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Year 2: Block 4: Paediatrics > the acutely ill child > Flashcards

the acutely ill child Flashcards

(51 cards)

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1
Q

normal physiological parameters for under 1 year old

A
  • heart rate= 110-160
  • resp rate= 30-40
  • systolic blood pressure= 70-90
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2
Q

normal physiological parameters for a 1-2 year old

A
  • heart rate= 100-150
  • resp rate= 25-35
  • systolic blood pressure= 80-95
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3
Q

normal physiological parameters for 2-5 year old

A
  • heart rate= 95-140
  • resp rate= 25-30
  • systolic blood pressure= 80-100
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4
Q

normal physiological parameters for 5-12 year old

A
  • heart rate= 80-120
  • resp rate= 20-25
  • systolic blood pressure= 90-110
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5
Q

normal physiological parameters for 12+ year old

A
  • heart rate= 60-100
  • resp rate= 15-20
  • systolic blood pressure= 100-120
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6
Q

children have a

A

larger surface area compared to their volume and their glottis is located more superior and anterior

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7
Q

children blood volume

A

80mls/ kg

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8
Q

meningitis

A

inflammation of the meninges

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9
Q

meninges

A

3 protective membranes covering the brain and spinal cord

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10
Q

meningitis more specifically refers to

A

inflammation of the 2 inner membranes called the arachnoid and pia matter known as leptomeninges

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11
Q

in meningitis WCC of CSF

A

is above 5

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12
Q

bacterial causes of meningitis

A
  • in neonates= group B strep, e.coli, listeria monocytogenes
  • in children and teens= neisseria meningitidis, strep pneumonia
  • in adults and elderly= strep pneumonia and listeria monocytogenes
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13
Q

viral causes of meningitis

A
  • enterovirus (particularly cocksackie)
  • Herpes simplex virus
  • HIV
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14
Q

symptoms of meningitis

A

headaches, fever, nucall rigidity, photophobia, phonophobia

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15
Q

diagnosis of meningitis

A

lumbar puncture

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16
Q

treatment of meningitis

A

depends on the underlying cause but for bacterial causes steroids and then antibiotics to prevent injury to the leptomeninges as the antibiotics destroy the bacteria

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17
Q

febrile convulsions

A

seizures occurring in children between the ages of 6 months- 5 years associated with a fever without any underlying cause such as a CNS infection or electrolyte imbalance

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18
Q

simple febrile convulsion

A

generalised tonic iconic seizure which lasts less than 15 minutes and does not recur within 24 hours or within the same febrile illness

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19
Q

complex febrile seizures

A

one of the following:

  • focal features at onset or during the seizure
  • duration of longer than 15 minutes
  • recurrence within the same febrile illness
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20
Q

febrile status epilepticus

A

febrile seizure which lasts longer than 30 minutes

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21
Q

most common causes of fever in children with febrile convulsions

Study These Flashcards
A

viral infections, otitis media, tonsilitis, gastroenteritis or post-immunisation

22
Q

history taking for a suspected febrile convulsion

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A
  • eyewitness account of the seizure including conscious level prior to the seizure, duration of the seizure, focal or generalised and the time take to recover from the seizure
  • are there any more sinister symptoms of meningitis or septicaemia
  • past medical history or family history of seizures
23
Q

febrile convulsions management

Study These Flashcards
A
  • generally managed at home, once child comes out of seizure place them in the recovery position
  • if seizure lasts more than 5 minutes call an ambulance
24
Q

treatment of febrile convulsions

Study These Flashcards
A

do not require treatment but if seizure lasts longer than 5 minutes rectal diazepam can be given

25
vasovagal syncope
syncope is transient loss of consciousness caused by transient global cerebral hypo perfusion characterised by rapid onset, short duration and spontaneous recovery
26
causes of vasovagal syncope
- postural hypotension - emotional stress - orthostatic stress e.g prolonged standing in hot crowded places
27
reflex anoxic seizures
paroxysmal, spontaneously reversing brief periods of asystole triggered by pain, fear or anxiety due to increased vagal responsiveness
28
during a reflex anoxic seizure
child becomes suddenly pale and limp and will fall over if standing, this is followed by stiffening and clonic jerking of the limbs
29
reflex anoxic seizure usually lasts for
30-60s does not cause tongue-biting (which is useful to differentiate it from epilepsy)
30
breath holding spells
episodes in which a child cries because he is hurt, frightened or upset and turns pale or blue before loosing consciousness
31
sepsis is the
commonest reason for acute illness in children
32
sepsis step 1
recognition: a child with suspected or proven infection and at least 2 of the following - temperature less than 36 or greater than 38 - inappropriate tachycardia - altered mental state (sleepiness/ irritability/ leathery/ floppiness) - reduced peripheral perfusion/ prolonged cap refill/ cool or mottled peripheries
33
sepsis step 2
reduced your threshold for considering sepsis i.e. some children are at a higher risk of sepsis so they can have it without fulfilling all criteria; - infants - immunosupressed/ immunocompromised/ chemotherapy - recent surgery - indwelling devices/ lines - complex neurodisability/ long term condition - high index of clinical suspicion - significant parental concern
34
sepsis step 3
stop and thick is this sepsis is yes implement SEPSIS 6 within one hour
35
paediatric sepsis 6
1. high flow O2 2. obtain intravenous or intra-osseous access and take blood cultures, blood glucose and blood lactate 3. Give IV or IO broad spectrum antibiotics if shocked... 4. Consider fluid rescucitation 20ml/kg isotonic fluid over 5-10 5. consider inotropic support early 0.3mg/kg of adrenaline in 50mls of 5% dextrose 6. GET SENIOR HELP
36
causes of paediatric cardiac arrest
respiratory failure is most common followed by circulatory failure
37
causes of respiratory failure
1. respiratory distress= foreign body, croup, asthma | 2. respiratory depression= convulsions, raised ICP, poisoning
38
causes of circulatory failure
1. fluid loss= blood loss, gastroenteritis, burns | 2. fluid maldistribution= septic shock, cardiac disease, anaphylaxis
39
respiratory arrest
has much better outcomes than cardiorespiratory arrest but if untreated will progress to cardiorespiratory arrest
40
PAEDIATRIC BLS ALGORITHM
- UNRESPONSIVE - SHOUT FOR HELP - OPEN AIRWAY - NOT BREATHING NORMALLY - 5 RESCUE BREATHS - NO SIGNS OF LIFE - 15 CHEST COMPRESSIONS: 2 RESCUE BREATHS
41
A
Airway open airway and listen for breathing
42
B
Breathing is evaluated by both effort and efficacy of breathing
43
effort of breathing
- rate - recession - accessory muscle usage - grunting - nasal flaring
44
efficacy of breathing
- chest expansion - additional noises; inspiratory stridor, expiratory wheeze - pulse oximetry - effects on end organs
45
C
circulation; - capillary refill - pulse volume, rhythm and rate - blood pressure If shocked 20mls/kg of 0.9% saline repeat if there is no response
46
20mls/kg
is 25% of circulating volume and is the point where clinical shock is detected
47
D
disability - AVPU - GCS - Pupillary response to light - Posture
48
posture
decorticate or decerebrate
49
what posture it worse
decerebrate but they both indicate severe brain damage
50
DEFG
don't ever forget glucose
51
E
Exposure; temperature and rash/ bruising/ bleeding

Year 2: Block 4: Paediatrics (14 decks)

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