Sick child 2, Recognising the sick child Flashcards
Appreciate some of the causes of resp and circulatory failure
What are the outcomes like for a child going into Respiratory vs Cardiopulmonary Arrest?
If you are able to intervene at the resp arrest stage rather then the cardiopulmonary arrest stage then the outcomes are so much better
What is the structured approach to a child in an emergency situation?
Primary Assessment - Do ABC
- If needed do Resuscitation
Secondary Assessment – think didn’t need to resuscitate but theres stuff I now might need to treat
- Provide Emergency Treatment
What is the acronym for the assessment of a sick child ?
ABCDE:
- Airway
- Breathing
- Circulation
- Disability - also don’t ever forget glucose
- Exposure
What are some of the signs you look for to assess the effort of breathing ?
- Rate
- Recession - e.g. the muscles in the ribs sucking in, notch at bottom of neck etc
- Accessory muscle use
- Grunting
- Nasal flaring
What are some of the signs you look for when assessing the efficacy of breathing ?
- Expansion
- Additional noises - Inspiratory stridor, Expiratory wheeze
- Pulse oximetry
- Effects on end organs – conscious level, pallor, tachycardia
What is the management of A&B in an emergency situation ?
Airway patent ?
If not:
- Airway manoeuvres (remember in kids under one go for neutral in head tilt chin lift, and for those in over this go for tilting it all the way back)
Think give high flow O2 if sats low:
- High flow O2 - even in kids give 15L per min
Make sure you reasses these after giving these interventions
What is hypo-tension a sign of in kids ?
Pre-terminal - due to kids being so good at compensating there BP that when they are hypotensive it is a sign that they are about to drop off the cliff
What are some of the things you assess in Circulation (C)?
- HR
- Rhythm
- Pulse volume
- Capillary return
- BP
Effects on other organs (think these are linked to hypotension):
- Conscious level
- Skin perfusion – temperature, colour
- Urine output -
Appreciate the signs and severity of dehydration
What are the management interventions for circulation (C)?
20mls/kg of 0.9% saline – always saline solution
Reassess
Repeat if still shocked
Reassess
What do you do when assessing conscious level for D ?
- AVPU
- GCS - glasgow coma scale
- Pupils
- Posture – decorticate/decerebrate
- Don’t ever forget Glucose
What signs are shown in the two pics ? (1 = top L, 2 = top R)
- Decorticate - person is stiff with bent arms, clenched fists, and legs held out straight
- Decerebrate posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward.
What are you assessing when exposing the patient for E?
- Temperature
- Rash or bruising
- Trauma
- Anything else
What are some of the symptoms of resp failure ?
- An inability to breathe
- Bluish coloration in the skin, fingertips, or lips
- Restlessness
- Anxiety
- Confusion
- Altered consciousness
- Rapid, shallow breathing
- Racing heart
- Profuse sweating
