week 10

Question 1

discuss the key anatomical and physiological considerations for paediatric who has suffered a traumatic brain injuiry

Answer 1

The brain is still developing - main consideration

Question 2

Outline the use of the GCS vs a standard AVPU assessment for paediatric concious levels

Answer 2

AVPU remains the same
GCS is modified for paeds:
eyes:
4 - spontaneously
3 - to verbal stimuli
2 - to pain
1 - no response
best verbal response:
5 - alert, babbles, coos, words usual to ability
4 - less than usual words, spontaneious irritable cry
3 - cries only to pain
2 - moans to pain
1 - no response to pain
best motor response:
6 - spontaneous or obeys verbal command
5 - localises to pain or withdraws to touch
4 - withdraws from pain
3 - abnormal flexion to pain
2 - abnormal extension to pain
1 - no response to pain

Question 3

in regard to paediatric patient assessment, what are the key features of a patient with increased intracranial pressure

Answer 3

Sunset pupils
Fontanelle feels hard rather than soft/pushing up

Question 4

Discuss the aetiology, pathophysiology and prehospital management of febrile convulsions

Answer 4

febrile seizures are the result of a rapid increase in temperature in paeds
mostly common in children 3months to 5 yrs
onset of seizure to finish of postictal stage is usually less than 15 minutes with no repeat in the next 24 hours (of course there are always outliers to these)
3-5% of all 0-14 yr olds will have a febrile seizure -> 30% of those will have a 2nd febrile seizure -> 3-6% of those will have ongoing seizure incidences or epilepsy diagnosis
A paeds CNS is not fully developed and leaves them vunerable to increased neuronal excitability. The cytokines produced and released during an acute inflammatory response accompaning fever plays a further role in neuron excitability

The management is as follows:
follow their management plan (if they have one)
otherwise general seizure management plan set by SAAS

Question 5

outline the APLS algorithm for paediatric seizures

Answer 5

The APLS algorithm is as follows:

1. begining of seizure
   support airway, high flow 02, consider reversible causes
   * hypoglycaemia, hyponatremia, hypotensive emergency, infection, bleed, raised ICP
2. 5 mins from onset of seizure
   do you have vascular access?
   yes - iv/io midaz 0.15mg/kg max 10mg
   no - im midaz 0.15mg/kg, buccal/intranasal midaz 0.3mg/kg
3. further 5 minutes
   still fitting?
   no -> monitor
   Yes-> second dose of midaz and prepare levetiracetam
4. 5 further minutes
   still fitting?
   no -> monitor
   yes -> give levetiracetam and prepare rapid sequence induction and intubition
5. further 5 mins
   still fitting?
   no -> monitor
   Yes -> rapid sequence induction and intubation