Paediatric Assessment Triangle
Appearance - Tone, Interactiveness, Consolability, Look/gaze, Speech/cry
Work of breathing - abnormal posturing, abnormal breath sounds, retraction, nasal flaring
Circulation - pallor, mottling, cyanosis
Anatomical differences to adults - head
- larger in proportion to body
- greater heat loss, heavier, larger occiput
- falls headfirst
Anatomical differences to adults - airway
- soft laryngeal cartilage
- nose breathers
- large head, short neck
- trachea diameter smaller and shorter
- cricoid narrow
- epiglotis large
- smaller oral cavity
- delicate mucosa
- large tongue
- small jaw
- loose teeth
Anatomical differences to adults - ribs/chest
- ribs more horizontal and more compliant
- diaphragmatic breathers
- full stomach impairs breathing
- blunt trauma without # therefore # ribs indicate severe injury
Anatomical differences to adults - abdo
- protruberant
- organs relatively larger, not protected by fat
- prone to infections, obstructions, constipation, malapsorption
- smaller stomach capacity
Anatomical differences to adults - musculoskeletal
- softer bones, more likely to bend
- fractures involve growth plate
Anatomical differences to adults - cardiovascular
- bradycardic arrest - hypoxia
- poor sympathetic innervation therefore poor tachycardic response to shock
- left ventricle underdeveloped therefore fixed SV , increased BP relies on increased HR and SVR
- higher HR
- hT indicates greater than 40% blood loss
Anatomical differences to adults - respiratory
-higher RR
-greater metabolic rate and higher o2 consumption
-TV 5ml/kg
little fatigue resistant muscle fibers therefore tire easily
Causes of cardiopulmonary arrest in paeds
hypoxaemia or hT or both
Causes of cardiac pulmonary arrests in paeds
- trauma
- SIDs
- drowning
- asthma
- septicaemia
- UAO
- congenital abnormalities
Paed resus is directed at
- adequate airway control
- ventilations
- compressions
- adrenaline
Airway positioning of infants
head and neck neutral position
padding beneath shoulders to prevent neck flexion and head extension
Airway positioning of children
use neck flexion and extension with caution
as child gets older, less need for padding
Starting CPR for infants and children
Infants (less than 1 yr) HR less than 60
Children (1-4yrs) HR less than 40
Croup definition
A viral infection of the larynx, trachea and bronchi which leads to airway obstruction that can cause stridor - inflammation and oedema of mucosa and submucosa causing narrowing of subglottic area - obstruction, resp distress, hypoxia
Patho of croup
URTI - migrates into and infects the glottis and subglottic regions - inflammatory oedema accumulation - narrowing of the airway causing partial airway obstruction - child devlops a hoarse barking cough caused by a decrease in mobility of the vocal cords due to the oedema
Signs and sypmpoms of croup
mild/mod:
-Barking cough, Urti, Retraction and resp distress, Stridor, Temp/tachycardia
Severe:
-Cyanosis, Lethargy, Altered conscious and agitation, Marked accessory use, Stridor reduces
Causes of croup
- viral
- spasmodic: sudden nocturnal onset, part asthma
- bacterial tracheitis: susp, with febrile croup with purulent secretions
Epiglottits definition
severe bacterial airway infection of supra-glottic portion of larynx and epiglottis
Signs and symptoms of epiglottits
Septic fever No cough Rapid onset Exp snore/low insp stridor Drool - mouth open tongue out
Upper airway obstruction symptoms
coughing, distressed, difficulty breathing, stridor, red or cyanosed, increased RR
Management of mild pain in paeds
Paracetamol 15mg/kg oral if no admin in 4 hours
Management of moderate pain in paeds
Fentanyl IN
-small child (10-17kg) 25mcg
-large child (18-39kg) 25-50mcg
repeat initial dose every 5-10mins titrated to pain and side effects (max 3 doses)
-consult for children under 10kg
OR
Methoxy 3ml, repeat if required (max 6ml)
Management of severe pain in paeds
Fentanyl IN or Methoxy
IM Morphine as last resort if pain not controlled by above
0.1mg/kg IM (single dose)
