acutely unwell child jay shetty clinical lecturer in child health
TRANSCRIPT
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Acutely Unwell Child
Jay Shetty
Clinical Lecturer in Child Health
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Unwell Child
• Different Physiology, anatomy and aetiology compared to adults.
• Approach for resuscitation and treatment are different
• Common causes of acute illness in children
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Aetiology of Cardiac Arrest in Children
Respiratory Obstruction
Respiratory Depression
Fluid Maldistribution
Fluid Loss
Foreign BodyAsthmaCroup
Convulsions Poisoning
Raised ICP
SepsisAnaphylaxis
Cardiac Failure
Blood Loss Burns
Vomiting
Cardiac Arrest
Respiratory Failure Circulatory Failure
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Age [Years]
Heart Rate
Respiratory rate
Systolic Blood Pressure [mmHg]
<1 110-160 30-40 70-90
1-2 100-150 25-35 80-95
2-5 95-140 25-30 80-100
5-12 80-120 20-25 90-110
>12 60-100 15-20 100-120
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Systematic Approach
• Airway
• Breathing
• Circulation
• Disability
• Exposure
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Potential Respiratory Failure
• Effort
• Effect• Efficacy
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Effort of Breathing
• Recession• Respiratory rate• Accessory muscle use• Nasal flare• Child’s position• Sounds
– Inspiratory stridor– Expiratory wheeze– Grunting
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Efficacy of Breathing
• Chest Expansion
• Air Entry
• Saturations
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Effects of Breathing
• Heart Rate
• Skin Colour
• Mental Status
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Potential Circulatory Failure
Early Recognition of Shock
• Cardiovascular Signs
• Effects of Circulatory Inadequacy
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Circulatory Signs
• Pulse Rate• Pulse Volume• Capillary Refill• Blood Pressure
Hypotension is a pre-terminal sign
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Effects of Circulatory Inadequacy
• Respiratory Rate
• Skin Temperature/Colour
• Mental Status
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Potential Central Neurological Failure
• Conscious Level
• Pupils
• Posture
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Conscious Level
• Alert
• Responds to Voice
• Responds only to Pain
• Unresponsive to all stimuli
• AVPU
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Posture
• Alert
• Decorticate/Decerebrate Posturing
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Summary – Rapid Assessment
• Airway and Breathing• Effort• Efficacy• Effects
• Circulation• Heart Rate• Capillary Refill Time• Blood Pressure• Skin Temperature
• Disability• Conscious Level• Posture• Pupils
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Common Causes
• Systemic Infection/Sepsis.
• Trauma/Burns/Overdose
• CNS: Meningitis, Encephalitis, Seizures.
• Respiratory: Pneumonia, Bronchiolitis, Asthma, Croup, Tracheitis, Epiglottitis.
• Cardiovascular: Congenital heart disease, arrhythmias
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Common Causes
• GI: Gastroenteritis, bowel obstruction, Appendicitis, Malrotation.
• Urogenital: UTI, Epididemo-orchitis, testicular torsion.
• Haematological: Acute leukaemia, Anaemia.• Musculoskeletal: Osteomyelitis, Reactive arthritis• Others: Metabolic disorders, Allergy and
anaphylaxis, Intoxication, Nonaccidental Injury.
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Infection/Sepsis
• Commonest cause for acute illness in children
• Varying presentation [rash, fever, poor feeding, lethargy, system specific symptoms]
• Treatment: supportive and antimicrobial
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Trauma
• RTA
• Trampoline, sports injuries
• Type: Fractures, Head injury, abdominal injuries.
• Initial approach to management is BLS with Cervical spine immobilisation.
• Burns and overdose (?NAI)
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CNS
• Meningitis: Bacterial and viral
• Encephalitis: Commonly viral
• Presentations and findings vary at different age groups
• Investigation includes lumbar puncture and imaging.
• Supportive and Specific treatment
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Fits, Faints and Funny turns
• Febrile seizures
• Epileptic attack, Status epilepticus
• Vasovagal episode, Reflex anoxic seizures
• Breath holding attacks
• Behavioural episodes
• Arrhythmias
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CVS
• Cyanotic Heart disease present early in life
• Bacterial endocarditis is a severe infection
• Heart murmurs
• Arrhythmias are rare in children, Supraventricular tachycardia is the commonest.
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GI/Urogenital
• Viral gastroenteritis is a common illness and can lead to severe dehydration.
• Congenital pyloric stenosis, Volvulus, Intussusceptions and malrotation are common causes of GI obstructions in children
• Appendicitis is the most common acute abdominal condition
• UTI’s are common in children
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Common Causes
• Systemic Infection/Sepsis.
• Trauma/Burns/Overdose
• CNS: Meningitis, Encephalitis, Seizures.
• Respiratory: Pneumonia, Bronchiolitis, Asthma, Croup, Tracheitis, Epiglottitis.
• Cardiovascular: Congenital heart disease, arrhythmias
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Common Causes
• GI: Gastroenteritis, bowel obstruction, Appendicitis, Malrotation, Hepatitis.
• Urogenital: UTI, Epididemo-orchitis, testicular torsion.
• Haematological: Acute leukaemia, Anaemia.• Musculoskeletal: Osteomyelitis, Reactive arthritis• Others: Metabolic disorders, Allergy and
anaphylaxis, Intoxication, Nonaccidental Injury.
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Shock
• Inadequate tissue perfusion resulting in impaired cellular respiration -inadequate supply of nutrients to tissues -inadequate removal of tissue wastes
• Failure of circulatory function [Heart, Blood, Blood vessels]
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Shock
• Cardiogenic [arrhythmia, cardiomyopathy, valvular heart disease, contusion]
• Hypovolemic [ haemorrhage, GE, gut obstruction, Burns, Peritonitis]
• Distributive [Sepsis, Anaphylaxis, Drugs]
• Obstructive [Pneumothorax, tamponade ]
• Dissociative [Anaemia, CO poisoning]
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