| General condition parts | Consciousness
Cardiovascular system
Respiratory system
General appearance |
| How do we grade state of awareness? | look picture |
| Quantitative disturbances of consciousness | awake
verbal
pain
unresponsive |
| Pediatric glasgow coma scale | see picture |
| Quantitative disturbances of consciousness | - Infection (encephalitis, meningitis)
- Head damagePoisoning (drugs, psychoactive substances, etc.)
- Bleeding into the CNS (premature babies !!)
- Expansive process (tumor) |
| Differentiation, diagnostics for quantitative disturbances of consoiusness | 1.history, accompanying symptoms (vomiting, nausea, pain, neurological symptoms (nerve
palsy, etc.)
2. Additional testing:
- examination of the cerebrospinal fluid (CSF)
- imaging tests (ultrasound, CT)
- toxicological and biochemical tests (blood, urine) |
| Dyspnoea is judged by? | Increased work of breathing is judged by:
• nasal flaring
• expiratory grunting – to increase positive endexpiratory pressure
• use of accessory muscles, especially sternomastoids
• retraction (recession) of the chest wall, from use of suprasternal, intercostal and
subcostal muscles
• difficulty speaking (or feeding). |
| Type of dyspnea | inspiratory, expiratory, mixed |
| Dyspnoea causes... | central (damage to the CNS (toxic, bleeding, etc.), cardiogenic,
hematological, etc. |
| What can be the cause of dyspnoea? | Infection (upper, lower respiratory tract)
• Foreign body in the respiratory tract
• Chemical burn
• Vascular ring
• Tracheo-esophageal fistula |
| Differentiation diagnostics of dyspnoea | 1. Interview, accompanying symptoms (fever, anorexia, cough, cyanosis, vomiting)
2. Physical examination !!
3. Additional research
- imaging (lung ultrasound, chest X-ray, contrast tests, -laryngo- endoscopy,
esophago-)
- laboratory (parameters of inflammation, antigens, anti-bodies)
- functional (functional) |
| Causes of cough | - Infection (upper, lower respiratory tract)
- Foreign body in the respiratory tract
- Vascular ring
- Tracheo-esophageal fistula
- Allergy
- Bronchial asthma |
| Differentiation diagnostics of cough | 1.history, accompanying symptoms (fever, anorexia, cyanosis, vomiting, rhinitis, skin changes)
2. Physical examination !!
3. Additional research
- pictorial
- laboratory
- functional
- allergic |
| What is syncope? | temporary loss of consciousness due to a decrease in brain perfusion
(interruption of cerebral flow for 6-8 seconds or a reduction of oxygen
delivered to the brain by 20%). Syncope is rapid onset, usually resolving
spontaneously and quickly (<20 s) |
| Causes of syncope | - Situational
- Neurocardiogenic
- Heart arythmia
- Shock,
- Hypovolemia
- Anemia
- Heart defect (e.g. aortic coarctation)
- Stress
- Migraine
- Poisoning |
| What is the difference between true and pseudo cyanosis? | true - increased concentration of deoxygenated hemoglobin in
the blood capillary (> 5 g / dL) or presence of pathological
hemoglobin (most often methemoglobin> 0.5 g / dl)
pseudo - abnormal pigment in the skin (drugs - chlorpromazine,
amiodarone, minocycline; heavy metals - silver, gold |
| What is the difference between peripheral and central cyanosis? | Peripheral cyanosis (blueness of the hands and feet) may occur
when a child is cold or unwell from any cause or with
polycythaemia
• Central cyanosis, seen on the tongue as a slate blue colour, is
associated with a fall in arterial blood oxygen tension. It can only
be recognised clinically if the concentration of reduced
haemoglobin in the blood exceeds 5 g/dl, so it is less pronounced if
the child is anaemic |
| Fever differentiation and diagnostics | Differentiation
• Infectious diseases (urinary, respiratory, nervous, digestive)
• Autoinflammatory diseases ((fever of unknown origin (FUO), recurrent fever
syndrome, juvenile idiopathic cellulitis, Kawasaki disease
• Diseases of the CNS (encephalopathy)
Diagnostics
• Interview!!
• Physical examination !!
• Additional tests - depending on the most probable cause |
| Pain rating | Visual scale
Verbal (descriptive),
Numeric (0-10) |
| Pain, diagnostic and differentiation | Diagnostics and differentiation
- location, radiation, character (piercing, etc.)
- accompanying symptoms
- Chronic diseases
any injuries, burn
acute pancreatitis
biliary colic,
appendicitis
renal colic
neuralgia (including the most common trigeminal neuralgia)
migraine
traumatic
Interview
Examination of the subject (elements of the neurological examination !!) |
| Primary vs secondary headache vs cranial neuralgias | Primary headaches: four main groups, comprising migraine, tensiontype headache, cluster headache (and other trigeminal autonomic
cephalalgias); and other primary headaches (such as cough or
exertional headache).
• Secondary headaches: symptomatic of some underlying pathology,
e.g. from raised intracranial pressure and space-occupying lesions
• Trigeminal and other cranial neuralgias, and other headaches
including root pain from herpes zoster. |
| What is a seizure? | A seizure is a clinical event in which
there is a sudden disturbance of
neurological function caused by
an abnormal or excessive neuronal
discharge.
Seizures may be epileptic or nonepileptic. |
| Epileptic vs non epilepleptic seizures | epileptic
-idiopathic in 80% of cases
-secondary (cerebral dysgenesis, cerebral vascular occlusion, cerebral damage)
-cerebral tumor
neurodegenerative dissorder
-neurocutaneous syndromes
non-epileptic
- febrile seizures
- metabolic (hypoglyceamia, hypomagnesemia, hypo/hypernatremia)
- head trauma
- meningitis
- encephalitis
- poison or toxin |
| Febrile seizures | - 3% of children (genetic predisposition)
- between 6m and 6y
- brief, tonic-clonic
-rapid rise in fever! |
