Topic 11 - Pediatrics/Geriatrics Flashcards
(36 cards)
1
Q
Pediatric airway features
A
- Obligate nasal breather when <6 months
- Easilyvblocked in URT infections
- 3-8 y.o. – adenotonsillar hypertrophy can contribute to obstruction and can make inserting airway adjuncts difficult
- Flexed in supine position – head large
- Large tongue
- High anterior larynx
- Reduction in airway diameter results insignificant loss of cross-sectional area
- Resistanceincreases 16 fold – can double this in turbulent flow (crying)
2
Q
Peadiatric breathing features
A
- Increased RR - Infants diaphragmatic breathers – muscles tire faster
- Increased metabolism and O2 consumption - 4ml/kgin adult, 6-8ml/kg in pediatric
- Decreased functional residual capacity and alveoli:surface area- more prone to hypoxia
- Increased chest wall compliance - prominent sternal recession and rib movement when compliance decreases or in airway obstruction
- Decreased alveolar recoil - Intrathoracic pressure less negative
3
Q
Pediatric circulation features
A
- Stroke volume in infants is relatively fixed (until 2 y.o.)
- Circulating volume per kilogram high but actual quantity low – small blood loss critical importance
- Hypotension is a late sign - use other markers of perfusion
- Maintain good SVR to maintain BP – decompensate rapidly
- Brachial pulse preferred site in infant (or apex of heart)
- Blood pressure:
- Hypotensiondefined (1-10 y.o.) - <70mmHg+ (childs age in years x 2)
- <3y.o. – Rely on central pulse such as carotid
- Cap refill in palms or soles of feet – a good indication of perfusion status
4
Q
Peadiatric vital signs
A
5
Q
Paediatric GCS
A
6
Q
Components of tha paediatric assessment traingle
A
- Appearance
- Work of breathing
- Circulation to skin
7
Q
Paediatric assessment of appearance
A
TICLS
- Tone
- Interactiveness
- Look/gaze
- Speach/cry
8
Q
Characteristics of ALTE
A
- Apnoea (respiratory pause > 15 seconds)
- Decreased mental status
- Colour change (pallor or cyanosis)
- Alteration in muscle tone (rigidity or limpness)
- Choking and;
Usually requires some degree of stimulation or resuscitation to resolve above symptoms.
Can be isolated or caused by life-threatening condition - should be investigated - usually no treatment required
No relationship with SIDS established
9
Q
5 most common causes of ALOC in paediatric population
A
GHOST
Glucose
Head trauma
O2 overdose/deficiency
Shock/Seizures
Tempurature
10
Q
Extra pertinant paediatric history questions
A
- Ask medication use in breast feeding mother
- Question parents/patient (as age appropriate) to:
- Prodromal illness, recent viral infections, abdominal pain
- Immunisation history
- General health
- Recent weight gain/loss
- Compliance with medications,if any.
- In infants – ask about nappies in particular:
- Have they been normal in appearance
- Have they been as “wet” asnormal.
- Colour of urine.
11
Q
Tetralogy of fallot diagram
A
12
Q
Barriers to pain releif in paediatrics
A
- Historical beleif infants don’t feel pain
- No data existed on short and long-term effects of analgesics on children
- Age-appropriate pain assessment tools leave physicians unable to conceptualise and quantify subjective pain experienced by children (FLACC or Wrong Backer)
- Fear of adverse events persists
- Parents believe the role of the hospital
- Fear of inducing addiction
- Childs fear of receiving injections
13
Q
Adrenaline indictions in Croup
A
Stridor at rest and:
- Cyanosis
- Retraction
- Decreased LOC
14
Q
Metabolic differences in paediatrics
A
- Metabolic consumption
- Large SA:body mass ratio
- Increased glucose requirement + decreased glycogen stores
15
Q
Trauma in adults versus children - size
A
- Increased likelihood of multiple injuries
- Less fat – closer proximity to vital organs
- Less elastic connective tissue
16
Q
Trauma in adults versus children - Ribs
A
- Diaphragmatic breathers - up and down movement not in and out (like adults) – decreased tidal volume - tachypnea is primary response to limited pulmonary compliance and greater chest wall compliance
- Infants and young children exhaust earlier - have less fatigue-resistant type 1 fibres in respiratory smooth muscle
- Higher O2 demand
- Smaller residual capacity
17
Q
Aerophagia in children
A
- Causes elevation of diaphram, severely impairing vital capcity
- Can predispose to apnoea with fatigue
18
Q
TBI in adults versus children
A
- The child’s head-to-body ratio is greater and the brain is less myelinated so is prone to serious injury.
- The head is larger in proportion to the body surface area, and stability isdependent on the ligamentous rather than bony structure. The pediatricbrain has a higher water content, 88% versus 77% in adults, which makes thebrain softer and more prone to acceleration-deceleration injury.
