Paediatrics CPGs Flashcards by Sarah Ricciuti

Paediatric Assessment Triangle

Appearance - Tone, Interactiveness, Consolability, Look/gaze, Speech/cry
Work of breathing - abnormal posturing, abnormal breath sounds, retraction, nasal flaring
Circulation - pallor, mottling, cyanosis

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Anatomical differences to adults - head

larger in proportion to body
greater heat loss, heavier, larger occiput
falls headfirst

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Anatomical differences to adults - airway

soft laryngeal cartilage
nose breathers
large head, short neck
trachea diameter smaller and shorter
cricoid narrow
epiglotis large
smaller oral cavity
delicate mucosa
large tongue
small jaw
loose teeth

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Anatomical differences to adults - ribs/chest

ribs more horizontal and more compliant
diaphragmatic breathers
full stomach impairs breathing
blunt trauma without # therefore # ribs indicate severe injury

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Anatomical differences to adults - abdo

protruberant
organs relatively larger, not protected by fat
prone to infections, obstructions, constipation, malapsorption
smaller stomach capacity

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Anatomical differences to adults - musculoskeletal

softer bones, more likely to bend

- fractures involve growth plate

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Anatomical differences to adults - cardiovascular

bradycardic arrest - hypoxia
poor sympathetic innervation therefore poor tachycardic response to shock
left ventricle underdeveloped therefore fixed SV , increased BP relies on increased HR and SVR
higher HR
hT indicates greater than 40% blood loss

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Anatomical differences to adults - respiratory

-higher RR
-greater metabolic rate and higher o2 consumption
-TV 5ml/kg
little fatigue resistant muscle fibers therefore tire easily

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Causes of cardiopulmonary arrest in paeds

hypoxaemia or hT or both

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Causes of cardiac pulmonary arrests in paeds

trauma
SIDs
drowning
asthma
septicaemia
UAO
congenital abnormalities

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Paed resus is directed at

adequate airway control
ventilations
compressions
adrenaline

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Airway positioning of infants

head and neck neutral position

padding beneath shoulders to prevent neck flexion and head extension

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Airway positioning of children

use neck flexion and extension with caution

as child gets older, less need for padding

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Starting CPR for infants and children

Infants (less than 1 yr) HR less than 60

Children (1-4yrs) HR less than 40

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Croup definition

A viral infection of the larynx, trachea and bronchi which leads to airway obstruction that can cause stridor - inflammation and oedema of mucosa and submucosa causing narrowing of subglottic area - obstruction, resp distress, hypoxia

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Patho of croup

URTI - migrates into and infects the glottis and subglottic regions - inflammatory oedema accumulation - narrowing of the airway causing partial airway obstruction - child devlops a hoarse barking cough caused by a decrease in mobility of the vocal cords due to the oedema

Signs and sypmpoms of croup

mild/mod:
-Barking cough, Urti, Retraction and resp distress, Stridor, Temp/tachycardia
Severe:
-Cyanosis, Lethargy, Altered conscious and agitation, Marked accessory use, Stridor reduces

Causes of croup

viral
spasmodic: sudden nocturnal onset, part asthma
bacterial tracheitis: susp, with febrile croup with purulent secretions

Epiglottits definition

severe bacterial airway infection of supra-glottic portion of larynx and epiglottis

Signs and symptoms of epiglottits

Septic fever
No cough
Rapid onset
Exp snore/low insp stridor 
Drool - mouth open tongue out

Upper airway obstruction symptoms

coughing, distressed, difficulty breathing, stridor, red or cyanosed, increased RR

Management of mild pain in paeds

Paracetamol 15mg/kg oral if no admin in 4 hours

Management of moderate pain in paeds

Fentanyl IN
-small child (10-17kg) 25mcg
-large child (18-39kg) 25-50mcg
repeat initial dose every 5-10mins titrated to pain and side effects (max 3 doses)
-consult for children under 10kg
OR
Methoxy 3ml, repeat if required (max 6ml)

Management of severe pain in paeds

Fentanyl IN or Methoxy
IM Morphine as last resort if pain not controlled by above
0.1mg/kg IM (single dose)

Upper airway obstruction management

Partial obstruction - encourage cough, utilise gravity, BLS Partial obstruction - utilise gravity, back slaps alternating with chest thrusts - if becomes unconscious: chest compression, suction, magill's, forced ventilation - if loss of CO mx as cardiac arrest Susp. epiglottitis - BLS and tx

Croup management

Moderate: Dex 600mcg/kg oral (max 12mg) , tx Severe: increasing resp distress, increasing lethargy, decreasing stridor - Adrenaline 5mg in 5ml neb, Dex 600mcg/kg oral (max 12mg) -repeat adrenaline at 5 min intervals until improvement

Management of mild or mod asthma in paeds

Salbutamol pMDI 6 or older: 4-12 doses 2-6yrs: 2-6 doses pt take 4 breaths per dose, repeat at 20 min intervals is required

Management of severe asthma in paeds

``` Salbutamol neb -small children (2-4): 2.5mg (1.25ml) -medium child (5-11): 2.5-5mg (1.25-2.5ml) -repeat every 20 mins if required Ipratropium Bromide 250mcg (1ml) neb ```

Management of critical asthma in paeds

Salbutamol all children (2-11): 10mg (5ml) neb, repeat every 5 mins if required Ipratropium Bromide: 250mcg (1ml) neb If unable to gain IV: Adrenaline 10mcg/kg IM repeat every 5-10 mins as required (max 30mcg/kg) Dexamethasone 600mcg/kg oral (max 12mg)

Management of paed asthma unconscious

small child - 12-15 ventilations per min medium child - 10-14 ventilations per min use Vt sufficient to achieve visible chest rise and fall moderately high resp pressures allow for prolonged expiratory phase gentle lateral chest pressure during expiration

Management of paed asthma loses CO

Apnoea 30s - exclude TPT - gentle lateral chest pressure - prepare for resus

Nausea and vomiting management paeds

Ondansetron ODT small 2mg medium 4mg

Hypoglycaemia management for paeds

BGL less than 4: Glucose 15g oral BGL less than 4 no response: under 25kg Glucagon 0.5 IU IM (0.5ml) 25kg or more Glucaon 1 IU IM (1ml)

Seizures management of paeds

-mx airway and ventilation as required -if airway patent, admin high flow o2 -Midaz IM Medium child (5-11yrs) 2.5-5mg IM Small child (1-4yrs): 2.5mg Small and Large child (under 12 months): 1mg Newborn: 0.5mg -continue to monitor airway, ventilation, conscious state, BP -repeat after 10mins once only, consult for further

Anaphylaxis management for paeds

- Monitor cardiac rhythm - Adrenaline 10mcg/kg IM - repeat at 5 mins until satisfactory results or side effects - provide high flow o2 - mx respiratory distress as indicated - where possible do not allow pt to stand or walk

Meningococcal Manegement for paeds

Ceftriaxone 50mg/kg IM (max 1000mg) - dilute 1000mg with 3.5ml Lignocaine 1% - admin into upper lateral thigh

Opioid overdose for paeds

- assist and maintain airway/ventilation - Naloxone 10mcg/kg (max 400mcg) IM - repeat after 10mins

Chest injuries management for paeds

- supp o2 - pain relief - position pt upright if possible unless: inadequate perfusion, altered consciousness, associated barotrauma, potential spinal injury

Burns management for paeds

- cool the burn, warm the pt - cool burn area - protect remainder of pt from heat loss where possible - provide analgesia - cover cooled burn area with cling wrap