Child Emergency Flashcards
(87 cards)
Signs of serious illness
\_\_\_\_\_\_\_\_ 58% \_\_\_\_\_49% \_\_\_\_\_\_\_\_\_\_41% \_\_\_\_\_\_42% \_\_\_\_\_\_\_\_\_\_\_\_\_ 42%
Drowsiness
Pallor
Chest wall retraction
Temperature >38.9°C or
<36.4°C
Lump >2 cm
ABCDEGF of Child emergency
- A irway
- B reathing
- C irculation
- D isability (neurological assessment)
- E xposure
- F luids: in and out
- G lucose
Two main groups of signs are good indicators of
serious illness
Group 1: common features with reasonable risk and indicator of toxicity
Group 2: uncommon features with high
risk requiring urgent referral
Group 1: common features with
reasonable risk and indicator of toxicity
A = poor Arousal, Alertness and Activity
B = Breathing difficulty
C = poor Circulation (persistent pallor, cold legs
to knees)
D = Decreased fluid intake and/or urine output
Group 2: uncommon features with high
risk requiring urgent referral
- Respiratory: ____
- GIT: ____
- CNS: convulsions
- Skin: petechial rash
apnoea, central cyanosis, respiratory grunt
persistent bile-stained vomiting, mass
>2 cm other than hydrocele or umbilical hernia,
significant faecal blood
Inspiratory noises with obstruction — \_\_\_\_\_\_—partial obstruction with fluid — snoring—decreased level of consciousness — \_\_\_\_\_—partial obstruction to larynx or trachea
bubbly noises
stridor
Secondary signs of worsening obstruction
• Increased respiratory rate or effort • Decreased oxygen saturation • Increasing tachycardia • Deterioration of colour • Development of agitation or decreased level of consciousness
Investigations for sick child
Culture and sensitivity
_______________
Full blood examination __________
All with fever
All <4 weeks
Risk factors present
Doctor uncertain
Investigations for sick child
Those on antibiotics
Doctor uncertain
C-reactive protein
Indications for CSF examin
Suspected meningitis (infant drowsy, pale and febrile) Convulsion in febrile child and: • source of fever unknown • receding drowsiness and pallor • infant <6 months, child >5 years • prolonged convulsion (>10 minutes) • postictal phase longer than usual (>30 minutes)
________
is the usual rhythm at the time of arrest.
Asystole or severe bradycardia
How is BLS done outside the hospital
Basic life support outside the hospital
setting is 30: 2 compression ventilation
ratio, including two initial rescue breaths.
The ratio of 30:2 is recommended for all
ages regardless of the number of revivers
present
How to ventilate properly
Ventilate lungs at about 20 inflations/min with
bag-valve-mask or mouth to mask or mouth to
mouth. An Air-viva using 8–10 L/min of oxygen
is ideal if available
If intubation not possible, use a needle
_______ as an emergency
cricothyroidotomy
How to do compressions in children
Use two fingers or thumbs for infants <1 year
and heel of one hand for children 1–8 years.
If >8 years use a two-handed technique
Differences in children’s airways for intubation:
• epiglottis\_\_\_\_\_\_\_ • larynx \_\_\_\_\_ → difficult to intubate ‘blind’ •\_\_\_\_\_\_\_ → cuffed tube not required • shorter trachea → increased risk intubating \_\_\_\_\_\_\_\_\_ • narrow airway → increased airway resistance
longer and stiffer, more horizontal
more anterior
cricoid ring is narrowest position
right main bronchus
Rule for endotracheal tube (ETT) size
(internal diameter in mm
• ETT (mm) = (age in years ÷ 4) + 4
or the size of the child’s little finger or nares
• ETT length (cm) oral = (age in years ÷ 2) + 12;
nasal—add 3 cm
Drugs that can be administered through the ETT
can be considered under the mnemonic NASALS:
N = Naloxone A = Atropine S = Salbutamol A = Adrenaline L = Lignocaine S = Surfactant
Give a single shock instead of stacked shocks
(single shock strategy) for _____
ventricular
fibrillation/pulseless ventricular tachycardia
Where the arrest is witnessed by a health care
professional and a manual defibrillator is available,
________ the first defibrillation attempt
then up to three shocks may be given (stacked
shock strategy) at
Monophasic or biphasic defibrillation:_______
first
shock—2 J/kg, subsequent shocks—4 J/kg.
Children
_____ old are most prone to accidental poisoning
1–2 years
The most common cause of death in comatose
patients is _______
respiratory failure
The common dangerous poisons in the past were
____ and _____
kerosene and aspirin
