Paediatric Science Health & Human Development 2 PDF

Paramedic Science Health & Human Development 2 Paediatrics Anatomical and Physiological Differences Airway Airway Breathing Fewer Alveoli in Lungs Weaker Intercostal Muscles Diaphragm used more by Infants...

Paramedic Science Health & Human Development 2 Paediatrics Anatomical and Physiological Differences Airway Airway Breathing Fewer Alveoli in Lungs Weaker Intercostal Muscles Diaphragm used more by Infants Higher metabolic rate Higher Oxygen Consumption Faster Respiratory Rate  Circulation Smaller Blood Volume (Infants 80ml/kg: total volume approximately 240ml in a 3kg newborn; so even small fluid loss significant). Lower Blood Pressure Faster Heart Rate  Disability Limited Communication Skills, leading to difficulty in expressing pain, symptoms & anxiety.  Exposure / Environment Heat Loss in Infants (larger body surface area to mass ratio) Anxious Family Members Difficult to establish History of Illness  Recognition of the Sick Child Assessment tools Paediatric Assessment Triangle Airway Breathing Circulation Disability Expose/Examine/Environment NICE ‘Traffic Lights’ Clinical Assessment Tool Early recognition and management of respiratory and / or circulatory failure will prevent the majority of paediatric cardiac arrests Paediatric Assessment Triangle (P.A.T)  Paediatric Assessment Triangle (P.A.T) Appearance (T.I.C.L.S) Tone: moving spontaneously? Floppy/Listless? Interactivity: engaged with surroundings / reacting to stimulus / people? Consolability: Can the child be consoled by parent / carer Look / Gaze: Does the child make eye contact or stare / ‘glassy eyed’ into distance? Speech / Cry: Normal? Strong? Muffled? Weak?  Paediatric Assessment Triangle (P.A.T) Work of Breathing Any abnormal airway sounds? (Stridor, grunting, wheezing?) Any abnormal positioning (upright, sniffing position, tripod?) Any recession / head bobbing? Any Nasal Flaring? Paediatric Assessment Triangle (P.A.T)  Paediatric Assessment Triangle (P.A.T) Circulation to Skin: Pallor? Cyanosis? Mottling?  Airway Is it patent? Positional Opening required? Is an adjunct or suction required? If suction is required Suction pressure should be kept at less than 200 mmHg in adults. It should be set at 80 mmHg to 120 mmHg in neonates. Abnormal Sounds? Minimise anxiety in the conscious child  Breathing Respiratory Rate? Adequate? Support with BVM required? Chest Movement? Recession? Tracheal Tug? Head bobbing or see saw breathing? Auscultate Air Entry? Inspiratory / Expiratory Noises? Oxygen Administration SPO2  Circulation Skin Colour / Temperature Pulse rate, rhythm, depth Heart Rate, rhythm Capillary Refill Time (Centrally and Peripherally) Blood Pressure Urine output? Filling nappies? Going to toilet? Fluid Loss? Haemorrhage? 80ml/kg normal volume. 20% TBL Volume would be considered Cat Bleed.  Disability Level of Consciousness (AVPU & modified GCS for children 2 seconds centrally, >3 seconds peripherally, hands / feet appear mottled. D: BM 5.0, photophobic. E: Non blanching rash on buttocks and back of legs, and chest. What colour traffic light? What else do you want to know? (HISTORY)  History Unwell for 3 days with fever, nausea, vomiting, appetite loss, sore throat and cold/flu symptoms. Mum has been treating with Calpol and Ibuprofen. Saw GP yesterday who advised it was viral infection but to call again if it got worse. Mum became concerned due to loss of colour, stiffness and pain in joints. Has recently become photophobic and has developed neck stiffness. Mum thinks rash was there for 1 day and is spreading now and is non blanching. No Allergies/Meds/ Normally Fit and Well. Loss of appetite over the last 24 hours. Decreased Urine Output last 12 hours.  Assessment Working Diagnosis? Viral as GP suggests? Differential Diagnosis? Meningococcal Septicaemia What are you going to do?  Meningitis Inflammation of the tissue surrounding the spinal cord and the brain Infection spreads rapidly through the CNS via the CSF Infants / Children under 5 and Elderly most at risk. What to look for Meningococcal Septicaemia  Treatment Follow JRCALC Meningococcal Meningitis and Septicaemia Guideline Sick Child Scenario 2  Management of a seriously ill Child 999 Call 0300 in the morning for 4-year-old male child; awoke with breathing problems / cough. PAT/TICLS: Increased Work of Breathing evident, with stridor, normal colour, quiet but alert, making eye contact, not speaking, sitting upright.  On Examination A: Stridor/’Seal Bark Cough’. At risk? B: RR 30, SP02 99%, Chest Clear. C: Pulse; 130bpm, Mum reports paler than usual complexion. CRT