Paeds COPY COPY

Question 1

Baby BLS <1yr

Answer 1

1. SSS (safe stimulate shout)
2. Air way opening manoeuvres
3. Look listen feel for breathing
4. If not breathing 5 initial breaths. Mouth over nose and mouth
5. Pulse check 5-10 secs (brachial/femoral)
6. 15 Chest compression with correct finger/ hand technique. Two thumbs on lower 1/3 of sternum with hand round thorax or two fingers on lower 1/3 of sternum.
7. 15:2 ratio
8. Call emergency services

Question 2

Child/adolescent BLS >1yr

Answer 2

1. SSS (safe stimulate shout)
2. Air way opening manoeuvres
3. Look listen feel for breathing
4. If not breathing 5 initial breaths. Pinch nose and cover mouth only.
5. Pulse check 5-10 secs (carotid/femoral)
6. 15 Chest compression with correct finger/ hand technique. Heel of 1 hand over lower 1/3 of sternum (younger child). Both hand for older child. Compress at least 1/3 chest for both.
7. 15:2 ratio
8. Call emergency services

Question 3

Choking

Answer 3

1. Coughing Y/N
2. If yes - encourage to cough and check for deteriation
3. If no - consciouss/unconsciouss
4. If Consciouss - 5 back blows:5 chest thrusts (<1yr) 5 abdo thrusts (child)
5. If unconsciouss - BLS

Chest thrust

• Two fingers on sternum pushing up and in

Abdo thrust

• One hand in fist above umbilicus and below xiphisternum
• One hand on top
• Thrust in and up

Question 4

General paeds Hx

Answer 4

1. Introduction + consent
2. Patient details
3. Relationship of adult
4. PC
   
   1. SOCRATES
5. HPC
6. DH
   
   1. Allergies
   2. Immunisations
7. PMH
   
   1. ObHx
   2. Development Hx
8. PSH
9. FHx/SHx
   
   1. Family trees
   2. Housings, Education, Smoking, Pets
   3. HHEADS (if adolescent)
   4. ?Consanguinity
   5. ICE
10. Feeding/Nutrition
    
    1. breast/formula
    2. nappies
    3. stools/wee’s

Summary

DD

Management

Question 5

Respiratory History exam DD management

Answer 5

Resp symptoms:

• Cough
  
  • Describe the cough: moist/dry, barking, blood?
  • Time of day? early morning, middle of night (disturbs sleep) = asthma
• SoB
• Dysopnoea
• Wheeze
• Chest pain
• Blue breath holding
• Intermitent (sp) symtpoms (between wheeze attacks)
• Coryzal sx

Systemic sx

• FTT (weight loss and growth stunting)?
• Syncope
• Blue breath holding
• fever
• lymphadenopathy

PMH: atopy

SH: exposure to cigarette smoke, recently abroad

Question 6

Respiratory Exam

Answer 6

1. Introduction, confirm patient details & consent

2. Wash hands

3. End of bed examination & General Appearance

• Chest wall
  
  • Scars
  • Lines
  • Shape (assymetry)
• noises/ask to cough (see attached picture)
• Signs of resp distress: intercostal/subcostal recession, trachael tug, nostral flaring, using accessory mm
• Cyanosis
• Energetic/apathetic/tired
• Comment on anything round bed (inhalers, sats monitors)

4. Inspect peripheries

Hands:

• Clubbing: CF, chronic lung disease, IBD
• Peripheral cyanosis
• Older children: CAP refill

RR

Eyes:

• pallor of conjunctiva: anaemia

Mouth:

• central cyanosis
• dry mucosal surfaces

5. Palpation

Trachea position

• deviation = tension pneumothorax

Lymph nodes

• signs of infection
• metasteses

Central CAP refill

• press on sternum for 5 seconds

Chest expansion

• poor: asthma
• asymetrical: pneumothorax?

Hepatomegaly

Oedema

• pretibial

Apex beat

• check medisatinal shift
• tension pneumothorax

6. Auscultate (first as percussion is unsettling for child)

16 areas - front(6), back(6), axilla (4)

Noises (see image + see below)

• harsh breathing sounds - upper airway problem (foreign body, allergic rxn, viral/bacterial URTI)
• crackles
  
  • fine: bronchiolitis
    
    • indicates small airway collapse due to loose secretions
  • coarse: pneumonia
    
    • excess fluid in lungs
• Dullness: consolidation

7. Further investigations/exams:

• ENT
• Peak flow
• Sats
• BP
• CVS
• Abdo