Respiratory Upper and Lower Flashcards
Main causes of death in children worldwide
Main causes of respiratory and circulatory failure leading to cardiac arrest in kids?
What are the three E’s of assessing a child breathing
Effort of breathing
-Looking for intercostal, subcostal and suprasternal recession
-Looking for accessory muscle use
-Determining the rate of breathing
-Listening for inspiratory and expiratory noises such as wheezing and stridor
-Fatigue
-Cerebral depression
-Neuromuscular disease
Efficacy of breathing
-Observing chest expansion
-Listening for air entry
-Performing pulse oximetry
Effects of respiratory inadequacy on other organ systems that may be present
- Heart rate. Initially hypoxia will cause a tachycardia however if it is severe and prolonged the heart rate will fall: this is a pre-terminal event.
- Skin colour. Hypoxia will cause vasoconstriction and skin pallor. Cyanosis is a late sign.
- Mental status. Initially hypoxia will cause agitation and distress. As it progresses the child will become more drowsy and finally unconscious. Hypercarbia will cause drowsiness as well.
Normal heart rates in kids
Normal blood pressures in kids
rapid assessment of conscious level in kids?
AVPU
A Alert
V responding to Voice
P responding to Pain OR
U Unresponsive
Type of rash?
Urticaria - allergy
Type of rash am i?
Non blanching purpuric rash Eg meningococcal sepsis
In the rapid assessment of the seriously ill child How do you assess?
A+B
-Effort of breathing
-RR + rhythm
-Stridor/wheeze
-Auscultate
-Skin colour
C
-HR
-Pulse volume
-CRT
-BP
-Skin temp
D
-AVPU
-Posture
-Pupils
E
-Fever
-Rashes
- Trauma
Why are children more susceptible to severe respiratory illness
- Immunity - lack of immunity to organisms adults have acquired immunity to
- Both upper and lower airways are narrower in children and are more easily obstructed.
- The thoracic cage of young children is more compliant leading to recession with respiratory obstruction and less support for the maintenance of lung volume
- There are fewer alveoli present in early childhood.
- The respiratory muscles of young children are relatively inefficient leading to muscle fatigue and apnoea.
Lack of immunity in a small airways that have less alveoli with small muscles and a soft chest wall
The initial resuscitation of a child with breathing difficulties always involves:
opening the airway,
giving oxygen and
providing ventilatory support if necessary.
Features of acute severe asthma and Life-threatening asthma in kids
First steps for management of asthma? If they don’t respond to this?
Assess ABC and give high flow oxygen via face mask
Administer salbutamol via spacer or via nebuliser
Administer oral prednisolone or IV hydrocortisone.
Continue inhaled salbutamol up to continuous nebulised
Consider inhaled ipratroprium
Commence intravenous therapy – this may be one or more of:
-Magnesium Sulphate
-Salbutamol
-Aminophylline
Paeds asthma doses of
Salbutamol neb
Ipatroprium neb
Prednisolone
Hydrocortisone
Salbutamol IV
Magnesium IV
Amiophiline IV
Salbutamol neb - 2.5-5mg continuous if needed
Ipatroprium neb - 125-500mcg every 20mins
Prednisolone - 1mg/kg (max 40mg) for 3 days
Hydrocortisone - 4mg/kg every 6 hours (max 200mgQDS)
Salbutamol IV - 1-5mcg/kg/hr
Magnesium IV - 50mg/kg = 0.2mmol/kg = (0.1ml of 50%) over 20 mins
Amiophiline IV - 10mg/kg over 1 hour
Signs of severe bronchiolitis
If a PCO2 is 60 what would you expect the pH to be
20 high = decrease in pH by 0.2
= pH of 7.2
Management of mild croup? Severe? how do the doses of meds change?
Mild/mod
Dex 0.15mg/kg
Severe
Dex 0.6mg/kg (max 12mg)
Adrenaline nebulised - 5mls 1:1000
Unwell child. Rx?
Intubation
IV antibiotics
Choking child algorithm?
First thing you check?
*Heimlich is not recommended as may damage abdominal organs
How are chest thrusts done in choking child ?
Back blows?
Like compressions in BLS (but slower rate - approx 1/second)
Heel of palm and strike firmly using gravity
Anaphylaxis algorithm
Dose of drugs?
Fluids?
