Paediatric Learning Issues - example
Identifying the serious or critically ill child is an important skill to
pick up.....
Case example
2 y.o. toddler presents with acute stridor initially
commencing as characteristic barking cough progressing to increasing respiratory
difficulties. Partially immunised child
Examination revealed fever, inspiratory stridor, tachypnoea and tachycardia with
tracheal tug, intercostal and sternal recession and symmetrically decreased air
entry.
The child is administered oxygen by face mask at 6L/min and given nebulised
adrenaline with a softening stridor but increased agitation. A disagreement
about treatment follows and the parent refuse oral steroids and suggest
penicillin instead. They also suggest natural remedies.
The patient improves by the next morning and the stridor only occurs during
coughing. A second dose of steroids is given and the patient is discharged on
day 3.
Learning Issues
- What is the immunisation schedule for children?
- What diseases are children more susceptible to if they are not immunised
properly?
- What are normal vital signs for a child and how do they change with age?
- Differentiate the causes of respiratory distress in child. What are the
possible complications or outcomes?
- Differentiate the causes of stridor.
- Differentiate the different types of abnormal breath sound, their
mechanism and the conditions that may cause them.
- How do you assess the severity of stridor?
- How do you assess the severity of respiratory distress and its response
to treatment?
- How do you decide when and how to administer oxygen? What device? What
dose?
- What is the rationale of treatment for different causes of stridor?
- What are the side effects of treatment
- What are the options when there is a disagreement about treatment?
- What are the laws surrounding children's rights in regards to the
responsibility of doctors?
- What are signs that a child is becoming critically unwell? i.e. needing
ICU