Spotting the sick child.

Steve Murray31 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• 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

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

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

Circulation

= 280 ml blood

<

3.5kg

Temperature control

• Large head• Large surface area• Poor thermoregulation

Prone to hypothermia

Food stores

• Small liver – therefore small sugar stores• High metabolic rate• Have to eat more frequently

Prone to hypoglycaemia

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

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

Infants

• Work at their height• Involve the parents• For most conditions the only proven, life-

saving pre-hospital intervention is........Hospital!!!

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

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

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

The DR ABCDE approach

• Systematic

• Same letters as adults

• Guides your treatment

• D and R roughly the same

Airway

• Is it clear, noisy or blocked?

• What can be restricting it?– Foreign body– Saliva– Tongue– Swelling – anaphylaxis, infections or injury.

Breathing

• Rate• Recession• Noises• Grunting• Accessory muscle use• Nasal flaring• (Pulse oximetry)

Exhaustion is a pre-terminal sign

Circulation

• Pulse rate• Capillary refill• Skin colour• Mental status• Blood pressure USELESS

Slow pulse is pre-terminal signThey will compensate well....then not.....

Disability

• Pupils• Posture

A

V

P

U

lert

oice

ain

nresponsive

Expose and examine

• Rashes• Bruising• Burns

Treatments

• Oxygen early

• Fever – DO NOT SPONGE

• Paracetamol or ibuprofen can reduce fever – but do not prevent convulsions

Thank you – any questions?