Flashcards in EOS revision Deck (58)
Airway changes in Downs Syndrome
Short neck, small head, ears and mouth, flattened facial profile, smaller glottis, large tonsils and adenoids and small trachea diameter
Other anatomical changes present in downs syndrome children
Decreased/poor muscle tone, upward slanting eyes, flat back of head, excessive skin folds in posterior neck, below average size at birth and hearing difficulties.
What are conditions down syndrome children more prone to?
Respiratory conditions, congenital heart defects, tracheomalacia, seizures (epilepsy), gastric reflux, sleep apnoea and obesity
What is cerebral palsy?
Stiff neck muscles, exaggerated reflexes, loss of muscle coordination, tremors, delayed development, difficulty walking (walking on toes, gait differences), excessive drooling or problems swallowing, seizures and difficulty with fine motor movements
What is spina bifida
Incomplete development of the brain, spinal cord or the meninges that occurs before the 28th day of pregnancy
what is a ventriculoperitoneal (VP) shunt
device that relieves pressure on the brain caused by fluid accumulation that goes from the lateral ventricles to the abdomen
What conditions warrant a VP shunt
Spina bifida, tumours, inflammation/infection and cysts
What is a ventricular assist device (VAD)
Designed to support a damaged or diseased heart to maintain bloodflow while a child s waiting for a donor heart
Why do patients have PG tubes or gastronomy tubes inserted
To provide long term nutritional supplement when someone cannot take food by mouth. Conditions include impaired swallowing, facial abnormalities, anorexia, increased nutritional requirements, congenital abnormalities and to manage disease
What happens if PEG tube is displaced or removed
A replacement tube needs to be inserted within 4 hours
What is a tracheostomy
Surgical opening of the trachea below the larynx through which an indwelling tube is placed to overcome upper airway obstruction, keep airway clear of secretions or facilitate mechanical ventilator support
Why might a pateitn have a trachostomy
Tracheal stenosis, trancheomalacia, craniofacial abnormalities, muscular dystrophy, spinal cord injury, TBI or cerebrovascular accidents
What 4 emergencies might occur with a tracheostomy
Exacerbation of underlying pulmonary disease, blocked tube, equipment failure or tube dislodgement
What do we do if tracheostomy is blocked
Suction tube, chane inner cannula, extend patient's neck, remove and re-insert tube and connect resus bag with oxygen flow to the tracheostomy tube
What is a greenstick fracture
When the bone bends and cracks instead of breaking into separate pieces. Due to softer, more flexible bones
When may a fracture lead you to think it is non-accidental
< 1 year, several fractures at different healing stages, MOI not consistent, bruising over non-bony areas and bilateral or multiple fractures
What is a differential fro kids that look like they have been abused
What signs indicate shaken baby syndrome
Poor feeding, inconsolable irritability, vomiting, seizures, posterior rib fracture, bulging fornanels, raised ICP and mechanism that doesn't line up with presentation
What is a SCIWORA injury
spinal cord injury without radiographic abnormalities: it refers to spinal injuries located in the cervical region in the absence of bony or ligamentous injury
What 4 MOI are most likely to cause SCIWORA
hyperexxtension, hyperfelexion,, distraction and spinal cord infarction
What are the signs of SCIWORA and how do we manage
signs mimic c-spine injury and management should be with spinal immobilisations, ABCs, and transport to receive MRI
What is a pulmonary contusion
Pulmonary parenchymal damage with edema and haemorrhage in the absence of an associated pulmonary laceration
Why is pulmonary contusion more common in children
Ribs are flexible and therefore blunt trauma more likely to impact on lungs
What are the clinical signs of pulmonary contusion
Blunt force injury, hypoxia, dyspnoea, increased WOBm, haemoptysis, crackles, decreased breath sounds and areas of consolidation
What is an epiphysial fracture
Fracture of growth plate separatng the epiphysis from the metaphyisis that is responsible for longitudinal growth of long bones
What are 4 complications of paediatric fractures
Embolus, infection, compartment syndrome, and growth deformity
What is the most common cause of traumatic death in children
Head injury from fall, RTC, and abuse
When do fontanels and sutures close
Between 12 and 18 moths
What is cushing's triad
Sign of raised raised intracranial pressure. Bradycardia, hypertension and apnoea
How is the anatomy of a child's abdomen different to an adult?
Liver and spleen lie lower and are less protected by ribs, blodder is an intra-abdominal injury and abdo injury can cause resp compromise by irritating the diaphragm
What is the definition of a fever in children and what is the most common cause
> 38 degrees
Commonly viral infection
What are the 3 different age ranges to classify fevers?
<3 month = >38 degrees
3 months - 3 years = >38 for more than 3 days or looks unwell and temp >38.8
> 3 years = >40 degrees, febrile seizures, fever for more than 7 day, fever + chronic illness or fever and a rash
How do we anage fever
focus on cause (URTI, LRTI, UTI), and give paracetamol
What is a retropharyngeal abscess and what causes it
Formation of an abscess in the retropharyngeal space followed by an URTI or trauma - bacteria spreads from tonsils, throat, sinuses, adenoids or nose.
Collection of puss in lymph nodes posterior to pharynx.
What is Epiglotitis
A bacterial infection (haemophilus influenza A) that is progressive
Who gets retropharyngeal abscesses
Most common prior to 3 years (50% of cases occur between 6 and 12 months)
What is the presentation of retropharyngeal abscess
Sore throat and neck, swollen neck, difficulty swallowing and speaking, stridor and excessive drooling.
When does epiglotitis occur
Peak incidence between 2-5 years.
Fever (>39), dysphagia, sore throat, dysphonia, respiratory distress and DROOLING+++.
What causes croup
Viral in origin (parainfluenza virus, RSV, influenza A and B, rhinovirus.
When is croup most prevalents
4 moths to 2 years (up to 6 years)
What is the primary presentation of croup?
Pre-existing URTI, fever? And seal bark cough, high pitched inspiration, stridor, worse at night and worse when its cold.
Define Bacterial Tracheitis
Severe inflammation of the trachea due to bacterial infection with the production of thick purulent secretions and sloughing off of damaged tissues.
What is the presentation of bacterial tracheitis
Insp/ exp stridor, hx of croup-like illness becoming progressively worse leading to sepsis and significant distress.
What is the presentation of bacterial tracheitis
Oxygen, parent and child reassurance, NEB adrenaline 5mg for croup and transport as they require Abs and possibly intubation.
How do we manage upper airway disorders
Oxygen, parent and child reassurance, NEB adrenaline 5mg for croup and transport as they require Abs and possibly intubation
What is bronchiolitis
Viral infection causing the acute inflammation of the bronchioles (most common RSV)
When is bronchiolitis most common
In winter and when the child is <12 months old.
Expiratory wheeze, febrile and usually URTI hx.
Generally just oxygen as bronchodilators (salbutamol) don’t work because wheeze is due to inflammation.
Narrowing or collapse of the trachea.
Difference between primary and secondary tracheomalacia
Primary= congenital disorder from underdeveloped tracheal cartilage and usually improves with age. Secondary= due to compression of the trachea by vascular rings, tumours or cysts.
Bacterial infection caused by bordetella pertussis (whooping cough).
When is pertussis most common
Most common <6 months but can occur up to 5 years.
What is the progression of pertussis?
1-2 wks= URTI prodromal and 2-4wks= paroxysmal phase (harsh cough followed by vomiting)
How is pertussis manage
PPE and infection control and symptomatic management. (Definitive management is with Abs)
What is the difference for children with asthma
The fatigue easier and therefore needs early intervention. (Bradycardia= bad)