Approach to the Acute Child Flashcards

1
Q

In what ways are children different from adults?

A
  • Anatomical differences
  • Physiological differences
  • Compensate well and decompensate quickly
  • Communication challenges
  • Parents usually present
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2
Q

How do children’s airways differ to adults?

A
  • Large head to body size
  • Short necks
  • Large tongue
  • Obligate nasal breathers
  • Nasal passages easily obstructed
  • Compressible floor of mouth and trachea
  • High anterior larynx
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3
Q

How does children’s breathing differ from adults?

A
  • Small total surface area for air tissue interface
  • Lower airways small- easily obstructed
  • Diaphragmatic breathing
  • Fewer type I (slow twitch) fibres- easy fatigue
  • Soft non-calcified bones- v. compliant chest wall- recession and in-drawing
  • Horizontal ribs- less expansion
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4
Q

How do children’s respiratory system differ physiologically from adults?

A
  • Higher metabolic rate/ oxygen consumption (Respiratory rate higher and gradually falls)
  • Oxygen dissociation curve shifted left in neonates (HbF predominance) (Neonates tolerate slightly lower saturations)
  • Immature lung vulnerable to insult
  • Apnoea may occur in babies
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5
Q

How do children’s cardiovascular system differ physiologically from adults?

A
  • Circulating blood volume- 70-80 ml/kg (Small loss can make a big difference)
  • Circulation changes from in-utero to ex-utero (PDAs/ PFO may remain open for several months)
  • ECG features vary with age
  • Stroke volume increases with size (Heart rate higher and gradually falls)
  • Systemic vascular resistance progressively rises from birth
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6
Q

What does bradycardia indicate in a child?

A

Life threatening pathology

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7
Q

Why are babies more susceptible to infections?

A

Immature immune system

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8
Q

Why can communication with children be difficult?

A
  • Babies have no or limited language
  • Talkative children can become quiet
  • They get scared
  • Play is useful
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9
Q

What are the normal vitals for a <1 year?

A

Heart rate
110-160

Respiratory rate
30-40

Systolic BP
80-90

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10
Q

What are the normal vitals for 1-2 years old?

A

Heart rate
100-150

Respiratory rate
25-35

Systolic BP
85-95

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11
Q

What are the normal vitals for 2-5 years?

A

Heart rate
95-140

Respiratory rate
25-30

Systolic BP
85-100

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12
Q

What are the normal vitals for 5-12 years?

A

Heart rate
80-120

Respiratory rate
20-25

Systolic BP
90-110

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13
Q

What are the normal vitals for >12 years?

A

Heart rate
60-100

Respiratory rate
15-20

Systolic BP
100-120

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14
Q

viral induced wheeze?

A

older kid (more than 1 year)
wheeze and NO crepitations
typical urticaria symptoms- blocked nose, fever

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15
Q

bronchiolitis presentatentpaion?

A

less than 1 year old
wheeze AND crepitations
typical URTI symptoms- blocked nose, temp

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16
Q

treatment for viral induced wheeze?

A

Start multi-dose salbutamol

Sats monitoring applied
Consider oxygen if sats dropping 
Start salbutamol MDI
Observe in PAU 
Repeat observations in 60 mins
Senior review
Any parental questions?