Assessing the acutely ill child-respiratory failure and arrest Flashcards Preview

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Flashcards in Assessing the acutely ill child-respiratory failure and arrest Deck (22):
1

Common presentations of acutely unwell child (10)

Acute onset high fever
Non-blanching rash (septicemia)
Convulsions
Altered level of consciousness
Anaphylaxis
Acute asthma
Choking, inhalation of foreign body
Drug ingestion
Severe dehydration
Burns and scalds

2

What does cardiac arrest usually follow

Circulatory failure or respiratory failure

3

Division of circulatory failure in children and causes

Fluid loss:
-Blood loss
-Vomiting
-Dehydration
-Burns

Fluid maldistribution
-Septic shock
-Cardiac
-Anaphylaxis
-Nephrotic syndrome

4

Division of respiratory failure in children and causes

Respiratory distress:
-Asthma
-Bronchiolitis
-Pneumonia
-Croup
-Foreign body

Respiratory depression:
-Opiates
-ICP
-Poisoning
-Convulsions

5

Features in ill child to recognise (5)

Colour
Activity
Respiratory
Hydration

Specific other features

6

Features of a low risk child

Normal skin colour
Responding to social cues, smiling, alert/awake, strong cry
Nil respiratory changes
Normal skin, eyes and moist mucus membranes

Nil features of intermediate/high risk

7

Features of intermediate risk child

Pallor (as reported by carer)
Not responding normal, need ++stimulation, decreased activity, not smiling
Nasal flaring
6-12 months >50 breaths/min
12 months >40 breaths/min
O2 sats 3 seconds, -ve urine output

Fever >5 days
Swollen limb/not weight bearing
New lump >2cm

8

Features of a high risk child

Pale/mottled/ashen
Not rousable/doesn't stay awake, appear ill to healthcare, no response to social clues
Grunting, indrawing, tachyP >60
Reduced skin turgor

Age 0-3 months T >38
Age 3-6 months T >39

Non blanching skin rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological
Focal seizures

Bile stained vomiting

9

Causes of shock

Blood loss
Fluid loss- DKA, nephrotic, diarrhea, vomiting
Dehydration
Septic shock
Burns
Heart failure
Anaphylaxis

10

Clinical features

TachyC
Thready pulse
Delayed CRT
Mottled
Cool extremities
Hypotension (very late)
TachyP
Restlessness
-ve urine
Metabolic acidosis

Fever->sepsis
Purpuritic rash->meningicoccal
Hepatomegaly-> HF
Focus of infection

11

Management of circulatory failure

ABC, call for help
High flow oxygen, resp support.
IVF bolus
Consider ionotropic support
Antibiotics for sepsis
Adrenaline and hydrocortisone for anaphylaxis
Complete investigations
Admit
Regular observations
Determine a cause

12

Causes of respiratory failure

Upper airway:
-Foreign body
-epiglotitis
-croup
-Loss of pharyngeal tone
-Flexion/hyperextension of neck

Lower airway:
-Asthma
-Bronchiolitis
-Pneumonia
-CF
-Neonatal lung disease

Neurological
-ICP
-Head injury
-Meningitis
-Muscle weakness

Severe cardiac failure
Drug ingestion

13

Clinical feature of respiratory failure

Respiratory distress->nasal flare, indrawing, grunting, stridor
TachyP
Cyanosis
Restless
Confusion

Wheee
Crackles
Neurological weakness

14

Investigations

CXR
ABG
Oxygen saturation

15

Management

ABC, call for help
Assess severity
High flow oxygen
Intubate and ventilate if +PCO2
Treat underlying cause->antibiotics, bronchoD + steroids, bronchoscopy etc

16

Define respiratory failure

Inadequate respiration to maintain normal arterial oxygenation and CO2 concentration

17

If epiglotitis is suspected, what must you not do

Examine the child's throat

18

What is the glass test and what to do if positive

Any rash, place glass over to see if blanching. If non-blanching, seek urgent medical attention

19

When should meningicoccal be suspected

Fever + non blanching rash
Child looks ill
>2mm purpura
Neck is stiff
CRT >3 seconds

20

Presentation of staphylococcal TSS

High fever
Muscle pain
Desquamating rash
Severe circulatory failure

21

Neurological warning signs

Drowsy, lethargy, ALOC
Severe headache (vomiting)
Irritability, high pitched cry
Bulging fontanelle in infants
Neck stiffness
Sudden onset of muscle weakness
Any new cranial nerve lesion
Abnormal movements
Convulsions

22

Importance of irritability

Consider hypoxia or CNS infection

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