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Flashcards in Acutely ill children Deck (47):
1

what are the trends in BP, HR and RR as you get older

HR and RR start high get lower, BP starts low and gets higher

2

what is you're blood pressure when your >1

70-90

3

describe the differences in head anatomy in children (simple)

large head, prominent occiput, high anterior larynx/ floppy epiglottis

4

why is the large surface area of babies important

if they get burned will be a large proportion of skin affected- will lose more fluid

5

why is the floppy epiglottis and high anterior larynx

when intubating have to lift up epiglottis

high larynx means when opening airway put head in neutral position up till age 1 to prevent obstructing airway

6

why do children get costal recession when breathing hard

as ribs are flexible- why is very usual for children to break their ribs

7

what is childrens blood volume

80mls/kg

8

what type of haemoglobin do children have

HbF

9

what are the most common causes of childrens abdominal pain

gastroenteritis and constipation

10

what is bronchiolitis

acute inflammatory injury of the bronchioles, viral cause- mainly RSV

11

what are the signs of bronchiolitis

widespread fine crackles throughout lung fields, cold that goes to chest, struggling with feed. might need oxygen, tends to be over 5 days

12

what is the treatment for bronchiolitis

supportive- may need oxygen, change to smaller meals more often if stuggeling to eat

13

what is the risk of children under a month who get bronchiolitis

can get apnoea- need CPAP

14

what is croup

larygnotracheobronchitis, viral - usually parainfluenza, causes narrowing of the upper air way (stridor)

15

what is the treatment for croup

steroids (very low morbidity and mortality)

16

what can cause upper airway obstruction

epiglotisitis, bacterial infection, croup, inhaled foreign body

17

what are the signs of asthma

prolonged expiratory phase, wheezy

18

what are the signs of pneumonia

crackles on one side, temp, cough, can affect any age- different pathogens for different ages

19

what causes encephalitis

commonly viral- coxsackie

20

what do tou get in encephalitis

focal neurological deficit

21

what can cause meningitis

bacterial- meningococcal, strep, e coli
viral

22

what are the investigations into CNS infections

lumbar punctures, imaging

23

describe the rash in meningitis

fulminant pupura, non blanching

24

what are febrile seizures

reaction to temperature- will last less than 5 mins

25

what is a reflex anoxic seizures

when you get a fright/ bangs head and stops breathing can make fitting movement - do no treat with anti epileptics

26

what are breath holding attacks

when you cry and then hold it and then cry again

27

what are absence episodes

seizures lasting 10-30 seconds where you dont know whats happened
can just not be listening

28

what injuries are suspicious of NAI

broken ribs, retinal haemorrhages from shaking, bruising behind ear

29

what are the common GI/UG problems

viral gastroenteritis, GI obstruction (congenital pyloric stenosis, volvulus, intussusception and malrotation), acute abdomen (appendicitis), UTI, testicular torsion

30

should you give children IV drips

avoid, get better a lot quicker when have food in belly

31

what are common CVS complications

congenital heart disease (cyanosis, HF), arrhythmias (SVT)

bacterial endocarditis is rare but severe

32

what is the commonest reason for acute illness in children

sepsis

33

what children are at increased risk of sepsis

infants <3/12
immunosuppressed/ immunocompromised/ chemotherapy/ long term steroids
recent surgery
indwelling devices/ lines
complex neurodisability/ long term conditions
high index of clinical suspicious (tachypnoea, rash, leg pain, biphasic illness, poor feeding)
significant parental concern

34

what is the paediatric sepsis 6

six things to do within an hour (ideally within 15 mins)
-high flow oxygen
-take bloods (cultures, glucose (target low), lactate)
-give IV or IO (into bone marrow) antibiotics
if shocked
-consider fluid resuscitation
-consider inotropic support early
involve senior clinicians/ specialists early

35

what can cause circulatory failure

fluid loss- blood loss, gastroenteritis, burns

fluid maldistribution- septic shock, cardiac disease, anaphylaxis

36

what can cause respiratory failure

resp distress- foreign body, croup, asthma

resp depression- convulsions, raised ICP, poisoning

37

how do you asses the effort of breathing

rate, recession, accessory muscle use, head bobbing, costal recession, grunting (can be due to being cold, low BG, or way of giving themselves CPAP), nasal flaring

38

how do you asses the efficacy of breathing

expansion, additional noises (inspiratory stridor, expiratory wheeze), pulse oximetry, effects on end organs (conscious level, pallor, tachycardia)

39

what can prolong cap refill time in kids

being cold or sepsis

40

hoe can you assess circualtion

HR, rhythm, BP, cap refill, effects on other organs- conscious levels, skin perfusion (temp, colour), urine output

41

what does hypotension suggest

very bad- pre terminal sign

42

how do you manage poor circulation in kids

20mls/kg of 0.9% saline
repeat if still shocked (may also need inotropes)
if 60mls/kg used then involve PICU

43

when might you need blood transfusions in children

trauma/ haemorrhage

44

what are the signs of 5-10% dehydration

mucous membranes, fontanelles/eyes mildly dry
skin turgor slightly decreased
urine output midly reduced
conscious level normal

45

what are the signs of >10% dehydration

mucous membranes, fontanelles/eyes dry ++, sunken
skin turgor decreased
urine output significantly reduced
conscious level altered

46

how do you asses a childs conscious level

AVPU
GCS
pupils
posture- decorticate (hand and feet inwards) /decerebrate (hands and feet outwards)

47

what are decorticate/decerebrate postures a sign of

problems with brain stem, show neurological bruising
decerebrate worse