Paediatrics

What is the oxygen use in a paediatric compared to an adult?

Adult: 3ml/kg/min
Paediatric: 6-8ml/kg/min

What are the differences in the paediatric upper airway?

Larger tongue, deciduous teeth, abundant secretions, nasal breathers, larger floppier horse shoe shaped epiglottis, and glottis more anterior

What are the differences in the paediatric lower airway?

Trachea is shorter, narrower and more easily compressed, smaller bronchioles

Airway considerations in paediatrics?

Hypoxia, dead space, head position, anticipate secretions ++

Alveoli number at birth?

10% of that of an adult

Breathing considerations in paeds?

Limited resp reserve, diaphragmatic breathing, fatigue causes apnoea, ribs are horizontal and soft, and more prone to chest trauma

Normal resp rate in paeds?

40 - (age x 2)

Cardiovascular considerations in paeds?

Cardiac output 200ml/kg/min, fixed SV, CO increased by tachycardia, hypotension is a poor indicator of shock

Normal pulse rate in paeds?

150 - (age x 3)

How does shock present in paeds?

Tachy or bradycardia
Absent peripheral pulses
CRT > 2 seconds
Lack of interest in surroundings

Normal BP in paeds?

Systolic:
Upper limit - 90 + (age x 2)
Lower limit - 70 + (age x 2)
Diastolic:
2/3 of systolic

Metabolic differences in paeds?

Limited glycogen - always assess BGL, high metabolic rate, underdeveloped hypothalamus

AVPU score for paeds?

A - Appropriate words, smiles
V - Cries but consolable
P - Persistently irritable, restless, agitated
U - No response

Pain in paeds results in...

Release of glucagon, catecholamines and corticosteroids resulting in tachycardia, tachypnoea and altered BGL

Describe the paediatric assessment triangle:

'The first impression'
Appearance:
- Mental status
- LOC
- Body position
Work of breathing:
- Visible movement of chest/abdomen
- Resp effort
Circulation to skin:
- Adequacy of perfusion

Describe TICLS:

Tone
Interactivity
Consolability
Look/Gaze
Speech/Cry

When do the posterior and 2 lateral fontanelles close?

6 months of age

When does the anterior fontanelle fully close?

In 2nd year of age

What do sunken fontanelles indicate?

Dehydration

What do raised fontanelles indicate?

Increased ICP

What is epiglottitis?

Bacterial infection causing inflammation of the epiglottitis and/or surrounding supraglottic tissues

In what age group is epiglottitis most commonly seen?

2 - 7 years of age, more common in males

What is the classic epiglottitis presentation?

Presents abruptly and rapidly as:
Fever > 39, sore throat, drooling, dysphagia, resp distress and anxiety
Commonly in tripod position

Management of epiglottitis?

Do not attempt to visualise airway
Give oxygen and leave positioning to patient
Reassure and transport to hospital

What is croup?

Viral infection of upper airway causing sub-mucosal oedema and variable airway obstruction

In what age group is croup most commonly seen?

6 months - 4 years

What is the classic croup presentation?

Low grade fever, seal like barking cough and inspiratory stridor.
Also URTI for last 2-3 days, hoarseness, chest retractions, restless

Management of croup?

If moderate to severe transport to hospital
Reduce anxiety
Keep interventions to a minimum
Consider oxygen

What is bronchiolitis?

Viral infection of the bronchiolar cells and cilated epithelium cells resulting in mucus secretion, cell death and sloughing of cells

What is the classic bronchiolitis presentation?

2 - 3 day prodromal phase of coryzal symptoms
Tachypnoea, hyperinflation of the chest, crepitations and wheeze, cough, head bobbing, grunting, poor feeding, vomiting post tussive

Management of bronchiolitis?

Supportive treatment

What is pertussis?

Highly infectious bacterial disease commonly known as 'whooping cough'

What is the classic presentation of pertussis?

'100 day cough'
May last up to 10 weeks, typically 2 - 4 weeks
Characteristic attacks of numerous rapid coughs (10-20) with no inspiration during
At end of attack high pitched whooping breath

Management of pertussis?

Supportive treatment
Assess immunisation status
Hospitalisation for infants < 6 months
Refer to GP

What is cystic fibrosis?

Disease of exocrine gland function that affects multiple body systems
Thick secretions plug ducts and passageways

What is the classic presentation of cystic fibrosis?

Genetic condition
90% of patients have pulmonary involvement
90 - 95% have pancreatic involvement

Management of cystic fibrosis?

Typically see acute presentations such as resp failure, bowel obstruction, cholecystis
Supportive treatment

Define dehydration:

Physiological disturbance caused by the reduction or translocation of body fluids

Causes of dehydration?

Decreased fluid intake
Increased fluid output
- Renal losses
- GI losses
- Translocation of fluid

Normal weight for paeds?

< 12 months - 4 + (age in months) / 2
1 - 9 years - (age in years x 2) + 8
10 - 14 years - age in years x 3

In the absence of trauma in the paed with abdominal pain what five questions should you ask?

1. Age of child
2. First episode or recurrence
3. Are there associated symptoms
4. Are there relevant pre-existing conditions
5. What are the characteristics of the pain

Most common causes of abdominal pain in neonate ?

Colic
Acute gastroenteritis

Most common causes of abdominal pain in school age and preschooler?

Constipation and acute gastroenteritis

Most common causes of abdominal pain in adolescents?

UTI and appendicitis

What is mesenteric adenitis?

Inflammation of the mesenteric lymph nodes in the abdomen
Often mistaken for appendicitis
Often lasts for 5 days with full recovery

What is intussusception?

Occurs when a segment of the bowel vaginates into the distal segment
Most common in the illeum segment and in < 1 year of age

Classic triad of intussusception:

Vomiting
Abdominal pain
Passage of blood in rectum

What is a herniae?

The protrusion of a viscus or part of a viscus into an abnormal location

What is Merkels diverticulum?

An abnormal sac or pouch that develops at a weak point in the intestines is known as a diverticulum

What is testicular torsion?

Spontaneous torsion of the testicle around the spermatic cord causing ischemia

Top 2 causes of paediatric death in all age groups:

0 - 4 years: Suffocation and drowning
5 - 9 years: Pedestrian and MVT
10 - 14 years: MVT and suicide
15 - 19 years: MVT and suicide

Describe Waddell's Triad:

Femoral fracture
Chest/abdominal injury
Head injury

What are the three most common factors associated with child homicide?

� Drug and alcohol use/abuse
� Physical punishment
� Extreme response to intimate partner separation