unit25 management of a child Flashcards

1
Q

Children Main Groups

A
Infants
Birth – 12 months (Neonates – first 4 weeks)
Toddler
Approx 1 – 2 years of age
Pre-school
2 – 5 years
School-age
5 – 12 years (onset of puberty)
Teenager
Onset of puberty – 18 years of age
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2
Q

Approach to the child

A
Prevent/minimise separation with parent/carer
 Attempt to decrease loss of control
 Use play to lesson stress (distraction)
 Support family members
 Demonstrate: interest, empathy, concern
 Never ignore/dismiss what a parent says
 Involve child & parents in all aspects of care
Be confident but gentle
 Never dominate the child
 Use appropriate communication
 Refer to the child by name
 Be aware of child development
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3
Q

Plan (consider)

A
The environment (privacy)
 Purpose of assessment
 Developmental level of recipients
 Stage of child’s illness/condition
 Emotional state of child/family
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4
Q

Paediatric Assessment Triangle (PAT)

A
Part of the initial assessment
Indication of how serious the patient is
Done across the room
Fast (30-60 seconds)
Not painful, not scary!
Repeatable
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5
Q

PAT – a useful tool

A

Appearance

Work of Breathing

Circulation to skin

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6
Q

PAT Appearance TICLS

A
Tone
Interactiveness
Consolability
Look/gaze
Speech/cry
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7
Q

PAT Work of Breathing – Signs

A

Abnormal Breath Sounds
Abnormal Positioning and Posture
Recession
Nasal Flaring

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8
Q

PAT Circulation to skin – Signs

A
Colour
White or pale skin/lips 
Mottling
Patchy skin 
Cyanosis
Bluish discolouration of skin and lips
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9
Q

child Primary survey

Airway

A

Look & listen for possible obstructions
Inspiratory stridor indicative of upper airway obstruction
Wheezing indicating lower airway obstruction
Volume does not indicate severity

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10
Q

child Primary survey

Breathing

A
Assess the effectiveness of breathing
Respiratory rate
Tachypnoea at rest gives cause for concern
Recession
Use of accessory muscles
Flaring of the nostrils
Presence of expiratory grunt (infants)
Positioning
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11
Q

child Primary survey

Respiration

A
Rate, effort, efficacy, effects
Recession:
	           intercostal		         increased      		
		       subcostal		work
		        sternal		of	
		     tracheal tug		breathing
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12
Q

Respiratory failure

A

Compensated: respiratory distress

Decompensated: unable to maintain appropriate blood levels of 02 & C02
Falling respiratory rate in presence of other worsening parameters is suggestive of exhaustion – indicating imminent respiratory arrest

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13
Q

child Circulation

A
Pulse volume (actually feel the pulse) 
Absent peripheral and weak central pulses = advanced shock
Capillary refill (forehead or sternum) 
Do not rely on feeling peripheral pulses to estimate blood pressure as in adults – children react differently
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14
Q

Child Heart rate

A
Site:	< 1 yr = brachial
	> 1 yr	= carotid
Capillary Refill
Ambient temperature
Forehead or sternum
Apply digital pressure for 5 seconds
Refill should occur within 2 seconds
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15
Q

Blood Pressure

A

Childs circulating volume is greater per kg of body weight (80 ml/kg) than that of an adult
Actual volume is small
Small amounts of blood loss may be critical
Hypotension is a late & pre-terminal sign
Children compensate well
BP is maintained until shock is severe
BP recording in the pre hospital setting is of limited use

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16
Q

Before the age of 12 months cranial sutures are not fused.
A large blood volume may be lost before changes occur.
Shock may be noticed before GCS changes

A

Compensated:
vital organ perfusion is maintained
BP stable

Decompensated:
Hypotensive
Reduced LOC

17
Q

Disability child PS

A

AVPU
GCS – modified for < 4 years
Pupils
Posture

18
Q

Time Critical child

A

Any child with significant difficulties with
Airway, Breathing, Circulation or Disability
Must be treated as time critical!
The recognition of the seriously ill child is of greater importance than establishing a specific diagnosis

19
Q

FLACC Scale

A
face
legs
activity
cry
consolibility
20
Q

History Taking

A
As for adult, also include:
Questioning
 PMH, inc birth history
 Meds
 Immunisations
 History of this illness
 Intake: diet &amp; fluids

Output: urine, bowels, vomit
Social history

21
Q

Observe

A

At skin level: chest, bruising/injury, rashes

Developmental stage

Interaction with carer

Vital signs

22
Q

Management Time critical

A

A & B problems addressed on scene

C problems addressed en-route

Rapid transport to a suitable receiving hospital with a pre-alert message

23
Q

Airway child

Management Time critical

A

Stepwise approach

Position of comfort/choice

Constant re-evaluation of vital signs

24
Q

Breathing child

Management Time critical

A

Adequate oxygenation via a non-rebreathing mask

If not tolerating find alternative method

Constant re-evaluation of vital signs

Consider assisted ventilations

25
Q

Circulation

Management Time critical

A

Consider Paramedic assistance for IV/IO fluids

Do not delay on scene to gain access

26
Q

Management Time critical

Exposure

A

Exposure
Prevent hypoxia

Normalise circulation (paramedic assistance)

Treat hypoglycaemia

27
Q

child Pain management

A

Non-pharmacological
Parent/carer present, preparation, distraction, dressings, splintage

Pharmacological
Paracetamol orally, Ibuprofen, Entonox (technician)
Morphine, Paracetamol IV (Paramedic).