway
noisy breathing out (wheeze) is caused by obstruction where?
lower airway
other differentials in croup?
epiglottitis (ENT emergency)
any upper resp tract obstruction
inhaled foreign body
how can you differentiate for croup?
had a cold for a couple of days, barking cough
causes of a wheeze in children?
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)
how is asthma/episodic wheeze managed?
in the same way
steroids, bronchodilators, oxygen
(don’t always give steroids in <2 y/o)
give 2 CNS presentations in children?
meningitis (bacterial and viral)
encephalitis (commonly viral)
how are meningitis/encephalitis symptoms investigated?
lumbar puncture and imaging
how are meningitis/encephalitis symptoms managed in infants?
can be difficult to tell in very young if meningitis is the true diagnosis so antibiotics are given regardless
signs of encephalitis?
focal neurological deficit
signs of meningitis?
non-blanching rash (not always present - only a sign on meningococcal meningitis)
- if rash is present, just treat without lumbar puncture
general signs on CNS problem?
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
how is a first seizure like episode managed?
everyone gets an ECG
don’t treat after the first fit
initial approach to management of accidents and trauma in children?
basic life support
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
other common presentations of NAI?
retinal haemorrhages (from shaking) rib fractures bruises in different and odd places - behind ear - not on bony prominences
what can cause GI obstruction in children?
congenital pyloric stenosis
volvulus
intussusception
malrotation (infants)
signs of pyloric stenosis
aklalotic
skinny
vomiting
common GI/urogenital presentations in children?
viral gastroenteritis GI obstruction acute abdomen (appendicitis) UTI testicular torsion
common cardiovascular presentations in children?
congenital heart disease (cyanosis, heart failure)
arrhythmias (SVT etc)
bacterial endocarditis (rare)
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
STOP part of sepsis protocol?
recognition child with infection + 2 of the following - temp <36 or >38 - tachycardia - altered mental state - reduced peripheral perfusion
THINK part of sepsis protocol?
reduce threshold for treatment (some children are at a higher risk so should be treated with fewer signs)
what can increase chance of survival after arrest?
if it is caught at respiratory arrest before it becomes a cardiac arrest
adult vs child arrest?
adult usually cardio
children usually resp first (then becomes cardio)
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
how can you assess effort of breathing?
rate recession accessory muscle use grunting nasal flaring
how can you assess efficacy of breathing?
expansion
additional noises (wheeze, stridor)
pulse oximetry
effects on end organs (conscious level, pallor, tachycardia)
how can circulation be assessed?
HR rhythm pulse volume capillary refill BP effects on other organs (conscious level, skin perfusion, urine output)
jooboobnnoob mcoobwoob?
Joanne McEwan
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
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
how much blood equates to 25% of circulating volume in children?
20ml/kg
- point at which clinical shock is detected
signs of <5% dehydration?
minimal or no clinical signs
signs of 5-10% dehydration?
mildly dry mucous membranes
slightly decreased skin turgor
mildly reduced urine output
signs of >10% dehydration?
dry, sunken mucous membranes decreased skin turgor significantly reduced urine output shock altered conscious level
how is conscious level assessed?
AVPU GCS pupils posture don't ever forget glucose
how is disability assessed?
conscious level
posture
pupils
