Paeds

Question 1

What’s is the PAT

Answer 1

Paed assemenr triangle

Includes
Appearance
Work of breathing
Circulation

Question 2

What to look for in appearance

Answer 2

TICLS 
T- tone 
I- Interactiveness 
C- consolability
L- look / gaze 
S - speech / cry

Question 3

What to look for in work of breathing

Answer 3

Abnormal sounds 
Snoring/ hoarse/ stridor 
Grunting 
Wheezing 
Recession 
Sniffing position 
Tripod 
Nasal flaring 
Head bobbing

Question 4

What to look for in circulation

Answer 4

Pallor
Mottling
Cyanosis

Question 5

Anaphylaxis

Answer 5

= severe allergic reaction

Give adrenaline
Salbutamol
Chlorphenamine
Hydrocortisone

Question 6

What age can be diagnosed with asthma

Answer 6

Age 5-6

Question 7

Mild moderate asthma clinical features

Answer 7

Able to talk in full sentences 
SpO2 above 92 
PERF more than 50% of best 
Pulse less than 140 age 2-5 
Pulse than 125 age 5 and above 

Encourage own inhaler use

Question 8

Severe asthma clinical features

Answer 8

Can’t complete sentences in one breath
SpO2 less than 92
PEFR 33%-50%

2-5
Pulse more than 140
Resp over 40

Over 5
Pulse more than 125
Resp over 30

Question 9

Severe asthma management

Answer 9

Salbutamol
Ipratropium bromide
Hydrocortisone

Question 10

Life threatening asthma clinical features

Answer 10

Silent chest 
SpO2 less than 92 
Cyanosis 
PEFR less than 33 
Poor resp effort 
Hypotension 
Exhaustion 
Confusion

Question 11

Life threatening asthma management

Answer 11

Continuous salbutamol
Administer 1 in 1000 adrenaline
Assess for tension pneumothorax

Question 12

How big is child’s airway

Answer 12

6 months - 3mm
4 years - 4.5mm
10 years - 6mm

Question 13

What to do in choking

Answer 13

If can cough encourage to cough

If can’t cough - 5 back slaps
5 abdo thrusts
Continue till Able to cough or out

Question 14

What to do in choking if loss of consciousness

Answer 14

Open airway
Laryngoscope
If see remove with mag ills or suction

Nothing visible 5 rescue breaths

15: 2 cpr

Question 15

What is croup

Answer 15

Infection of the upper airway

Most common 6 months to 6 years

Seal like barking cough

Question 16

Treatment for croup

Answer 16

Dexamethasone

Question 17

What to do in febrile convulsion

Answer 17

Temperature
Cool then down
Diazepam

Question 18

Paed pharmacology

Answer 18

Children have different response to drugs 
General rule 
- age based dosing regimen
- weight based rules 
- body surface calculation

Question 19

Adme - how is absorption affects in paeds

Answer 19

Intestinal transit time - shorter in younger children affect absorption for poorly soluble drugs

New born gastric ph is neutral, cause greater peak in acid liable drugs e.g. penicillin

Bile secretion - in first 2-3 weeks of life is poor. Decreased drug solubility. Risk in drugs e.g hydrocortisone

Intestinal permeability- higher in Pre term babies becomes more permeable with age

Passive and active transport - full mature by 4 months

Question 20

Adme - how distribution affects paeds

Answer 20

Body composition - affects distribution for instance amount of fat

Extracellular water - decreased through development, higher doses of water soluble drugs must be given to obtain the same effect

Protein binding - less in younger children, means drugs can’t bind so free fractions of these drugs are circulating, meaning can penetrate various tissues compartments yielding higher distribution

Question 21

Adme - how metabolism affects paeds

Answer 21

Enzymes - less enzyme activity, CYP3A very responsible various studies say increase or decreases with age

Liver has higher blood flow in children, hepatic clearance of drugs quicker, can increase first pass effect

Metabolites may be produced in children than are not in adults

Bacterial colonisation - intestines changed with age.

Gut lumen and wall can decrease bioavailability and the pharmacological effect of some drugs

Question 22

Adme - how elimination affect paeds

Answer 22

Predominantly via the kidney

Glomerular filtration rate reached the same as adults at 12 months

Renal excretion - similar or greater with certain drugs, related to kidneys. Children may require extra dose per kg

Urinary ph values can influence the reabsorption of weak acid or bases. So influence drug elimination

Question 23

What SpO2 is likely to cause an arrest in children

Answer 23

Less than 90%

Question 24

Fluid for kids in trauma

Answer 24

5ml/kg can be repeated till child improves

Question 25

Consideration of airway in paeds

Answer 25

Larger occiput may need something under shoulders Larger tongue more likely to occlude Any airway needs to be appropriately sized could cause laryngospasm If occurs gently bvm

Question 26

Consideration of breathing with paeds

Answer 26

Assess ventilation - head bobbing, gasping, flares nostrils, chest recession Ensure right size mask and be gentle around the jaw Children are more prone to tension pneumothorax, use saline syringe as it will show bubbles

Question 27

Consideration of circulation with paeds

Answer 27

A child with haemorrhage can maintain adequate circulatory volume by increasing their peripheral vascular resistance Peripheral shutdown - mottled, cool extremities, peripheral pallor Lower threshold for IO

Question 28

Consideration for disability paeds

Answer 28

Different gcs for verbal

Question 29

Skin layers

Answer 29

Epidermis - first line of defence Dermis - tough, elastic, connective tissue Subcutaneous - fatty layer Muscles/tendons/burns

Question 30

Classifications of burns

Answer 30

Superficial - epidermis involvement, blisters may happen after 24 hours, take 3-5 days to heal Superficial partial thickness - blisters, very painful, few weeks to heal Deep partial thickness - white and waxy Full thickness - dry and leathery (may need to cut through burnt skin to relieve pressure)

Question 31

Approach to burns

Answer 31

A - consider airway burns | B - apply oxygen as may not have reliable SpO2. Consider salbutamol if there is a wheeze

Question 32

Treatment for burn

Answer 32

Cooling/irrigation for 20 minutes maximum, up to 3 hours after, do not irrigate chemical burns Loose clingfilm, not in chemical burns

Question 33

Trauma centres for children

Answer 33

Coventry will accept even though just adult Nottingham Birmingham =children only

Question 34

5 key message for paed als

Answer 34

``` Use ABCDE approach 15L then do 94/98% In shock give fluids, blood products 15:2 bsl Search for and treat reversible causes ```

Question 35

Airway obstruction paed

Answer 35

If effective coughing - encourage to cough If ineffective coughing - Infant - 5 back blows/ 5 chest thrusts Child - 5 back blows/ 5 abdo thrusts Unconscious- open airway remove object do 5 rescue breaths

Question 36

How many newborns have difficulty breathing when born

Answer 36

10% of newborns

Question 37

Resus council points for neonatal

Answer 37

Leave at least 60 seconds before cord clamping if not possible consider cord milking Do not suction/ use laryngoscopy If no response to initial inflation consider extra pressure

Question 38

Important recommendation for neonatal CPR

Answer 38

``` If after 30 seconds hr slows commence cpr 3 compressions to 1 ventilation Intubate early Secure access Sats probe right hand ```

Question 39

Neonatal cpr

Answer 39

5 inflation breaths More pressure Then 60 secs do cpr 30:1

Question 40

What does the APGAR score look at

Answer 40

``` Appearance Pulse Grimace Activity Respiration ```