Episode 35: The collapsed infant

PHEMCAST

https://phemcast.co.uk/wp-content/uploads/2019/09/infant-with-fluid-clarification.mp3

A: Optimal airway position for infants

Note how a rolled towel is placed under the baby’s shoulders to allow space for the occiput and avoid flexion of the neck and airway.

From: https://www.jems.com/2017/02/28/an-overview-of-ems-pediatric-airway-management/

‘B’ assessment

Video links to examples of children with signs of respiratory distress:

• Stridor
• Grunting
• Increased work of breathing

‘D’ assessment

Example video showing a bulging fontanelle (excuse the slightly cheesy style!)

From: http://casemed.case.edu/clerkships/neurology/NeurLrngObjectives/Floppy%20Baby.htm

Non accidental injury

Sadly, NAI in under 2’s causes more than 10% of serious injuries to children.

Stigmata of possible NAI include:

• Bruising on the cheeks, neck, genitals, buttocks and back
• Pattern bruising from an implement including fingertip bruising
• Burns to hands, legs, feet and buttocks
• Subconjunctival haemorrhage
• Epistaxis in infants

Example of subconjunctival haemorrhage:

From: http://champprogram.com/question/3a.shtml

2017 NICE guidance: When to suspect maltreatment in under 18s.

Sepsis

Click for UK Sepsis Trust guidance for different clinical settings. Scroll down for the Screening and Action tool for under 5s for prehospital care and ambulance services.

References regarding IM benzylpenicillin that Tim mentions:

• Harnden A. Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study. BMJ. 2006 Jun 3;332(7553):1295–8.
• Hahné SJM, Charlett A, Purcell B, Samuelsson S, Camaroni I, Ehrhard I, et al. Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review. BMJ. 2006 Jun 3;332(7553):1299–303.
• Sörensen HT, Nielsen GL, Schönheyder HC, Steffensen FH, Hansen I, Sabroe S, Dahlerup JF, Hamburger H, Olsen J: Outcome of pre-hospital antibiotic treatment of meningococcal disease. J Clin Epidemiol 1998, 51:717–721.

Drug calculator

Example of a paediatric drug calculator from WATCh.