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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

Osteogenesis imperfecta


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
Inflamed epiglottis


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.


Epiglotitis Presenaton

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.


Bronchiolitis presentation

Expiratory wheeze, febrile and usually URTI hx.


Bronchiolitis Management

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.


Define pertussis

Whooping cough
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)


What helps diagnose otitis media in children

Pulling on ears, unsettled, fever and discharge.