1 Page Notes : Recognizing A Seriously Ill Child

Recognizing a seriously ill child. Serious Illness Respiratory Failure

Respiratory rate (breaths/min) Age Normal Neonate 30 – 50 Infants 20 – 30 Young children 20 – 30 Older children 15 – 20

Effort of breathing increased - Nasal flaring - Tracheal tug - Recessions : subcostal, intercostals, sternal - High RR : know what’s normal, T - Use of accessory muscle, SCM (head bobs) - Child’s position : asthma (sit forward) - Extra sounds : stridor, wheeze, grunting. ** absent in exhaustion, central resp depression, neuromuscular disease.

Circulatory Shock

Tachypnoea >60 >50 >40 >30

CNS Failure

Resting pulse rate (beats/min) Age Normal <1 110 – 160 2–5 95 – 140 5 – 12 80 – 120 >12 60 - 100

Respiratory Failure Efficacy of breathing impaired - Chest expansion - Air entry - Pulse oximetry : poorly perfused, movement, <85% in air is pre-terminal

Increase with Stress, Exercise Fever Arrhythmia

Effects of respiration decreased - Heart rate - Skin colour (cyanosis) - Mental status (anxious)

*silent chest is also a preterminal sign.

Circulatory Shock CV signs Signs of poor circulation - Heart rate - RR - Pulse volume - Skin temperature - Capillary Refill : central , peripheral - Colour - BP (very late sign, goes up then down) - Mental status - Hypotension ( pre-terminal sign) Distinguishing cardiac problems : • Cyanosis despite giving oxygen • Marked tachycardia • Increased JVP • Gallop rhythm/ murmur • Enlarged liver • Absent femoral pulses Alert of times when there’s circulatory change : • 7 - 10 days (PDA close) • Within 6 weeks (VSD shunting) 1. present with fluid overload 2. poor feeding, failure to thrive Resuscitation (a) interosseus (b) IV CNS Failure

Conscious level A - alert V - voice P – respond to pain U – unresponsive to all stimuli

Posture - decorticate - decerebrate (worse)

Pupillary signs - Trauma - SAH - Opiates (pinpoint)

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