Week 2.1 - Peds Assessment Flashcards
What is the ABCDEFG assessment?
Airway
Breathing
Circulation
Disability (Neuro)
Exposure
Fluids
Glucose
What are the three aspects of the pediatric assessment triangle?
Appearance
–> Tone, interactiveness, consolability, abnormal gaze, abnormal speech/cry
Work of Breathing
–> Abnormal sounds or position, retractions, flaring, apnea/gasping
Circulation to Skin
–> Pallor, mottling, cyanosis
What combination of the triangle assessment would indicate CNS or metabolic issues?
Altered appearance
–> Tone, consolability, interactivness, gaze, speech/cry
What combination of the pediatric assessment triangle would indicate shock?
Issues with circulation to skin with or without changes in appearance
What changes in the pediatric assessment triangle would indicate respiratory distress?
Changes in work of breathing
What combination of findings in the pediatric assessment triangle would indicate respiratory failure?
Changes in work of breathing and appearance
What changes in the pediatric assessment triangle indicates cardiopulmonary failure?
Changes in appearance, circulation to skin, and work of breathing.
How does the pediatric airway differ from the adult airway?
The airway is smaller and softer
–> Edema causes a significant difference is airway patency
+tongue is larger, prominent occiput, higher larynx
What kind of behaviour might be seen with a partially obstructed pediatric airway?
Agitated or drowsy
Tripod/sniffing position
What are some signs of a partial upper airway obstruction in a pediatric patient?
Stridor
–> on exertion is mild, at rest is moderate, with exhaustion is severe
Drooling, gurgling, snoring
Changes in colour, behaviour, tripod
What are some signs of a partial lower airway obstruction in a pediatric patient?
Wheezes
–> End expiratory is mild, expiratory is moderate, ins/ex is severe
Crackles
–> May be fine or coarse
Decreased Air Entry
Increased Respiratory Effort
Does loudness of airway noises have significance?
Not necessarily.
A quiet wheeze means that not much air is entering the lungs
Should you use head tilt-chin lift with an infant?
No, can cause airway obstruction d/t shape of head
what is the most common cause of cardiac arrest in the pediatric population?
Hypoxia secondary to respiratory arrest
Children are abdominal breathers, what does this mean?
Rely on diaphragm as principal muscle to breathe
What is the normal respiratory rate for an newborn (0-3 months)
30-60 rpm
Why should breathing in children be assessed over 60 seconds?
Breathing in children is irregular
What is considered apnea in children?
Cessation of breathing for more than 20 seconds
What is considered bradypnea and tachypnea in children?
RR less/more than the normal range for age - normal ranges are age dependent
What should we assess about the quality of pediatric breathing?
Effort to breathe
–> Work of breathing
Efficacy of breathing
–> Effective gas exchange
Why is pediatric grunting a sign of increased resp effort?
To slow the rate of expiration and decrease alveoli surface tension, prevent alveoli collapse, to decrease effort of inhalation
(Positive end expiratory pressure)
Which age group does not have enough surfactant and struggles to prevent alveoli collapse?
Pre-term babies
The following:
Agitated/confused behaviour, drowsiness, being unable to talk/cry /eat, grunting, severe recessions, and changes in colour, and significantly increased respiratory rate apnea lasting longer than 20+ seconds
Are signs of what in pediatric patients?
Severe respiratory distress
–> Hypoxia not corrected with oxygen
Intermittent irritability, difficulty talking/crying/eating, and nasal flaring are signs of what in pediatric patients?
Moderate respiratory distress
–> Mild hypoxia that can be corrected with oxygen
Also might be associated with moderate increase in resp rate and moderate retractions
What is a normal arrythmia in children?
A sinus arrhythmia
How long should you listen to a pediatric heart rate?
60 seconds.
What is considered pediatric bradycardia? What might this indicate?
HR less than 60 bpm
–> Impending arrest
Can children maintain tachycardia for long periods of time?
Yes they can, but once exhausted they can decompensate quickly
What is considered pediatric tachycardia?
Outside of normal range for age group
What might cause mottling? What symptoms might accompany it?
Poor perfusion of extremities
–> Also seen with cap refill longer than 3 seconds, or weak pulses.
A decrease in urine output in a pediatric patient can say what about perfusion?
Can indicate poor renal perfusion
What might indicate poor central perfusion in a pediatric patient?
Decreased LoC, agitation, irritability
Decreased muscle tone
Hypotension in children indicates what?
That a child is very ill, systolic hypotension is a late sign of CDV compromise
–> Manual can be helpful d/t accuracy
How is neuro assessed on children who cannot speak (under 2)?
A modified GCS
Assess with smiles, listens, follows vs cried but consolable, vs inappropriate persistent cry vs agitated, restless, vs no response
Peripheral nerves on infants differ in myelination than adults in which ways?
They are not completely myelinated at birth. Motor control improves as myelination progresses
What does proximodistal mean?
Centrally –> distal from core
What is the moro reflex?
Startle reflex when infant feels like they’re falling
When does grasp reflex disappear?
4-6 months
How do children and infants’ fever response differ from that of adults?
Immature hypothalamus in neonates means that fever response might be weak.
Immature immunity in young children means that fever response might be exaggerated
How should temperature be assessed on a child?
Axillary
–> Least invasive
Rectal
–> Definitive
What is a normal temperature range for children? What would be considered extreme high and lows?
36.5-37.5 C
Higher than 41.0 or lower than 34.5 is considered extreme hyper/hypo
Petechiae and purpura on the hands and feet can indicate which infection?
Meningococcal - interferes with coagulation
In what ways do children’s ratio of body surface differ from adults?
Brain, skin, and GI tract are larger
How do children’s fluid spacing/composition differ from adults?
Infants have higher extracellular than intracellular water - means it is more easily lost
What can indicate poor hydration status in an infants?
–> Sunken eyes, fontanelles
–> Pale, mottled, cool limbs, prolonged cap refill
–> Reduced urinary output
–> Dry mucous membranes
–> Tachypnea and tachycardia
What is the first sign of dehydration in an infant?
Tachycardia - compensation for low stroke volume
How to calculate fluid maintenance for for a an infant that is…
10 or less kg
10-20 kg
21+ Kg
First 10 kg
–> 4 ml/kg/hr
Second 10 kg
–> +2 ml/kg/hr
Subsequent kg
–> 1 ml/kg/hr
What is the minimum urine output for children?
1ml/kg/hr minimum for infants and small children (prof emphasized this as minimum)
Or 4+ wet diapers/day
What is the specific gravity of pediatric urine?
Less than 1.030
hypoglycemia in children is more common because…
Children need more sugar than adults
What are signs of hyperglycemia in children?
Increased urine output, excessive thirst, weight loss
If there is any alteration in a child’s LOC, you should always check…
BGL
What are two major notes when assessing and recognizing a sick child?
- Parental anxiety should not be discounted
- Any infant under 3 months presenting to the ED should be considered sick until proven otherwise.
At what age can a radial pulse be taken? What must be used before then?
A radial pulse can be taken at 2 years of age
–> Must use apical before then
How can children be diagnosed with hypertension?
If the SBP or DBP is greater than or equal to the 95th percentile for age, sex, and height. Must be measured on at least three separate occasions.
What is strabismus?
When one eye deviated from fixation (cross-eyed), can result in weakening of muscle.
Can result in amblyopia if not corrected by ages 4-6.
How should the eardrum be visualized in children under 3?
By pulling the pinna down and back.
What is the difference between a functional and organic murmur?
Functional - No autonomic cardiac defect, but with a physiological defect like anemia
Organic - A cardiac defect with or without a physiological abnormality exists.
