Acute Illness

Question 1

Describe the normal physiological RR, HR and BP in a child

Answer 1

RR - high
HR - high
BP - low

Question 2

How does child anatomy vary from adult anatomy?

Answer 2

Larger head and more prominent occiput in children
Large surface area of skin compared to volume (important if burned)
High anterior larynx/floppy epiglottis (different intubation)
More flexible ribs
Blood volume 80mls/kg

Question 3

What respiratory noise is usually heard in Croup and why?

Answer 3

Stridor (inspiratory noise)

As Croup affects upper respiratory tract

Question 4

What respiratory noise would be heard if the child had a lower respiratory tract infection?

Answer 4

Wheeze (on expiration)

Question 5

How is Croup usually treated?

Answer 5

Steroids

Question 6

Under what age can children NOT attempt a peak flow reading?

Answer 6

2 years

Question 7

What CNS problems usually affect children acutely?

Answer 7

Meningitis: bacterial and viral
Encephalitis: commonly viral

Question 8

How are CNS infections investigated?

Answer 8

Lumbar puncture and imaging

Question 9

What does the purpuric rash often seen in meningitis confirm?

Answer 9

A meningococcaemia

=> present in bloodstream and is a different (and more severe) disease than meningitis which is limited to the CNS

Question 10

What are the most common causes of fits/faints/seizures in children?

Answer 10

• Febrile seizures
• Vasovagal episode
• Reflex anoxic seizures
• Breath holding attacks
• Epilepsy
• Arrhythmias

Question 11

What are the most common types of accidents/trauma that children will present with to the GP?

Answer 11

RTA
Trampoline, sports injuries
Burns
Ingestion 
Drowning, near-drowning
Choking

Question 12

What does a rib fracture in a child create suspicion of?

Answer 12

NAI

as childrens ribs are flexible, so fracture would take a lot of force

Question 13

What GI problems cause children to present acutely ill?

Answer 13

• Viral gastroenteritis
• GI obstruction
  (congenital pyloric stenosis, volvulus, intussusception
  and malrotation)
• Acute abdomen [in older children] - appendicitis
• UTI (OR abnormal renal tract)
• Testicular torsion

Question 14

What cardiovascular conditions are most common in children?

Answer 14

Congenital heart disease – cyanosis, heart failure
Arrhythmias (SVT)
Bacterial endocarditis (rare but severe)

Question 15

What manoeuvre can be performed to make a child’s airway as patent as possible?

Answer 15

NOT head tilt, chin lift (due to high larynx)

Return to neutral position

Question 16

How do you manage Breathing when carrying out ABCDE on a child?

Answer 16

High flow O2 if breathing

Not breathing – rescue breaths

Question 17

Hypertension in a child is a pre-terminal sign. TRUE/FALSE?

Answer 17

FALSE

HYPOtension is a pre-terminal sign

Question 18

How much fluid should be given if a child presents in shock?

Answer 18

20mls/kg of 0.9% saline

Question 19

How can you see if a child is dehydrated?

Answer 19

Mucous membranes visibly dry
Skin turgor decreased
Urine output decreased

Question 20

What postures during fitting can indicate a severe problem in the child?

Answer 20

decorticate (back of wrists together in front)

decerebrate (hands inturned by side)