Assessment of an Unwell child

• Airway


  Large prominent occiput (big head). Put infants in the sniffing position.
• Paeds triangle


  Appearance, work of breathing and circulation
• Paeds primary survey


  Airway, breathig, circulation, Disability (AVPU, Pupils, BM!!!!), expose, frequently reassess.
• Signs of deterioration


  Increased work of breathing, cyanosis, BRADYCARDIA, Altered mental status/drowsiness, Hypo/hypertonia, Dehydration/signs of shock, Hypoglycaemia.
• Respiratory illness and emergencies

  Astmha, Bronchiolitis, URTIs, LRTIs/Pneumonia, Croup, Epiglottitis
• Asthma in children


  Affects 1 in 11 children, Inflmation of the airway, Presents early morning/night, trigger, pollen, dust, pet hairs, excersise.
• Bronchiolitis 


  Inflammation of the bronchioles, Acute, self limiting infection, autumn and winter, 2-5months, worse in 72hours before improving.
• Bronchiolitis symptoms


  Reduces SPO2, Increased RR, Recession, Irregular breathing, Inspiratory crackles, Expiratory wheeze, Low grade fever, Possible apnoea.
• Bronchiolitis treatment


  IF A&B CRITICAL TRANSPORT. Incourage feeding/drinking. Transfer if high risk baby, less than 2 months old, Reported periods of apnoea, diminished feeding, hypoxia (SATS <95%). Tachycardiac, tachypnoeic or irregular breathing.
• Upper respiratory tract infections (URTI)

  Common in winter - Tonsillitis/sore throat, otitis media, common cold, rhinosinusitis, Acute cough/bronchitis.
• URTI Assessment


  Sore throat, cough, fever, headache, earache, systemic illness, anorexia, lethargy.
• URTI Physical exam


  Cervical lymphadenopathy, breath odour, Inflamed tonsils, Respiratory distress or stirdor, muffled voice - quinsy, Tender mastoid process, dehydration.
• LRTI Assessment - signs and symptoms

  Fever, cough, tachypnoea, nasal flaring, chest recession, SATS <95%, crackles in chest, cyanosis.
• URTI/LRTI managment 


  Primary survey, Provide respiratory support if required, encourage fluid intake to increase hydration, advise rest, analgesia, consider antipyretic. Refer to GP if left at home
• URTI/LRTI take to further care if

  Under 2, Unable to take meds orally, Dehydrated, Severe DIB, Concerns of meningoccal disease, diminshed fluid intake.
• What is croup?


  Inflammed around the larynx, Acute, usually self limiting, 6months-3years, Summer and autumn, Follow a cold.
• Croup presentations


  Cough (barking), Accessory muscles, Respiratory distress/failure, Runny nose, Hoarse voice, Sore throat, Strior.
• Management of croup


  Consider dexmethasone, Oxyegen as per JRCALC, Upright positon, Calm approach, Must transfer.
• what is Epiglottisis


  Inflammation of the epiglottis and potentially fatal.
• Causes of epiglotitis 


  Bacteria infection or injury, Rare due to HIB vaccine.
• Symptoms of Epiglotitis


  Fever, Unwell/distressed, Stridor, Difficult and painful to swallow, Sitting up/drooling/chin forwards.
• Febrile illness


  Most common illness. Underlying infection. Temp over 38 is likley, over 6 month age is likely.
• Febrile illness assessment


  Temp, Duration of illness, Other symptoms, fluid intake, underlying conditons, med history, contact with ilness, family hx and travel hx.
• Febrile illness assessment pt2

  ABC - Tachypnoea, tachycardia, consider sepsis or meningoccal disease. Use NICE traffic light tool.
• Managment for febrile ilness

  ANtipyretics, paracetamol, ibuprofen.
• Febrile illness requiring hospital

  Any 'red' NICE criteria, Any febrile child under 5 without obvious cause. Signs of serious illness, Recieved antiobiotics last 48 hours with fever. Immuno supressed. Social/psychological concerns for welfare, consider 'amber' patients.
• Dehydration red flags


  Unwell, altered responsiveness, sunken eyes, tachycardia, tachypnoea, reduced skin turgor
• Convulsions causes 


  Febrile - temp. Brain insults, epilepsy, convulsive status epilepticus.
• Convulsion assessment and managment

  NP, Oxygen in active seizure, Oxygen 94-98% in post ictal, assess BM, temp, spo2, assess for rash. Prepare with BVM and convey to A&E.
• Childhood gastroenteritis 


  10% of under 5s will have. SUdden onset diarrhoea and vommiting, dehydration , resolves whithin 1-2weeks (D) 2-3 days (V).
• COnsider alternative diagnosis of gastroenteritis if the following are present

  >38 in over 3, >39 in under 3.. SOB/tachypnoea, altered consiousness, neck stiffness, bulging fontanelle in infants, non-blanching rash, blood or mucas in stool, billous vomit, seriour abdo pain
• Gastroenteritis managment


  Encourage fluids, Convey to hosp if risk of dehydration.
• Glycaemic emergencies


  Displaying reduced LOC, convulsing, seriously unwell, traumatised, BM <4.
• Overdose /poisening management


  Injestion, inhalation, absorption, injection. Oxygen, history, 12 lead, convey.
• Meningoccocal meningitis and septicaemia

  Meningitis - meninges inflamed. Septicaemia - bacteria invade the bloodstream.
• Meningococcal meningitis and septicaemia

  Highflow o2, a&e, Benzylpenicillin.
• Stroke in children


  HASU are 16+. If under 16 fast+, convey to a&e while managing.
• Non conveyence of paeds

  Under 2 MUST convey. 2-5 MUST be referred to GP. 5-12 consider GP.