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Child Health > The sick child > Flashcards

The sick child Flashcards

1
Q

What are common symptoms of a sick child?

A 
Difficulty breathing
Poor feeding
Fever
Rash
Lethargy
Dehydration
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2
Q

What is the normal HR and RR for a child under 1?

A

HR: 110-160
RR: 30-40

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3
Q

What is the normal HR and RR for a child aged 1-2?

A

HR: 100-150
RR: 25-35

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4
Q

What is the normal HR and RR for a child aged 2-5?

A

HR: 95-140
RR: 25-30

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5
Q

What is the normal HR and RR for a child aged 5-12?

A

HR: 80-120
RR: 20-25

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6
Q

What is the normal HR and RR for a child over 12?

A

HR: 60-100

RR@ 15-20

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7
Q

What are the guidelines for suspecting sepsis in a child?

A

A child with suspected or proven infection AND at least 2 of the following:
Core temp below 36 or above 38
Inappropriate tachycardia
Altered mental state (sleepiness/irritability/lethargy/floppiness)
Reduced peripheral perfusion (cap refill above 2 secs/ cool or mottled peripheries)

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8
Q

What factors reduce the threshold in children to think about sepsis?

A 
Infants under 3 mnths
Immunosuppressed
Recent surgery
Indwelling devices/ lines
Complex neurodisability 
High index of clinical suspicion (tachypnoea, rash, leg pain, biphasic illness, poor feeding) 
Significant parental concern
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9
Q

What is the paediatric sepsis 6?

A

Give high flow oxygen
Obtain IV or IO access and take blood tests:
Blood cultures, blood glucose, blood lactate
Give IV/IO broad spectrum antibiotics
Consider fluid resuscitation
Consider inotropic support early
Involve senior clinicians

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10
Q

What is the fluid management in children?

A

Titrate 20 ml/kg isotonic fluid over 5-10 mins and repeat if necessary
Aim to reverse shock: normal HR, BP and peripheral perfusion
Assess for fluid overload after more than 40 ml/kg

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11
Q

What inotropic support should be given to children in sepsis 6?

A

Adrenaline 0.3mg/kg in 50mls 5% dextrose

Commence 1 ml/hr = 0.1mic/kg/min

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12
Q

What can lead to circulatory failure?

A

Fluid loss: blood loss, gastroenteritis, burns

Fluid maldistribution: septic shock, cardiac disease, anaphylaxis

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13
Q

What can lead to respiratory failure?

A

Respiratory distress: foreign body, croup, asthma

Respiratory depression: convulsions, raised ICP, poisoning

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14
Q

How is breathing assessed in a child?

A

Effort of breathing

Efficacy of breathing

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15
Q

How is the effort of breathing assessed?

A 
Rate
Recession 
Accessory muscle use
Grunting 
Nasal flaring
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16
Q

How is the efficacy of breathing assessed?

A

Expansion
Additional noises: inspiratory stridor or expiratory wheeze
Pulse oximetry
Effects on end organs - conscious level, pallor, tachycardia

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17
Q

How is circulation assessed?

A 
HR
Rhythm
Volume
Cap return 
BP 
Effects on other organs
HYPOTENSION IS A PRE-TERMINAL SIGNAL
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18
Q

How is circulation managed?

A

20ml/kg of 0.9% saline then reassess
Repeat is still shocked
At 60ml/kg, inform PICU

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19
Q

How will 5-10% dehydration present?

A

Mildly dry mucous membranes
Decreased skin turgor
Mildly reduced urine output
Normal conscious level

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20
Q

How will more than 10% dehydration present?

A 
Dry ++ mucous membranes
Sunken fontanelle
Decreased skin turgor
Significantly reduced urine output 
Shocked
Altered conscious level
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21
Q

How is conscious level assessed?

A 
AVPU
GCS
Pupils
Posture - decorticate/ decerebrate
DEFG (don't ever forget glucose)
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22
Q

What is assessed in exposure?

A

Temperature

Rash/ bruising

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23
Q

What is the normal systolic BP for a child under 1?

A

70-90 mmHg

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24
Q

What is the normal systolic BP for a child aged 1-2?

A

80-95 mmHg

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25
Q

What is the normal systolic BP for a child aged 2-5?

A

80-100 mmHg

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26
Q

What is the normal systolic BP for a child aged 5-12?

A

90-110 mmHg

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27
Q

What is the normal systolic BP for a child aged over 12?

A

100-120 mmHg

28
Q

What is different in the anatomy of children?

A 
Large head with prominent occiput
Sitting height proportionally more
Large surface area compared to volume
High anterior larynx/ floppy epiglottis
Flexible ribs 
Blood volume 80mls/kg 
HbF at birth
29
Q

How does a large surface area compared to volume impact clinically?

A

To burns - will lose more volume from a burn

30
Q

How will a high anterior larynx/ floppy epiglottis impact clinically?

A

When intubating, need to use a straight bladed laryngoscope as the epiglottis needs to be physically lifted up and out of the way

31
Q

How does flexible ribs impact clinically?

A

NAI

32
Q

What system will the majority of children present with?

A

Respiratory

33
Q

What is bronchiolitis, what causes it and how is it treated?

