What are pediatric early warning scores (PEWS) used for?
To assist in identifying clinical deterioration.
What physiological measurements are used in PEWS?
Heart rate, respiratory rate, level of consciousness, oxygen saturation, temperature, blood pressure.
What is the normal heart rate for a newborn (0-1 month)?
100-160 bpm.
What is the normal respiratory rate for an infant (1-12 months)?
30-40 bpm.
What is the normal systolic blood pressure for a toddler (1-3 years)?
70-110 mmHg.
What should be assessed in the airway and breathing step?
Airway obstruction, respiratory rate, stridor, wheeze, cyanosis.
What should be assessed in the circulation step?
Heart rate, pulse volume, capillary refill time, blood pressure.
What should be noted in the disability assessment?
Level of consciousness, posture, pupil size and reactivity.
What are signs to observe during exposure assessment?
Fever, rash, bruising.
What are key considerations during resuscitation?
Jaw positioning, oxygen, suction, foreign body removal, chest compression.
What should be examined for evidence of trauma in children?
What investigation is essential for pediatric patients?
Blood glucose
What are common presentations of serious illness in children related to airway and breathing?
What can cause upper airway obstruction in children?
What are lower airway disorders that can affect children?
What can lead to respiratory depression in pediatric patients?
What are the signs of circulation issues in children?
What causes hypovolemia in children?
What can cause maldistribution of fluid in pediatric patients?
What are the causes of cardiogenic shock in children?
What can cause neurogenic shock in children?
Spinal cord injury
What are signs of disability in pediatric patients?
What infections can cause disability in children?
What metabolic issues can lead to disability in children?
What types of head injuries can affect children?
What are the steps in pediatric basic life support?
What is the compression to breath ratio in pediatric CPR?
15 chest compressions to 2 breaths
What is the recommended rate for chest compressions in pediatric CPR?
100-120 compressions/min
What is required for pediatric advanced life support?
Access to resuscitation equipment, means of respiratory support, defibrillator, IV/intraosseous access, and drugs like adrenaline.
What is a common use for Automated External Defibrillators (AEDs) in public?
Improve survival of out-of-hospital cardiac arrests in adults
What varies widely in pediatric resuscitation compared to adults?
Equipment size and medication doses according to the child’s size
What can complicate accurate weight assessment in seriously ill pediatric patients?
It is rarely possible to ascertain an accurate weight
What does the acronym 'WETFLAG' help estimate?
The weight of a child based on age.
What may conscious children with partially obstructed airways adopt?
A posture that maximizes air entry and comfort.
What can respiratory failure lead to?
Hypoxemia or hypercarbia, or both.
What is the first step in supportive therapy for respiratory failure?
Administration of supplementary oxygen.
What is the maximum FiO2 delivered by facemask?
0.60 unless using a non-rebreather mask with a reservoir bag.
What is included in non-invasive respiratory support?
High-flow nasal cannula therapy, CPAP, BiPAP.
What should be considered in any child with impending or severe respiratory failure?
Mechanical ventilation.
What indicates the need for mechanical ventilation?
Worsening hypoxemia or hypercarbia.
What condition is common in critically ill children?
Shock.
What are the types of shock?
What are the clinical features of shock?
Features are manifestations of compensatory mechanisms and effects of poor perfusion on tissues/organs.
What maintains blood pressure in early compensated shock?
What signifies late feature of pediatric shock?
Low blood pressure indicates failing compensatory responses.
What contributes to dehydration in young children?
Why are infants at risk of dehydration?
They have: - Higher body water content - Higher metabolic rate - Increased surface area-to-body mass ratio
What is the maintenance fluid requirement for infants?
100–120 ml/kg per day (10%–12% of body weight).
How is the degree of dehydration assessed?
By weight loss during illness: 1) No dehydration: <5% 2) Clinical dehydration: 5-9% 3) Shock: ≥10%
What is fluid resuscitation?
Initial rapid re-expansion of intravascular volume using intravenous fluids for shock.
What fluids are used in fluid resuscitation?
What is the volume for fluid boluses in shock?
10 ml/kg bodyweight of balanced isotonic crystalloids.
What is the fluid replacement in trauma?
Replace circulating volume with blood and blood products in 5-10 ml/kg volumes.
What should be done after each resuscitation bolus?
Reassess circulatory adequacy to determine if further boluses are needed.
When should infants and children not receive fluid boluses?
Unless they show clinical signs of shock.
What is the initial fluid management for dehydration and shock?
1) Resuscitation with 0.9% crystalloid boluses 2) Assess volume needed to restore circulating volume
What is the initial bolus for fluid resuscitation following trauma?
10 ml/kg bodyweight
How is fluid deficit replacement assessed?
What does 1 kg of body weight loss equate to in fluid loss?
1 litre of fluid loss
How are fluid boluses during resuscitation handled?
They are deducted from the fluid deficit.
What is the formula for calculating maintenance fluids for a child over 24 hours?
Use 0.9% NaCl with 5% dextrose and consider 20 mmol KCl per 500-ml bag.
When should fluids be adjusted due to SIADH risk?
