PEDIATRICS L5 Dodo Agladze

ACUTELY ILL OR INJURED

CHILD
Common manifestations of acute illness or injury – respiratory failure, cardiac failure, shock

Assessment _
A (airway)
B (breathing)
C (circulation)
History of a patient
Physical examination
INITIAL DIAGNOSTIC
EVALUATION
Screening tests – pulse oximetry, blood gas exchange, glucose test

Diagnostic tests which show evidence of hemorrhage and tissue injury -

Imaging tests (X-Ray, CT, MRI)
Serum electrolyte level

First steps of resuscitation – Oxygen supplementation, Inter Venous Fluids ,

Vasoactive substances (increasing or decreasing blood pressure)
RAPID CARDIOPULMONARY
ASSESSMENT
CARDIOPULMONARY ARREST

Outcome of CA in children is poor

Survival rate: 6% out of hospital, 27% in hospital arrest

Recommendation is to start chest compressions immediately

CIRCULATION
Chest compression is necessary
1. Pulse cannot be palpated
2. Heart rate is less than 60b/min

Ventilation is important
Compression rate must be100/min
Breaths delivered must be 8-10 times/min
AIRWAY

Inspection of the airway

If necessary intubation of patient

Before intubation patients must be ventilated with 100% oxygen

Medications used: Sedatives, Analgetics and Paralytics

After intubation endotracheal tube is assed: Adequate chest wall movement

If patients condition fails consider: Displacement of the tube, Obstruction, Pneumothorax or Equipment failure
BREATHING
Major role of intubation is to protect the airways and to ensure an adequate delivery of
oxygen

Consider that patient should not be hyperventilated

Medications as Epinephrine and vasopressin can be administrated through the endotracheal

tube

Electrical defibrillation is indicated when ventricular fibrillation or tachycardia is noted

RESPIRATORY FAILURE
Occurs when pulmonary system is unable to maintain adequate gas exchange to meet
metabolic demands of the patient

Classification: hypoxemic and hypercarbic

Main cause of RF in children: Acute lung injury or acute respiratory distress

syndrome
EPIDEMIOLOGY OF RF
Distress syndrome is mainly caused by:
Bronchiolitis
Bronchitis
Asthma
Pneumonia
Upper airway obstruction
Sepsis

Frequency of RF which will require ventilation - 7to 21%

CLINICAL MANIFESTATION OF
RF
Tachypnea (elevation of respiratory rate)

Tachycardia (heart rate over 100b/min)

Dyspnea (difficult breathing)

Nasal flaring (widen nostrils while breathing)
Grunting
Diaphoresis (excessive abnormal sweating)
Cyanosis (blue, gray, or dark purple discoloration of the skin or mucous membranes caused by
deoxygenated or reduced hemoglobin in the blood)
Altered mental status
LAB AN IMAGING STUDIES

Chest X-ray
Bronchoscopy (endoscopic technique of visualizing the inside of the airways for
diagnostic and therapeutic purpose)
CT Scan
Pulse oximetry
Arterial blood gas measurement
RESPIRATORY FAILURE
Treatment – CPR sometimes with noninvasive or mechanical ventilation

Complications of RF – multiple organ dysfunction, lung injurie

Prognosis – <1% of previously healthy children will have lethal outcome

Prevention – immunization against organisms causing primary respiratory diseases

SHOCK
Shock is inability to provide sufficient perfusion of oxygenated blood and
substrate to tissues to meet the metabolic demands

Hypovolemic
Distributive
Cardiogenic
Obstructive
Dissociative
LAB AND IMAGING STUDIES
FOR SHOK
Measurement of blood oxygen saturation
Complete Blood Count (CBC)
Electrolyte measurement in blood
Bacterial cultures (bacteriology)
Viral detection test (Antigen or Antibody test)
TREATMENT OF SHOCK
Fluid resuscitation
Respiratory support
Renal salvage
Cardiovascular support with medications
INFECTIOUS DISEASES, RISK ASSESSMENT
SCREENING TESTS
Bacterial morphology
C reactive protein (CRP)
CBC – (Checking for leukocytosis, atypical lymphocytes, eosinophilia)
Urine test
Lumbar punction
Blood culture for bacteria
Rapid tests - antigen test or antibody test (bacterial, viral, fungal, parasitic)
Serologic tests – showing IgM and IgG
Molecular tests – Polymerase Chain Reaction (PCR)
DIAGNOSTIC IMAGING

X-ray
CT
MRI
IMMUNIZATION
Active immunization – induces immunity through the administration of vaccine or
toxoid
Passive immunization – includes trans placental transfer of maternal antibodies and
administration of antibody via breastmilk

Vaccine types:
Attenuated viruses (reduced virulence)
Recombinant products of the virus
VACCINATION CALENDAR

HBV, TB, MMR (measles, mumps, rubella), Diphtheria, Tetanus

Meningococcus
Rabies
FEVER WITHOUT A FOCUS
Most febrile illnesses in children may be categorized:

Fever of short duration – fever <14 days accompanied by localizing signs and symptoms
Fever without localizing sign – when examination fail to establish any cause
Fever of unknown origin – fever >14 days without an identified etiology despite:
history,
examination,
lab tests,
after 1 week of hospitalization
FEVER IN INFANTS <3M

Fever in infants is associated with high risk of bacterial infections

Bacterial infections include –

bacteremia,
urinary tract infections,
pneumonia,
meningitis,
bacterial diarrhea,
septic arthritis
FEVER IN CHILDREN 3M-3Y
Associated with viral infections

Observational assessment shows:

Appearance of alertness
Irritability
Crying
FEVER OF UNKNOWN ORIGIN
FUO is a temperature greater than 38 lasting for more then 14 days
Etiology of infections causing FUO is an unusual presentation of common disease
Inflammatory diseases account for 20% of episodes
Malignancies are less common cause of FUO
Approx. 15% children with FUO have no diagnosis
Common infections causing FUO are: Viral hepatitis, EBV, CMV, Salmonella, TB,
chlamydial diseases, localized infections.
SCREENING TESTS FOR FUO
CBC – White blood cell count, Platelet count, ER,
C reactive protein (CRP)
Bacterial cultures of urine, blood, throat, stool
Imaging studies
Anti Nucleic Antibodies (ANA)
Reumatoid Factor (RF)
Tuberculosis skin test
HIV
EBV
End of part 5