- Higher incidents of diffuse axonal injury
- Lower incidence of mass lesions than adult so 12-18mth infants tolerate ICP better (open sutures) - otherwise children are more prone to intracerebral hypertension - can contribute to ischemia and herniation
- Unlike in adults - can lead to hypotensive shock due to increased head:body ratio
- Softer bony structures transmit force to brain tissue more readily
19
Q
C-spine injuries in children versus adults
A
- C-Spine fulcrum C2-C3 in toddlers and C5-C6 in 8-12 year olds - adult injuries tend to be lower in vertebral column
- Large head size results in greater risk of flexion and extension injuries
- Smaller neck muscle mass with ligamentous injuries more common than fractures
- SCIWRO more common - focal neurological deficits may be delayed
20
Q
Blunt chest injuries in children
A
- May not result in rib fracture due to increase chest wall compliance
- Concurrent abdominal trauma common
- Increased mediastinal mobility - can cause pneumothorax to tension and transect small mediastinal vessels
21
Q
Traumatic asphyxia
A
- Venous back-flow caused by traumatic insult to thorax
- Observed in children due to flexible thorax and absence of valves invenous system of the inferior and superior vena cava
- At thetime of injury, if the glottis is closed and the thoracoabdominal muscles aretensed, the increased intrathoracic pressure is transmitted through the centralvenous system to organs such as the brain, liver, spleen, and kidneys.
22
Q
Differences in limb fractures - adults versus children
A
- Approximately 15% of extremity fractures inchildren involve disruptions of the growth plate, which is 2 - 5 times weaker than any other structure in the pediatric skeleton.
- The epiphyseal plate does not fuse untilchildren reach skeletal maturity, which occurs after puberty.
- Long bone fractures – critical event forchildren especially open – life threatening hemorrhage
23
Q
5 differences in paediatric burns - adults versus children
A
- Children have increased airway vulnerability:
- Children are more susceptibleto carbon monoxide intoxication.
- Children have an increased risk of hypothermia (“Cool the burn not the patient”).
- Children have different body-surface proportions than adults. This affects the estimation of the extentof the burn.
- A child’s skin is much thinnerthan an adult’s, which makes children more prone to deeper, more severe thermal injuries.
24
Q
(4) Goals in fluid resuscitation of paediatric and neonatal patients
A
- Normal mental status
- Normal tempurature
- Cap refill <2 seconds
- Normal urine output (1ml/kg/hr)
25
Changes in cardiovascular features of geriatric patients
* Decreased cardiac output leads to increased HR – Mild left hypertrophy
* Decreased elasticity of blood vessels
* Increase peripheral resistance
* Increased SBP
* Decreased CO + increased peripheral resistance = risk of hypoxia
* Higher risk of dysrhythmias
26
PVC's and risks in elderly patients
When accompanied by underlying heart disease, frequent premature contractions canlead to chaotic, dangerous heart rhythms and possibly sudden cardiac death.
27
Electrolyte changes in geriatric patients
* Older people have lower % water
* Kidney issues affecting ability to concentrate urine
* Response to ADH insufficient
* Diminished sense of thirst
* Potassium issues due to diuretics (K sparring and not - hypo/hyperkalemia)
28
Hyperkalemia symptoms
* Vague muscle weakness or decreased energyof movement
* Irritability
* Slurred speech
* Decreased deep tendon reflexes
* Nausea and diarrhoea
* Hyperkalaemia becomes a medical emergency if there are ECG changes
29
Hypokalemia symptoms
* Leg and general body cramps
* Weakness
* Constipation
* Abdominal distention
* Anorexia
* Nausea
* Paralytic ileus
* Confusion and lethargy
* At very low levels, cardiac arrhythmias such as ventricular tachycardia may occur.
30
Hypercalcemia causes
* Overuse of antacids
* Conditions that cause relase of calcium into extracellular fluid
31
Hypercalcemia symptoms
* Anorexia
* Abdominal pain
* Constipation
* Confusion
* Pathological fractures
* Cardiac arrest
32
Respiratory changes in geriatric patients
* Stiffeningof trachea and rib cage
* Kyphosismay occur increasing the size of the rib cage
* Musclesof respiration weaken
* Reduction in ventilation, cough and gag reflex
* Hypertrophy of mucous producing cells and loss of cilia action increases the risk ofinfection
* Reducedarterial partial pressure of oxygen
33
Renal system changes in geriatric patients
* Nephrons decrease in both size and number - ↓ GFP
* Kidney reduces in size by 20%
* Hypotension more likely to cause renal damage
* At higher risk of:
* Metabolic acidosis
* Fluid imbalance – overload versus dehydration
34
CNS changes in geriatric patients
* The brain’s size decreases by 20% from ages 25 – 95- loss of neurons and atrophy of the cortex
* Cerebral blood flow is decreased and the blood-brain-barrier becomes less effective
* Narcotic drugs have more of an effect onthe CNS
* Nervous system is less able to cope with external temperature changes
* Neurotransmitter function can also be altered, slowing mental function
35
Muskuloskeletal changes in geriatric patients
* Muscle atrophy
* Fibers replaced by fibrous tissues
* Decreased strength and movement
* Tendons shrink and harden
* Bone mass decreases
* Decreased Ca absorption - brittlebones - increased risk of fracture
36
Polypharmacy issues in geriatric populations
* Adherence
* Inappropriate prescribing
* Adverse drug reactions, drug-druginteractions
* Geriatric syndromes: Those patients taking\>2 psychotropic agents had a 2.4- to 4.5-fold increased risk of falling thanthose taking 1 central nervous system drug.
* Morbidity/mortality: There are data thatsuggest that, even after controlling for multiple comorbidities, polypharmacyis associated with a decline in physical and instrumental activities of daily living.
