lectures recognition of the seriously ill child. recognition of the seriously ill child to...
TRANSCRIPT
Recognition of the seriously ill child
• To understand the structured approach to the recognition of the seriously ill child
• To learn a rapid clinical assessment sequence to identify serious illness in a child
• To introduce the equipment used for the resuscitation of a seriously ill child
Objectives
Recognition of the seriously ill child Causes of death worldwide <5 years
Neonates < 1m Children aged 1m-5yrs
Preterm birth complications
12% Diarrhoea 14%
Birth asphyxia 9% Pneumonia 14%
Sepsis 6% Other infections 9%
Other 5% Malaria 8%
Recognition of the seriously ill child Causes of cardiac arrest in children
Airway Obstruction
Respiratory Depression
Alveolar/Chest Wall Failure
Fluid Loss
Fluid Mal-distribution
Heart Failure
Foreign body, asthma, croup, bronchiolitis
Respiratory Failure
Cardiac Arrest
Circulatory Failure
Convulsions, sepsis, poisoning, ↑ICP
Pneumonia, chest trauma & myopathy
Bleeding, burns, diarrhoea, vomiting
Sepsis, anaphylaxis
Myocardial depression, congenital abnormality
Recognition of the seriously ill child Systematic approach
• Primary assessment• Resuscitation• Secondary assessment• Emergency treatment• Stabilisation, transfer to definitive care
AirwayBreathingCirculationDisabilityExposure
Recognition of the seriously ill child Recognition of serious illness
• Potential respiratory failure
• Potential circulatory failure
• Potential central neurological failure
Recognition of the seriously ill child Potential respiratory failure
Effort of Breathing
Effectivenessof Breathing
Effects of RespiratoryInadequacy
Recognition of the seriously ill child Effort of breathing
• Respiratory rate
• Accessory muscle use
• Flaring of the nostrils
• Child's position
Recognition of the seriously ill child Effort of breathing – associated sounds
• Stridor• primarily inspiratory noise• upper airway pathology
• Wheeze• primarily expiratory noise• lower airways pathology
• Grunting• expiration with partially closed glottis• alveolar pathology
Recognition of the seriously ill child Exceptions to the effort of breathing
Increased effort absent in:• exhaustion• central respiratory depression• neuromuscular disease
Recognition of the seriously ill child Potential respiratory failure
Effort of Breathing
Efficacy of Breathing
Effects of RespiratoryInadequacy
Recognition of the seriously ill child Efficiacy of breathing
• Chest expansion
• Air entry
• Pulse oximetry
Recognition of the seriously ill child Potential respiratory failure
Effort of Breathing
Efficacy of Breathing
Effects of RespiratoryInadequacy
Recognition of the seriously ill child Effects of respiratory inadequacy
• Heart rate
• Skin colour
• Mental status
Recognition of the seriously ill child Effects of respiratory inadequacy
CYANOSIS IS
A PRE–TERMINAL SIGN
OXYGEN SATURATION OF
<85% IN AIR
IS A PRE-TERMINAL SIGN
Recognition of the seriously ill child Potential circulatory failure – early recognition of shock
Cardiovascular Signs
Effects of CirculatoryInadequacy
Recognition of the seriously ill child Cardiovascular signs
• Heart rate
• Pulse volume
• Capillary refill time
• Blood pressure
Recognition of the seriously ill child Cardiovascular signs – capillary refill
(1) press for 5s
(2) release(3) colour should return <2s in well-perfused, warm child
Recognition of the seriously ill child Cardiovascular signs – capillary refill
• A delay of >2s with other signs of shock and in a warm child suggests poor peripheral perfusion
Recognition of the seriously ill child Potential circulatory failure – early recognition of shock
Cardiovascular Signs
Effects of CirculatoryInadequacy
Recognition of the seriously ill child Effects of circulatory inadequacy
• Respiratory rate
• Skin temperature/colour
• Mental status
Recognition of the seriously ill child Distinguishing cardiac problems
• Cyanosis despite O2
• Marked tachycardia
• Raised jugular venous pressure
• Gallop rhythm / murmur
• Enlarged liver
• Absent femoral pulses
Recognition of the seriously ill child Case report 1
Case Report: 2 months oldCough and wheeze for 1 week
Sign Observation
Skin colour PaleRespiratory rate 20/min (recession ++)Heart rate 200/minCapillary refill time NormalMental status Unresponsive
Recognition of the seriously ill child Case report 2
Case Report: 2 months old Poor feeding and vomiting for 1 day
Sign Observation
Skin colour PaleRespiratory rate 70/min (no recession)Heart rate 220/minCapillary refill time PoorMental status Unresponsive
Recognition of the seriously ill child Potential central neurological failure
Conscious level
Posture
Pupillary signs
Recognition of the seriously ill child Potential central neurological failure:conscious level
A-V-P-U approach:
AlertResponds to VoiceResponds only to PainUnresponsive to all stimuli
Recognition of the seriously ill child Potential central neurological failure
Conscious level
Posture
Pupillary signs
• assess with painful stimulus
Recognition of the seriously ill child Potential central neurological failure:postures
• Decorticate • Decerebrate
Recognition of the seriously ill child Potential central neurological failure
Conscious level
Posture
Pupillary signs