BIOMED - Pathophysiology

🧅 𝘎𝘢𝘴𝘵𝘳𝘰𝘦𝘯𝘵𝘦𝘳𝘪𝘵𝘪𝘴 - 𝘗𝘢𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘔𝘢𝘯𝘢𝘨𝘦𝘮𝘦𝘯𝘵

Objectives:
☞ Assess circulation in paediatric patients
☞ Understand fluid maintenance and boluses in children
☞ Calculate fluid boluses in children

Assessment of Circulation:

☞ Appearance and level of consciousness
     - Lethargy and decreases consciousness can be signs of poor end organ perfusion. AVPU to assess consciousness

☞ Skin turgor and colour
     - ↓ skin turgor may = dehydration, pillow and mottling may be circulatory failure signs

☞ extremities
     - poor perfusion

☞ eyes
     - sunken eyes are usually in moderately dehydrated children

☞ mucous membranes
     - dry mucous membranes indicate dehydration

☞ central capillary refill
     - Prolongues cap refil may indicate dehydration. Hold for 5 seconds, then release.

☞ heart rate

     - Children will ocmpensate with tachycardia. Bradycardia is a serious and pre-terminal sign of impending cardiac arrest

☞ breathing
     - Tachypnoea and abnormal breathing pattern in perms of poor circulation may indicate severe dehydration and metabolic acidosis

☞ peripheral pulses
     - Weak, threads pulses are a very worrying sign of a very sick child

☞ blood pressure
     - Hypotension is a very late and serious sign in children

☞ urine output
     - Assess number of wet nappies. May be difficult to differentiate urine from diarrhoea stool

☞ infants 
     - Assess the fontanelle. If sunken, may be a sign of dehydration

☞ Blood Glucose
     - children presenting with poor feeding, vomiting, diarrhoea should have their BGL assessed to rule out hypoglycaemia

🛑 SEPSIS ASSESSMENT SCREENING

🚦Once complete, our goal is to prevent dehydration.

Those at higher risk for dehydration are:

☞ very young infants
☞ immunocompromised
☞ those with comorbidities

Rehydration
Start with oral rehydration solution (ORS) for treatment of gastroenteritis, but should not be used in those with suspected or confirmed shock, Ileus, or altered level of consciousness (aspiration risk). It is best given in small amounts every 5 minutes, and can be coadministered with ondansetron in children <6 months old.

ORS may be given down a nasogastric tube if child refuses.

IV fluid bolus
0.9% Sodium Chloride is the recommended fluid for giving a fluid bolus. It is given in a 10-20mL/kg bolus which is immediately assessed after for a response.

0.9% NaCl + 5% Glucose is used for fluid maintenance. 

Calculating fluid maintenance rate:

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