Children with critical illness

Children with critical illness The most common life-threatening diseases that are accompanied by: respiratory failure, heart failure and neurological disorders. Rarely can occur: acute liver failure and acute renal failure.
Identifying the cause of organ failure may demand more time, physiological instability, but treatment should begin immediately. Provide for several steps. Detection of physiological instability is a simple assessment, but the consistency of the patient: close observation, rapid and complete clinical examination. It is preferable to lose a few minutes more by examination rather than inadequate treatment to begin. Observation begins by determining: - Lack of vivacity; - Low response to stimuli; - Decrease movement; - Muscle weakness; - Loss of voice. Next assessment of vital signs such as pulse and heart rate. Peripheral pulse is determined at different points (radial, femoral, preauricular, pedia, etc.). It is therefore, the frequency and amplitude. The follow proper fit physical signs: breathing, movements, cough, coloration of the skin. Increased pulse rate (tachycardia) may be associated with decreased stroke volume, decreased the amplitude that will cause poor perfusion and agitation. Bradycardia or pulse slowdown may signal a pre-cardiac arrest. Blood pressure (BP) defines a poor perfusion thus a decrease in systolic blood pressure (SBP). Organ perfusion is reflected in an infusion of good skin for this purpose is assessing skin temperature, Recolor time (2-3 seconds), pulse oximetry measures oxygen saturation of hemoglobin.
Work of breathing and gas exchange is suggested by this circulation, muscular nose wing beats, cornaj, wheezing, cyanosis.
Cardiac dysrhythmia is life-threatening emergency. In this category falls the infant bradycardia or asystole and ventricular fibrillation is more common in adolescent or adult. Is manifested by abnormal heart rhythm: - Collapse; - Shortness of breath; - Tachypnea; - Tachycardia; - Palpitations. Much attention is given asistoliei, manifest symptomatic tachycardia, bradycardia, it is very important recognition and timely intervention. Children who have higher risk and electrolyte imbalances.
Evaluation of pulmonary blood flow is also an urgent priority. Cardiac malformations associated with pulmonary hypertension and may occur in certain pathophysiological conditions of pulmonary hypertension crisis with clear risk for hypoxic or anoxic events.
Evaluation of metabolic status expressly provides tracking of two major disorders the critically ill child: acidosis and hypoglycemia.
Measurement of oxygen (O2) and carbon dixidului pressure (PCO2) of central venous blood (pulmonary artery) is performed by placing the child than Swan-Ganz probe. This is to assess if tissue perfusion is adequate and that anaerobic metabolism is increased, highlighting the high levels of lactic acid are suggestive in this regard. Current resuscitation guidelines underline the need assessment: airway, this ventilation, heart rate, peripheral perfusion adequate sodium bicarbonate before giving another agent or buffer.
Sodium bicarbonate (Na) is recommended: - Symptomatic hyperkalemia; - Hipermagneziemie; - Poisoning with tricyclic antidepressants; - Metabolic acidosis. Routine administration during resuscitation can be dangerous so be administered only in cases of documented metabolic acidosis by the gas meter. It is good to know that after prolonged respiratory arrest with resuscitation should be administered every 10 minutes.
Hypoglycemia is the decrease in glucose level values that can destabilize energy production. Brain activity is dependent on a normal level of glucose in the blood. Hypoglycaemia symptoms: fatigue, lethargy that can be followed by convulsions. Emergency resuscitation should include the administration of glucose in the amount of 250-500 mg / kg infused in minutes. Hypoglycaemia should be documented.
Evaluation function central nervous system (CNS) monitors its integrity based on the history and physical examination that investigates the possibility of trauma surgery: ingestion of toxic drugs, seizures, ischemia, intra-cranial lesions (Hemorrhage, tumors, abscesses, congenital malformations).
Assessment is by Glasgow scale: - Open eyes (total 4 points): Spontaneous (4 points), the Voice (3 points), pain (2 points), none (1 point); - Motor response (6 points): run (six points), localized pain (5 points), withdrawal of the member (4 points), flexion (3 points), extension (2 points), none (1 point); - Verbal response (5 points) in infants and young children: respond appropriately to words, smile and watch (5 points), slightly attenuated scream (4 points), to be continuously irritated (3 points), agitated without stopping (2 points) none (1 point). - Verbal response (5 points) in the older children: oriented (5 points), confused (4 points), inadequate (three points), incomprehensible (2 points), none (1 point).
Clinical staging of encephalopathy
Stage I is caraterizeaza by: lethargy, follow orders, reactive pupils, normal respiration and normal muscle tone. Stage II includes the following symptoms: psycho-motor agitation, confusion in the enforcement of controls, reacting difficult pupils, hyperventilation and diminished reflexes. Stage III shows the following symptoms: comatose, occasionally respond to commands, can be diverted eyes, irregular breathing and posture of the shelling. Stage IV is characterized by symptoms of coma, responds to pain, poor pupillary response, very irregular breathing, cerebration Stage V shows the following clinical signs: comatose, unresponsive to pain, pupil areactive, eclama mechanical ventilation, absence of reflexes.
Criteria for admission to the pediatric intensive care unit Receiving medical care in the intensive care unit patients who require invasive monitoring: central venous or arterial catheter, intracranial pressure, pulmonary arterial line. There also benifeciaza of medical care patients who have: respiratory failure, cardiovascular compromise, shock, hypotension or hypertension, acute neurological damage, coma, status epilepticus, intra-cranial pressure increased. Patients with acute renal failure (ARF) requiring dialysis and those with haematological disorders requiring massive transfusions.
Criteria for admission in the intermediate intensive care unit are: - Patients not requiring respiratory support for respiratory failure, but can claim a non-invasive monitoring by monitoring vital signs: blood pressure (BP), oxygen saturation (SaO2), transcutaneous measurement of oxygen (O2) and carbon dioxide (CO2) ; - Patients requiring non-invasive cardiovascular monitoring for early heart failure; - Patients with multiple organ dysfunction; - Patients with neurological injuries.