In lieu of an abstract, here is a brief excerpt of the content:

Emergency Management 1. ETAT (Emergency Triage Assessment and Treatment) Sources: WHO, Pocket book of hospital care for children, 2013; American Heart Association, BLS for healthcare providers, 2015; WHO, Updates on paediatric emergency triage, assessment and treatment, 2016. • Discuss importance of triaging patientsºº If identify any emergency or priority signs → call for extra help and more senior providers Anatomy Differences for Children vs Adults • Infant tongue is larger in proportion to oropharynx → tongue lies more superiorly and therefore can cause airway obstruction more easily. • Infant/child subglottic airway is smaller and more compliant → more easily obstructed.ºº Trachea and larynx are funnel-­ shaped in children and cylindrical in adults.ºº Narrowest part in airway of a child is at the cricoid cartilage; in adults, at the glottic opening. • Ribs and sternum function to maintain lung volume in adults, but in infants these are more compliant/flexible → fail easier 6 Emergency Management to maintain lung volume. Infants are more dependent on diaphragm movement for lung expansion. • Infants/children have limited oxygen reserve. • Cardiac output in children primarily depends on maintaining an adequate heart rate; ie, bradycardia → rapid fall of cardiac output and is one of most common rhythms observed prior to child’s death. Emergency Signs These require immediate attention/intervention, starting with ABCs—Airway, Breathing, Circulation: • Airwayºº Obstructed or absent breathing • Breathingºº Severe respiratory distressºº Central cyanosis • Circulation * Signs of shock (cold extremities, capillary refill >3 seconds, weak pulse) • Convulsions • Coma (or seriously reduced level of consciousness) • Signs of severe dehydration in a child with diarrhea (lethargy, sunken eyes, very slow return of skin pinch) Priority Signs: 3TPR MOB Children with any of these signs should be assessed without undue delay: • Tiny infant (any sick child 3 sec, weak pulse), otherwise give over 30–60 minutes • Basic life support: If no pulse, provide compressions: 30 compressions , 2 breaths; if 2 rescuers, 15:2. Compressions should be about 1/3 of AP (anterior-­ posterior) diameter. If 8 y.o., 2-­ handed compressions as in adults. Convulsions • Diazepam, rectal or IV (see chapter 3) • Assess for hypoglycemia (see chapters 3 and 16) Coma • Position to protect airway • Assess for hypoglycemia (see chapters 3 and 16) Dehydration • See chapter 18. 2. Shock 9 2. Shock Sources: WHO, Pocket book of hospital care for children, 2013; The Harriet Lane handbook, 19th ed., 2012; Bugando Medical Centre, Paediatrics management guidelines, 2011; WHO, Updates on paediatric emergency triage, assessment and treatment, 2016; Maitland et al, “Mortality after fluid bolus in African children with severe infection,” NEJM 2011. Physiology Preload = amount of muscle stretch before contraction; ~end-­diastolic volume Afterload = impedance to ejection from ventricle; as this increases , the heart has to expend more energy to eject volume and ejects a greater volume (ie, increases end-­ systolic volume). Stroke Volume (SV) = end-­ diastolic volume minus end-­ systolic volume = volume of blood pumped out of ventricle with each beat; depends on heart size, preload, contractility, afterloadºº Increases with increases in preload (by Frank-­ Starling curve relationship) or contractilityºº Decreases with increases in afterload Cardiac Output (CO) = SV times Pulse Rate (PR) = volume of blood pumped from the heart every minute 10 Emergency Management Oxygen delivery = CO times oxygen content Oxygen content = Hb (g/dL) × 1.34 (ml O2 /g Hb) × SpO2 (oxygen saturation) + 0.0032 × PaO2 (partial pressure of oxygen in torr) Shock: Inadequate delivery of oxygen and nutrients to tissues for metabolic demands Compensated shock: Body able to maintain perfusion to vital organs → tachycardia Decompensated shock: Body unable to maintain perfusion → tachycardia, hypotension Causes Causes of shock depend on type: • Hypovolemic: Diarrhea, vomiting, hemorrhage, burns, inadequate fluid intake, DKA, third-­ space losses (ascites, pleural effusion ), trauma • Distributive: Septic (bacteremia, meningitis, PNA, osteomyelitis, UTI, etc), anaphylactic, neurogenic (head injury, spinal injury) • Cardiogenic: Congenital heart disease, myocarditis, cardiomyopathy , arrhythmias, poisoning, drug toxicity, myocardial injury (trauma) • Obstructive: Cardiac tamponade, tension pneumothorax, massive pulmonary edema, ductal-­ dependent congenital heart lesion WHO Shock Definition All 3 criteria are met: • Increased capillary refill > 3 seconds • Cold extremities • Weak pulse If does not meet all 3, then patient has impaired circulation but not shock per WHO. • Child also may have tachycardia +/-­hypotension. Summary of Shock Types, Signs, and Treatment Shock Type Pulse Rate Preload Contractility Systemic Vascular Resistance Treatment Hypovolemic Increased Decreased +/-­ Increased - High-­flow oxygen - Fluids (after 60ml/kg → pressors) Distributive Septic Increased Decreased Decreased Initially decreased, then increased - High-­flow oxygen - Fluids - Antibiotics Anaphylactic Increased Decreased Decreased Decreased - High-­flow oxygen - Epinephrine (adrenaline) - Fluids Neurogenic Increased Decreased +/-­ Decreased - Fluids - Pressors (norepinephrine) Cardiogenic Increased Increased Decreased...


Additional Information

Related ISBN
MARC Record
Launched on MUSE
Open Access
Back To Top

This website uses cookies to ensure you get the best experience on our website. Without cookies your experience may not be seamless.