When there is a risk of SIADH, give two thirds of standard maintenance.
What might require an increase in maintenance fluid?
Ongoing losses, e.g., profuse diarrhea or diuretic phase after acute tubular necrosis.
How should maintenance fluids be adjusted for oral intake?
They should be reduced to take account of oral intake.
What is the recommended fluid replacement time for certain conditions?
Increased to 48 hours to avoid rapid changes in osmolarity.
What is assessed during primary assessment of disability?
Why is it essential to assess neurological status during primary assessment?
Reduced consciousness may cause airway instability.
What are some reversible causes of coma?
Hypoglycemia and opiate toxicity.
What conditions need to be identified and treated in cases of seizures?
Sepsis, meningitis, and herpes simplex encephalitis.
What is the physiological derangement caused by sepsis?
Dysregulation of the host response leads to the clinical syndrome of sepsis.
What can sepsis rapidly lead to if not treated quickly?
Septic shock, multiorgan failure, and death.
What are the most common organisms identified in bacteremia in children in the UK?
What causes early-onset sepsis in neonates?
Group B streptococcus and E. coli.
What is often a contaminant in blood cultures of older children?
Coagulase-negative staphylococcus (CoNS).
What are some clinical features of sepsis?
What are the initial symptoms of septic shock in children?
What history may indicate a risk for septic shock?
What are some predisposing conditions for septic shock?
What examination findings suggest septic shock?
What is a characteristic rash in meningococcal septicaemia?
What is a potential outcome of multiorgan failure in septic shock?
What is the management priority for children with septic shock?
What is the first step in antibiotic therapy for septic shock?
What broad-spectrum antibiotic is commonly used in septic shock beyond the neonatal period?
What condition may cause severe hypovolemia in sepsis?
What may be required to assess fluid balance in septic shock?
What can cause pulmonary oedema in sepsis?
What type of support may be needed due to myocardial dysfunction in septic shock?
What is a complication of widespread inflammation in sepsis?
What are the signs of anaphylaxis?
What is the definition of status epilepticus?
What should be treated to prevent status epilepticus?
What is the acute management of anaphylaxis?
What is a common cause of anaphylaxis in children?
What age group has the majority of anaphylaxis fatalities?
What test may assist in confirming anaphylaxis?
What may assist in confirming anaphylaxis?
Ptases may assist in confirming anaphylaxis where the diagnosis is unclear.
What does a negative ptase test indicate for anaphylaxis?
A negative test does not rule out anaphylaxis.
What is the acute management of anaphylaxis?
Early administration of intramuscular adrenaline.
What does BRUE stand for?
Brief Resolved Unexplained Events.
What are the characteristics of a BRUE episode?
What must happen for an episode to be classified as BRUE?
The episode must resolve completely and cannot be explained by a thorough history and physical examination.
What were BRUE episodes previously called?
They were previously called apparent life-threatening events (ALTEs).
What do low-risk BRUEs require?
No more than a period of observation and monitoring of vital signs.
What should parents receive regarding low-risk BRUEs?
A detailed explanation about the nature of these events and basic life support training.
What investigations may be considered for BRUE?
What is the definition of SUDI?
Refers to deaths that occur suddenly and unexpectedly in infants.
What underlying conditions may be revealed in SUDI cases?
What is classified as SIDS?
Sudden Infant Death Syndrome, where no cause is identified after autopsy.
What is the peak age for SIDS?
2–4 months, but can occur throughout the first year.
What is the gender distribution for SIDS?
55% are boys.
What is a significant risk factor for SIDS?
Low birthweight: Fivefold increased risk.
What is the risk associated with young maternal age for SIDS?
<20 years: 5x increased risk compared to older mothers.
What is the risk of bed sharing in relation to SIDS?
Risk of unintentional overlying or suffocation (rare).
What is the initial evaluation following a SUDI?
A detailed history and physical examination by a pediatrician.
What must families be informed about after a SUDI?
The Coroner will likely mandate a postmortem examination.
What are pediatric early warning scores (PEWS) used for?
To assist in identifying clinical deterioration.
What physiological measurements are used in PEWS?
Heart rate, respiratory rate, level of consciousness, oxygen saturation, temperature, blood pressure.
What should be assessed in the airway and breathing step?
Airway obstruction, respiratory rate, stridor, wheeze, cyanosis.
What should be assessed in the circulation step?
Heart rate, pulse volume, capillary refill time, blood pressure.
What should be noted in the disability assessment?
Level of consciousness, posture, pupil size and reactivity.
What are key considerations during resuscitation?
Jaw positioning, oxygen, suction, foreign body removal, chest compression.
What should be examined for evidence of trauma in children?
What are common presentations of serious illness in children related to airway and breathing?
What can cause upper airway obstruction in children?
What are lower airway disorders that can affect children?
What can lead to respiratory depression in pediatric patients?
What can cause maldistribution of fluid in pediatric patients?
What metabolic issues can lead to disability in children?
What are the steps in pediatric basic life support?
What is required for pediatric advanced life support?
Access to resuscitation equipment, means of respiratory support, defibrillator, IV/intraosseous access, and drugs like adrenaline.
