An easy method for blood gas interpretation
Assess the pH. Is it raised gt 7-44 alkalosis or lowered lt 7-36 acidosis This is the overall status of the patient, regardless of compensatory mechanisms. If the CO2 provides a cause for the abnormal pH, i.e. low pH and high CO2 acidosis and high pH with low CO2 alkalosis , then the overall picture is a respiratory acidosis or alkalosis. If the CO2 does not provide a cause for the pH, it is compensating for a metabolic abnormality. Confirm your findings by looking at the base excess of...
Cricothyroidotomy cannulae and ventilation systems
Purpose-made cricothyroidotomy cannulae are available, usually in three sizes 12-gauge for an adult, 14-gauge for a child, and 18-gauge for a baby. They are less liable to kinking than intravenous cannulae and have a flange for suturing or securing to the neck. In an emergency a 14-gauge intravenous cannula can be inserted through the cricothyroid membrane, and oxygen insufflated at 11 min year of age to provide some oxygenation but no ventilation . A side hole can be cut in the oxygen tubing...
Pulseless Electrical Activity Pea
This is the absence of a palpable pulse despite the presence of recognisable complexes on the ECG monitor. This is often a pre-asystolic state and is treated in the same way as asystole. Sometimes, pulseless electrical activity is due to an identifiable and reversible cause. In children this is most often associated with trauma. In the trauma setting PEA may be caused by severe hypovolaemia, tension pneumothorax and pericardial tamponade. PEA is also seen in hypothermic patients and in patients...
Pelvis
A single, anteroposterior pelvic view is usually taken. As with other films this can be reviewed using the ABC approach. Rotation of the pelvic film causes great difficulty in interpretation. In a non-rotated pelvic film the tip of the sacrum and spine will be aligned with the symphysis pubis. The whole of the pelvis from the top of the iliac crests to the ischial tuberosities should be included, as should both hips with the femoral necks shown to the level of the trochanters. Figure 25.9....
Reassess airway
Is the airway partially obstructed or narrowed and what is the likely cause Note the presence of inspiratory noises. If bubbly noises are heard, the airway is full of secretions requiring clearance.This also suggests that the child is either very fatigued, or has a depressed conscious level and cannot clear the secretions himself by coughing. The child with cerebral palsy may often demonstrate this sign as he may have permanently poor airway control. If stertorous snoring respiratory noises are...
Needle Thoracocentesis
This procedure can be life saving and can be performed quickly with minimum equipment. It should be followed by chest drain placement. Large over-the-needle intravenous cannula 16-gauge or larger . 1. Identify the second intercostal space in the mid-clavicular line on the side of the pneumothorax the opposite side to the direction of tracheal deviation . 2. Swab the chest wall with surgical preparation solution or an alcohol swab. 3. Attach the syringe to the cannula. 4. Insert the cannula...
Surgical Airway
Cricothyroidotomy is a technique of failure. It is indicated if a patent airway cannot be achieved by other means. It must be performed promptly and decisively when necessary. In children under the age of 12 years, needle cricothyroidotomy is preferred to surgical cricothyroidotomy. In the adolescent either technique can be used but the surgical technique allows better protection of the airway. The relevant anatomy is shown in Figure 22.5. Figure 22.5. Surgical airway - relevant anatomy Figure...
Circulation Ajp
Heart rate and rhythm. Tachycardia is expected bradycardia is a sign of respiratory failure Pulse volume Capillary refill Blood pressure Effects of circulatory inadequacy on other organs Pale or cyanosed skin colour. Central cyanosis that does not improve with high flow oxygen suggests a congenital heart disease with a right to left shunt Mental status agitation or depressed conscious level Urinary output Note the presence of signs of heart failure which will suggest a cardiac cause for the...
Raised intracranial pressure 1
The initial priority in the management of the unconscious child is the maintenance of adequate respiration, circulation, and metabolic homoeostasis. Once this has been done, the possibility of raised intracranial pressure should be considered. In very young children, before the cranial sutures are closed, considerable intracranial volume expansion may occur if the process is slow. However, if the process is rapid and in children with a fixed volume cranium, increase in volume due to brain...
Hypervolaemia
Hypervolaemia in children is uncommon and is usually due to either cardiac or renal failure. Occasionally water intoxication due to deliberate ingestion of water or excessive administration of desmopressin DDAVP may be the cause. Signs of hypervolaemia include raised venous pressure, a triple rhythm on auscultation of the heart, and pulmonary crackles. Hypertension may be present, particularly in fluid overload of renal origin.Treatment of hypervolaemia is initially with diuretics. These may be...
Weight
The most rapid changes in size occur in the first year of life. An average birth weight of 3-5 kg has increased to 10-3 kg by the age of 1 year. After that time weight increases more slowly until the pubertal growth spurt. This is illustrated in the weight chart for boys shown in Figure 2.1. As most therapies are given as the dose per kilogram, it is important to get some idea of a child's weight as soon as possible. In the emergency situation this is especially difficult because it is often...
Causes Of Death In Childhood
As can be seen from Table 1.1, the greatest mortality during childhood occurs in the first year of life with the highest death rate of all happening in the first month. Table 1.1. Number of deaths by age group Table 1.1. Number of deaths by age group The rate for under ones is per 1 000 population and for over ones per 100 000 population England and Wales, 1991 and 1998 Office of National Statistics ONS Australia 1998 The rate for under ones is per 1 000 population and for over ones per 100 000...
Pathways Leading To Cardiorespiratory Arrest
Cardiac arrest in infancy and childhood is rarely due to primary cardiac disease. This is different from the adult situation where the primary arrest is often cardiac, and cardiorespiratory function may remain near normal until the moment of arrest. In childhood most cardiac arrests are secondary to hypoxia, underlying causes including birth asphyxia, inhalation of foreign body, bronchiolitis, asthma, and pneumothorax. Respiratory arrest also occurs secondary to neurological dysfunction such as...