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Spotting the sick child.

Spotting the sick child. Steve Murray 31 March 2014. Objectives. Review the anatomical differences between adults and children Describe systematic assessment Discuss treatment of sick children by CFRs. They’re not just small adults!. Airway. < 6 months – nasal breathers

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Spotting the sick child.

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  1. Spotting the sick child. Steve Murray 31 March 2014

  2. Objectives • Review the anatomical differences between adults and children • Describe systematic assessment • Discuss treatment of sick children by CFRs

  3. They’re not just small adults!

  4. Airway • < 6 months – nasal breathers • Narrow nostrils, large tongue • Loose teeth (if at all) • Short soft windpipe • Large head (back) therefore change airway opening manoeuvre in babies Prone to airway obstruction

  5. Breathing • Diaphragmatic breathers • Soft chest wall • Ribs do not fracture easily • High respiratory rate due to high metabolic rate • Breathing rate decreases with age If working hard at breathing, will tire

  6. Circulation • Blood volume larger than in adults (per kg body weight) • Higher heart rate, decreasing with age • Only way to increase amount of blood circulated is to increase rate (inflexible stroke volume) Compensate well – then deteriorate quickly

  7. Circulation 280 ml blood = < 3.5kg

  8. Temperature control • Large head • Large surface area • Poor thermoregulation Prone to hypothermia

  9. Food stores • Small liver – therefore small sugar stores • High metabolic rate • Have to eat more frequently Prone to hypoglycaemia

  10. Abdominal organs • Liver and spleen unprotected by ribs • Remember the ribs are soft anyway • Bladder extends higher out of pelvis Abdominal organs at risk of injury

  11. Psychology • Think different to us! • Never lie to a child – you could loose trust forever and/or develop phobias • Ideally keep parents and child together • They can sense fear in parents • Parents may feel guilt or fear and can be very protective

  12. Infants • Work at their height • Involve the parents • For most conditions the only proven, life-saving pre-hospital intervention is.... ....Hospital!!!

  13. Toddlers • Often most difficult to examine: • Wary of strangers • Maybe wilful not to be examined • Mobile • Get down to their level • Involve parents • Allow them to play with instruments

  14. School children • Regress in times of stress • Do not draw attention to “babyish” behaviour • Previous experience may work against you • They pick up on non-verbal cues

  15. Assessment and treatment • Prognosis for cardiac arrest is very poor, so prevention is better than cure • Often more valuable information can be learnt by merely observing a child than by trying to perform detailed examination • You do not need to diagnose to be able to treat

  16. The DR ABCDE approach • Systematic • Same letters as adults • Guides your treatment • D and R roughly the same

  17. Airway • Is it clear, noisy or blocked? • What can be restricting it? • Foreign body • Saliva • Tongue • Swelling – anaphylaxis, infections or injury.

  18. Breathing • Rate • Recession • Noises • Grunting • Accessory muscle use • Nasal flaring • (Pulse oximetry) Exhaustion is a pre-terminal sign

  19. Circulation • Pulse rate • Capillary refill • Skin colour • Mental status • Blood pressure USELESS Slow pulse is pre-terminal sign They will compensate well....then not.....

  20. Disability A V P U lert oice ain nresponsive • Pupils • Posture

  21. Expose and examine • Rashes • Bruising • Burns

  22. Treatments • Oxygen early • Fever – DO NOT SPONGE • Paracetamol or ibuprofen can reduce fever – but do not prevent convulsions

  23. Thank you – any questions?

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