What is a common use for Automated External Defibrillators (AEDs) in public?
Improve survival of out-of-hospital cardiac arrests in adults
What varies widely in pediatric resuscitation compared to adults?
Equipment size and medication doses according to the child’s size
What can complicate accurate weight assessment in seriously ill pediatric patients?
It is rarely possible to ascertain an accurate weight
What may conscious children with partially obstructed airways adopt?
A posture that maximizes air entry and comfort.
What is the first step in supportive therapy for respiratory failure?
Administration of supplementary oxygen.
What is the maximum FiO2 delivered by facemask?
0.60 unless using a non-rebreather mask with a reservoir bag.
What should be considered in any child with impending or severe respiratory failure?
Mechanical ventilation.
What are the types of shock?
What are the clinical features of shock?
Features are manifestations of compensatory mechanisms and effects of poor perfusion on tissues/organs.
What maintains blood pressure in early compensated shock?
What signifies late feature of pediatric shock?
Low blood pressure indicates failing compensatory responses.
What contributes to dehydration in young children?
Why are infants at risk of dehydration?
They have: - Higher body water content - Higher metabolic rate - Increased surface area-to-body mass ratio
What is the maintenance fluid requirement for infants?
100–120 ml/kg per day (10%–12% of body weight).
How is the degree of dehydration assessed?
By weight loss during illness: 1) No dehydration: <5% 2) Clinical dehydration: 5-9% 3) Shock: ≥10%
What is fluid resuscitation?
Initial rapid re-expansion of intravascular volume using intravenous fluids for shock.
What fluids are used in fluid resuscitation?
What is the volume for fluid boluses in shock?
10 ml/kg bodyweight of balanced isotonic crystalloids.
What is the fluid replacement in trauma?
Replace circulating volume with blood and blood products in 5-10 ml/kg volumes.
What should be done after each resuscitation bolus?
Reassess circulatory adequacy to determine if further boluses are needed.
When should infants and children not receive fluid boluses?
Unless they show clinical signs of shock.
What is the initial fluid management for dehydration and shock?
1) Resuscitation with 0.9% crystalloid boluses 2) Assess volume needed to restore circulating volume
How is fluid deficit replacement assessed?
What is the formula for calculating maintenance fluids for a child over 24 hours?
Use 0.9% NaCl with 5% dextrose and consider 20 mmol KCl per 500-ml bag.
When should fluids be adjusted due to SIADH risk?
When there is a risk of SIADH, give two thirds of standard maintenance.
What might require an increase in maintenance fluid?
Ongoing losses, e.g., profuse diarrhea or diuretic phase after acute tubular necrosis.
How should maintenance fluids be adjusted for oral intake?
They should be reduced to take account of oral intake.
What is the recommended fluid replacement time for certain conditions?
Increased to 48 hours to avoid rapid changes in osmolarity.
What is assessed during primary assessment of disability?
Why is it essential to assess neurological status during primary assessment?
Reduced consciousness may cause airway instability.
What conditions need to be identified and treated in cases of seizures?
Sepsis, meningitis, and herpes simplex encephalitis.
What is the physiological derangement caused by sepsis?
Dysregulation of the host response leads to the clinical syndrome of sepsis.
What can sepsis rapidly lead to if not treated quickly?
Septic shock, multiorgan failure, and death.
What are the most common organisms identified in bacteremia in children in the UK?
What is often a contaminant in blood cultures of older children?
Coagulase-negative staphylococcus (CoNS).
What are the initial symptoms of septic shock in children?
What history may indicate a risk for septic shock?
What examination findings suggest septic shock?
What is the management priority for children with septic shock?
What broad-spectrum antibiotic is commonly used in septic shock beyond the neonatal period?
What may be required to assess fluid balance in septic shock?
What is the definition of status epilepticus?
What should be treated to prevent status epilepticus?
What age group has the majority of anaphylaxis fatalities?
What may assist in confirming anaphylaxis?
Ptases may assist in confirming anaphylaxis where the diagnosis is unclear.
What does a negative ptase test indicate for anaphylaxis?
A negative test does not rule out anaphylaxis.
What are the characteristics of a BRUE episode?
What must happen for an episode to be classified as BRUE?
The episode must resolve completely and cannot be explained by a thorough history and physical examination.
What were BRUE episodes previously called?
They were previously called apparent life-threatening events (ALTEs).
What should parents receive regarding low-risk BRUEs?
A detailed explanation about the nature of these events and basic life support training.
What investigations may be considered for BRUE?
What underlying conditions may be revealed in SUDI cases?
What is classified as SIDS?
Sudden Infant Death Syndrome, where no cause is identified after autopsy.
What is the risk associated with young maternal age for SIDS?
<20 years: 5x increased risk compared to older mothers.
What is the risk of bed sharing in relation to SIDS?
Risk of unintentional overlying or suffocation (rare).
What is the initial evaluation following a SUDI?
A detailed history and physical examination by a pediatrician.
What must families be informed about after a SUDI?
The Coroner will likely mandate a postmortem examination.
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