Week 3 Recognition of the Sick Child

Question 1

What’s the anatomical difference between children and adult?

Answer 1

Airway

• smaller, ↑resistance (more rapid reaction to impact)
• soft laryngeal cartilage (different way in position head for CPR)

Respiratory
- less lung capacity

Circulatory

• less blood but faster circulation (loss of blood has greater impact)
• sick children general display tachycardia

Neurologic

• proportionally large heavy head
• thin but flexible skull (injury is hard to detect if underlying)

Musculoskeletal

• flexible and plastic bones
• soft rib cartilage (risk of underlying injury)

Immunity
- immature immunity (vaccination)

Metabolic & Thermoregulation

• higher metabolic rates (SpO2 coming down when unwell)
• less subcut fat (variable baseline to body temperature)

Question 2

What are the common causes and clinical features of children cardiac arrest?

Answer 2

Respiratory obstruction
                   ↓
                   Respiratory failure → 
                   ↑
Respiratory depression

                                                                CARDIAC FAILURE
Fluid loss
        ↓
        Circulatory failure →
        ↑
Fluid maldistribution

Question 3

What is the Paediatric Assessment Triangle?

Answer 3

Work of breathing: ?exertion

Appearance: ?cyanosis, rashes

Circulation: ?tachycardia

Question 4

What is the structured assessment for children?

Answer 4

Airway:

• Inspiratory noises being abnormal: bubbly, snoring, stridor
• Changes in vital signs (ie. ↑RR, ↓SpO2)
• Croup (upper airway inflammation)

Breathing:

• Effort: how hard is the baby/child working → ?RR
• Efficacy: how effective they are in gas exchange → ?cyanosis ?HR

Circulation:

• Direct signs: ?HR ?BP ?Capillary Refill Time
• Secondary signs: level of consciousness ?confusion ?agitation
• Perfusion: ?Colour (pale; mottled) ?Cap refill<3sec

Disability:
A - alert ?drowsy
V - respond to voice
P - respond to pain
U - unresponsive

Modified GCS (paediatric version)

Fluids:

• Intake & Output
• Hydration status ?sunken eye ?dry mucous membranes
• Gastroenteritis: virus-induced, damage to gut mucosa and result in absorbing disturbance*
• Antiemetic is not preferred due to AEs*

Temperature:

• 36.5~37.5
• Antipyretics given as a comfort to distress (ie. Paracetamol)

Question 5

Croup Management

Answer 5

Croup: sternal recession, trachea tug

• Positioning
• Frequent Obs
• PRN O2/Intubation
• administer medications:
  • dexamethasone
  • Nebulised adrenaline

Question 6

Bronchiolitis

Answer 6

Etiology:

• Most common severe LRTI
• RSV* (Respiratory Syncytial Virus)

Pathophysiology:
- mucosal inflammation/edema
- bronchioles constrict during expiration 
causing air trapping in alveoli and 
hyperinflation of lungs
- impaired gas exchange

S/S:

• rhinorrhea, cough, fever
• tachypnea, tachycardia

Initial management:

• frequent VS
• humidified O2
• nasopharyngeal suctioning
• infection control

Question 7

Asthma

Answer 7

Etiology:

• genetic defects
• allergens

Examination:

• Prolonged expiration
• Generalised wheeze
• Be aware of Slient Chest*

Management:

• Oxygen (high flow)
• Beta-Agonists (eg. Salbutamol)
• Reduce inflammation & mucus in airways
• Anticholinergics (Ipratropium bromide)
• Works on nerves that tighten airways (works in 30 minutes)
• Oral Corticosteroids (Prednisolone)
• Reduce inflammation & mucus in airways