L3 Unwell Infant Child V8 November 2022.pdf

Management of Newborns, Infants and Children – Component 10 Unwell Children & Infants ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Objectives Be able to recognise a seriously ill child & baby...

Management of Newborns, Infants and Children – Component 10 Unwell Children & Infants ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Objectives Be able to recognise a seriously ill child & baby Be able to assist the clinician in the management of seriously ill children and babies ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Anatomical and Physiological Differences Little children have very big heads, an infant head is already 2/3 the size it will be in adulthood. Large tongue Small nostrils and nasal breather up to 6 months which can cause serious respiratory distress if the nostrils fill with mucus Loose teeth can be a cause of a foreign body obstruction in the airway, especially as the infant/child airway is much smaller than that of an adult. ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Airway differences: – Large prominent (occiput) – Small face – Narrow nostrils opening of the nostrils 5 with recession, this is a sign during laboured inspiration. of serious respiratory compromise. ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 P.A.T. - Circulation to Skin Colour – Pallor (white or pale skin, indicates shunting of blood away from the skin) – Cyanosis (blue discolouration of skin caused by inadequate oxygenation) NOTE: Cyanosis in – Mottling (abnormal vessel tone in hands and feet may be capillary bed, causing patchy areas normal under 2 months of pallor & cyanosis) of age or when exposed to a cold environment. ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Paediatric Primary Survey Airway Breathing – Check Page for Age Circulation , Pulse, Cap refill, Skin warmth– Check Page for Age Disability – AVPU – Pupils – Blood sugar Expose Frequently reassess Should take < 2 minutes ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Signs of Deterioration Increasing work of breathing (recession, RR ) Cyanosis Bradycardia (pre-terminal sign in a sick child) Altered mental status / drowsiness Hypo / hypertonia Dehydration / signs of shock Hypoglycaemia ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 LAS policy on conveyance of paediatrics ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Respiratory Illness and Emergencies Childhood respiratory illnesses and emergencies are common and usually self limiting Tachypnoea is a feature in all They include: respiratory illness – Asthma – Bronchiolitis – URTIs – LRTIs / Pneumonia – Croup – Epiglottitis ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Asthma Acute inflammation of the airways – wheeze, mucus plugging, hypoxia, dehydration Asthma is very rare under 5 years Hypotension >110 in adults Respiratory Rate: Respiratory Rate: Exhaustion ≤40/min ages 2-5 years >40/min ages 2-5 years ≤30/min aged >5 years >30/min aged >5 years Abnormal PaC0₂ >25/min in adults (Normal range 4.6-6.0kPA) ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Bronchiolitis Inflammation of the bronchioles Acute, self limiting infection usually caused by respiratory syncytial virus (RSV) Predominantly in autumn and winter Coryzal baby (peak age 2-5 months) and first wheezy episode Worse in the first 72 hours before improving Other household members may also have similar features ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Signs and Symptoms Reduced SP02 Increased RR Recession Irregular breathing Inspiratory crackles Expiratory wheeze Low grade fever Possible apnoea ©Department of Clinical Education & Standards  Unwell Infant and Child - Component 10 Bronchiolitis Management DR ABCDE (time critical correct A&B then transport) Aim of treatment is to provide respiratory support and feeding/hydration Give oxygen if saturations are persistently lower than