A

Acute inflammatory injury of the bronchioles
Caused by RSV virus most commonly
Widespread crackles throughout all lung fields
Supportive treatment - smaller feeds or NG tube, oxygen support

34
Q

What is croup, what causes it and how is it treated?

A

Laryngotracheobronchitis - narrowing of the upper airways
Presents with stridor - barking cough
Steroid treatment

35
Q

What CNS problems to children commonly present with?

A

Meningitis - meningococcal, strep meningitis, e.coli. Do lumbar puncture and start on antibiotics
Encephalitis - commonly coxsackie. Give acyclovir and do a lumbar puncture

36
Q

What rash will meningococcemia present with?

A

Fulminant purpura that is non-blanching

37
Q

What things present as a fit?

A 
Febrile seizure
Vasovagal episode
Reflex anoxic seizure
Breath holding attacks
Behavioural episodes
Epilepsy
Arrhythmias
38
Q

What sort of traumas do children present with?

A 
RTA
Trampoline
Burns
Ingestion
Drowning
Choking
ALWAYS CONSIDER NAI
39
Q

What GI/urogenital problems do children present with?

A 
Viral gastroenteritis 
GI obstruction - pyloric stenosis, volvulus, intussusception and malrotation 
Acute abdomen - appendicitis 
UTI
Testicular torsion
40
Q

What CVS problems do children present with?

A

Congenital heart disease - cyanosis, heart failure
Arrhythmias: SVT
Bacterial endocarditis

41
Q

What questions in a history are important for determining the severity of the illness?

A 
History of symptoms
Red flags
Eating/drinking
Bowels/urine
Parental concern
PMH
Meds/allergies
Family history
Immunisation history
42
Q

What will neonates present to the GP with?

A

Jaundice - UTI/hypothyroidism/galactosaemia/breast milk jaundice/ biliary atresia
Vomiting - reflux/CMP intolerance/ pyloric stenosis/ duodenal atresia
Failure to thrive
Sepsis

43
Q

What is defined as prolonged jaundice?

A

14 days in a term infant

21 days in a preterm infant

44
Q

What is the buzzword for pyloric stenosis?

A

Projectile vomiting

45
Q

What sign in neonates will send them straight to a+e?

A

Temp of 38 or above

46
Q

What are common respiratory paediatric presentations?

A 
Bronchiolitis - RSV
Croup - parainfluenza, influenza, RSV
Viral URTI
Asthma 
Acute tonsilitis
47
Q

What are rare respiratory paediatric presentations?

A 
CF
Acute epiglottitis - immunize against Hib so rare now
Foreign body
Pneumonia
Cardiac causes
Malignancy
48
Q

How is the resp system assessed in GP practice?

A 
Cyanosis
Tachypnea (RR) 
Wheeze/stridor/ cough 
Pulse ox
Percussion 
Auscultation 
ENT exam
49
Q

What GI problems will children present to the GP with?

A 
Abdo pain
Vomiting 
Diarrhoea
Nausea
Constipation
50
Q

From birth to 18 years, what are the common medical causes of abdominal pain?

A

Gastroenteritis
UTI
Constipation

51
Q

From birth to 1 year, what are the common surgical causes of abdominal pain?

A

Intussusception
Volvulus
Incarcerated hernia

52
Q

From 2-5 years, what are the common surgical abdomen presentations?

A

Intussusception
Volvulus
Appendicitis

53
Q

From 6-11 years, what are the common surgical abdomen presentations?

A

Appendicitis
Trauma
Testicular torsion

54
Q

From 12-18, what are the common surgical abdomen presentations?

A

Appendicitis
Trauma
Ovarian torsion
Testicular torsion

55
Q

From birth to 1 year, what are the other causes of abdominal pain?

A

Infantile colic

Hirschprung’s disease

56
Q

From 2-5 years, what are the other causes of abdominal pain?

A

Mesenteric lymphadenitis
HSP
DKA
Sickle cell

57
Q

From 6-11 years, what are the other causes of abdominal pain?

A 
Mesenteric lymphadenitis
Abdominal migraine
HSP
DKA
Sickle cell
Pneumonia
Functional abdominal pain
58
Q

From 12-18 years, what are the other causes of abdominal pain?

A 
Dysmenorrhoea
DKA
Mittelschmerz (ovulation) 
Threatened miscarriage
Ectopic pregnancy
PID
IBD
Adrenal crisis
59
Q

What are common MSK presentations in children?

A 
Inflammatory arthritis
Perthes
SUFE
Osgood Slatters
Growing pains
Bone tumours
Septic arthrits
60
Q

What should you suspect in a child with a limp?

A

DDH

Perthes

61
Q

What causes slapped cheek (erythema infectiosum)?

A

Parovirus B19

62
Q

What causes molluscum?

A

Pox virus

63
Q

What causes scarlet fever?

A

Streptococcus - triad of florid rash on trunk, rash on cheeks and strawberry tongue

64
Q

What causes hand foot and mouth disease?

A

Coxsackie

65
Q

What childhood development screening is available?

A

GP 6-8 week check
Red light reflex - congenital retinoblastoma
Hips - barlow/ortolani
Genitalia - undescended testes
Femoral pulses - absent in aortic coarctation

Child Health (12 decks)

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