Summary Essentials of Paediatric Intensive Care

Essentials of Paediatric Intensive Care CONTENTS Preface vii Section 1 Basic Principles of PICU 1 Chapter 1 Differences between the child, the neonate 3 and the adult Chapter 2 Neonatal problems in the PICU 10 Chapter 3 Resuscitation 14 Chapter 4 The structured approach to the seriously 20 injured child Chapter 5 Airway and ventilation 24 Chapter 6 Circulation and rhythm disturbances 37 Chapter 7 Sedation and analgesia in PICU 43 Chapter 8 Fluid, electrolytes and nutrition 50 Chapter 9 Transport of the critically ill child 61 Chapter 10 Death on the PICU 65 Section 2 Specific PICU Problems 69 Chapter 11 Respiratory disease 71 Chapter 12 Cardiac disease on the PICU 83 Monica Stokes – Birmingham Children’s Hospital Chapter 13 Dysrhythmias and myocardial disease 95 Chapter 14 Neurological and neuro-muscular disease 106 Chapter 15 Gastrointestinal and hepatic disorders 122 Chapter 16 Renal disease 129 Chapter 17 Haematology and oncology 134 Chapter 18 Endocrine disorders 138 Chapter 19 Inborn errors of metabolism 143 Chapter 20 Infection and related illness 146 Chapter 21 Trauma 155 Chapter 22 Poisoning 171 Chapter 23 Neonatal and other surgical patients in PICU 176 Section 3 Drugs Used in Paediatric Intensive Care 179 Bibliography 222 Index 223 CHAPTER 1 DIFFERENCES BETWEEN THE CHILD, THE NEONATE AND THE ADULT Children are not just small adults.Various anatomical, physiological and pharmacological differences occur.The differences are significant and there is a continuous and variable change from the neonate onwards. This chapter covers the relevant differences between neonates and adults. Anatomy and physiology Airway Neonates have relative to adults: • the cricoid ring which is the narrowest part of the airway in the child; the vocal cords are in the adult • the cricoid cartilage which is a full ring of cartilage • large tongue • large omega shaped epiglottis • anterior larynx which is at a higher level • large head • short trachea, greater angle of carina; left main bronchus more hori- zontal • the nasal passage which is approximately the same size as the cricoid ring in children • obligate nose breathers Problems/relevance • for basic airway management the head needs to be in the neutral pos- ition • tend to be more difficult to intubate than older child or adult • a straight bladed laryngoscope is needed to lift the epiglottis in chil- dren up to about 2 years of age to give a better view of the vocal cords • uncuffed endotracheal tubes are used up to about 10 years of age to reduce the risk of sub-glottic oedema and long-term sub-glottic stenosis • risk of endobronchial intubation (tubes too long) Breathing • alveoli increase mainly in number in infants and in size in older children • bronchi have relatively more cartilage, less muscle and more glands • small airway obstruction is more likely to be due to inflammation and oedema in infants and muscle spasm in older children