Pediatric versus Adult

Patient Considerations

PED 11
PED
®
 Objectives
• Review physiologic differences
which influence evaluation and
treatment
• Evaluate difference in incidence of
conditions, consequences, and
complications

PED 2
®
 General Examination
• Skin perfusion – color, warmth,
capillary refill
• Hydration
• Responsiveness – irritability, alertness,
response to stimuli, restlessness
• Respiratory – tachypnea, bradypnea,
expiratory grunting, obligate nose
breathing, nasal flaring
PED 33
PED
®
 General Examination
• Compensated shock – tachycardia,
skin vasoconstriction/mottling,  pulse
pressure, long capillary refill, BP may
be normal
• Seizures may present as  alertness,
abnormal vital signs, abnormal muscle
activity
• Fever always ominous

PED 4
®
 Respiratory Principles
• CNS receptors/effectors – biphasic
response (tachypnea  bradypnea) to
hypoxia in neonates
• Chest stability/strength –
cartilaginous thorax, more horizontal
ribs and diaphragm
• Airways – increasing alveoli with age,
higher airway resistance
PED 5
®
 Respiratory Principles

• Less respiratory reserve

• Airway obstruction common
• Allow position of comfort or sniffing
position (if no C-spine injury)
• High levels of supplemental oxygen

PED 6
®
 Orotracheal Intubation
• Careful bag-mask ventilation
• Sniffing position (if no C-spine injury)
• Consider obstruction by tongue
• Straight blade to entrap epiglottis
• Endotracheal tube – proper
size/placement

PED 7
®
 Cardiovascular Principles
• Small absolute blood volume
• Cardiac output dependent on rate due
to low stroke volume
• Bradycardia ominous
• Response to fluids after 8 wks similar
to adult; CVP less accurate
• Reactive pulmonary vasculature
• Variable catecholamine response
PED 8
®
 Nonhypovolemic Shock
• Initially treat with titrated fluid to 40 mL/kg
• Possible etiologies:
– Pneumothorax
– Pericardial effusion, myocardial dysfunction
– Intestinal ischemia, sepsis
– Adrenal insufficiency
– Pulmonary artery hypertension, coarctation
of aorta

PED 9
®
 Metabolic / Thermal Principles
• Greater insensible water loss
• Hypoglycemia more common
• Appropriate urine output for age
• Greater heat loss
• Hypo- and hypernatremia
• Hypocalcemia in newborns

PED 10
PED 10
®
 Immunologic Principles
• Neonates
–  WBC function and reserve
–  Antibody synthesis
–  Inflammatory response
– Passive immunity gone by 2–5 mo;
adult levels by age 4–7 yrs
• Early empiric antibiotics

PED 11
®
 Summary
• Variations in maturation of organ
systems and physiologic responses
• Body size and surface area constraints
• Vascular responses and volume
considerations
• Small “margin for error”
• Early consultation

PED 12
®
 Key Points

PED 13
®