Jay Shetty Clinical Lecturer in Child Health Acutely Unwell Child Jay Shetty Clinical Lecturer in Child Health

Unwell Child Different Physiology, anatomy and aetiology compared to adults. Approach for resuscitation and treatment are different Common causes of acute illness in children

Aetiology of Cardiac Arrest in Children Respiratory Obstruction Respiratory Depression Fluid Maldistribution Fluid Loss Foreign Body Asthma Croup Convulsions Poisoning Raised ICP Sepsis Anaphylaxis Cardiac Failure Blood Loss Burns Vomiting Respiratory Failure Circulatory Failure Cardiac Arrest

Age [Years] Heart Rate Respiratory rate Systolic Blood Pressure [mmHg] <1 110-160 30-40 70-90 1-2 100-150 25-35 80-95 2-5 95-140 25-30 80-100 5-12 80-120 20-25 90-110 >12 60-100 15-20 100-120

Systematic Approach Airway Breathing Circulation Disability Exposure

Potential Respiratory Failure Effort Effect Efficacy

Effort of Breathing Recession Respiratory rate Accessory muscle use Nasal flare Child’s position Sounds Inspiratory stridor Expiratory wheeze Grunting

Efficacy of Breathing Chest Expansion Air Entry Saturations

Effects of Breathing Heart Rate Skin Colour Mental Status

Potential Circulatory Failure Early Recognition of Shock Cardiovascular Signs Effects of Circulatory Inadequacy

Circulatory Signs Hypotension is a pre-terminal sign Pulse Rate Pulse Volume Capillary Refill Blood Pressure Hypotension is a pre-terminal sign

Effects of Circulatory Inadequacy Respiratory Rate Skin Temperature/Colour Mental Status

Potential Central Neurological Failure Conscious Level Pupils Posture

Conscious Level Alert Responds to Voice Responds only to Pain Unresponsive to all stimuli AVPU

Posture Alert Decorticate/Decerebrate Posturing

Summary – Rapid Assessment Airway and Breathing Effort Efficacy Effects Circulation Heart Rate Capillary Refill Time Blood Pressure Skin Temperature Disability Conscious Level Posture Pupils

Common Causes Systemic Infection/Sepsis. Trauma/Burns/Overdose CNS: Meningitis, Encephalitis, Seizures. Respiratory: Pneumonia, Bronchiolitis, Asthma, Croup, Tracheitis, Epiglottitis. Cardiovascular: Congenital heart disease, arrhythmias

Common Causes GI: Gastroenteritis, bowel obstruction, Appendicitis, Malrotation. Urogenital: UTI, Epididemo-orchitis, testicular torsion. Haematological: Acute leukaemia, Anaemia. Musculoskeletal: Osteomyelitis, Reactive arthritis Others: Metabolic disorders, Allergy and anaphylaxis, Intoxication, Nonaccidental Injury.

Infection/Sepsis Commonest cause for acute illness in children Varying presentation [rash, fever, poor feeding, lethargy, system specific symptoms] Treatment: supportive and antimicrobial

Trauma RTA Trampoline, sports injuries Type: Fractures, Head injury, abdominal injuries. Initial approach to management is BLS with Cervical spine immobilisation. Burns and overdose (?NAI)

CNS Meningitis: Bacterial and viral Encephalitis: Commonly viral Presentations and findings vary at different age groups Investigation includes lumbar puncture and imaging. Supportive and Specific treatment

Fits, Faints and Funny turns Febrile seizures Epileptic attack, Status epilepticus Vasovagal episode, Reflex anoxic seizures Breath holding attacks Behavioural episodes Arrhythmias

CVS Cyanotic Heart disease present early in life Bacterial endocarditis is a severe infection Heart murmurs Arrhythmias are rare in children, Supraventricular tachycardia is the commonest.

GI/Urogenital Viral gastroenteritis is a common illness and can lead to severe dehydration. Congenital pyloric stenosis, Volvulus, Intussusceptions and malrotation are common causes of GI obstructions in children Appendicitis is the most common acute abdominal condition UTI’s are common in children

Common Causes Systemic Infection/Sepsis. Trauma/Burns/Overdose CNS: Meningitis, Encephalitis, Seizures. Respiratory: Pneumonia, Bronchiolitis, Asthma, Croup, Tracheitis, Epiglottitis. Cardiovascular: Congenital heart disease, arrhythmias

Common Causes GI: Gastroenteritis, bowel obstruction, Appendicitis, Malrotation, Hepatitis. Urogenital: UTI, Epididemo-orchitis, testicular torsion. Haematological: Acute leukaemia, Anaemia. Musculoskeletal: Osteomyelitis, Reactive arthritis Others: Metabolic disorders, Allergy and anaphylaxis, Intoxication, Nonaccidental Injury.

Shock Inadequate tissue perfusion resulting in impaired cellular respiration -inadequate supply of nutrients to tissues -inadequate removal of tissue wastes Failure of circulatory function [Heart, Blood, Blood vessels]

Shock Cardiogenic [arrhythmia, cardiomyopathy, valvular heart disease, contusion] Hypovolemic [ haemorrhage, GE, gut obstruction, Burns, Peritonitis] Distributive [Sepsis, Anaphylaxis, Drugs] Obstructive [Pneumothorax, tamponade ] Dissociative [Anaemia, CO poisoning]