Anaphylaxis / emergency Flashcards
What type of reaction is anaphylaxis
Type 1 IgE
What is acute symptoms
Facial swelling Tight throat Breathing issue Urticaria Oedema Itch Wheeze Stridor Laryngeal obstruction Collapse
How do you monitor
Pulse
Sats
ECG
BP
What can tell if had allergic reaction
Serum tryptase
How do you assess
A - swelling / stridor
B - RR / wheeze / fatigue / cyanosis / sats
C - pale / clammy /low BP / low HR / coma
How do you treat
Remove allergen + raise legs ABCDE IM adrenaline High flow O2 trauma mask IV acesss Fluid IV Hydrocortisone IV Chlorophenamine
When do you intubate
If obstruction
Call anaesthetist early
How much adrenaline and how often and what dose for children
1 in 1000
Every 5 minutes
Can still detioriate after so keep giving
<6 = 0.15ml 6-12 = 0.3ml >12 = 0.5ml
How much fluid
20ml / kg 0.9% saline bolus
How much hydrocortisone
200mg >12
100mg >6-12
50 mg >6 months-6
25mg <6 months
How much chlorophenaimine
10mg >12
5mg 6months-12
2.5mg <6months
When do you discharge
Diet review Avoid nuts if unclear trigger Skin prick test Epipen Train how to use Anti-histamine Emergency plan Allergic clinic referral
What is most common cause of arrest
Respiratory
Hypoxia due to choking
What do you do
Airway Breathing 5 rescue breaths Check pulse CPR 15:2
What is agonanl breathing
Occurs first few minutes of cardiac arrest
Brain stem reflex
What is most common cause of death
SIDS
What are major RF
Prone sleeping Smoke during pregnancy Premature / LBW Bed sharing Hyperthermia
What are minor RF
Male
Social class
Drugs
What is protective
Breast Room sharing Dummies Keep babies lying on back Don't cover head Avoid smoking / co-sleeping
What do you screen for siblings for
Sepsis
Errors of metabolism
What causes non-blanching rash
Bleeding under skin
What is petechiae
<3mm non blanching spot caused by burst capillary
What is purpura
> 3mm non blaching rash due to bleeding from vessel
What is differential
Meningococcal septicaemia= main HSP ITP Acute leukaemia HUS Trauma / NAI VIral illness - Most likely cause even if non-blanching - Esp if child well
How do you investigate
Refer and admit for observation +- bloods FBC - Will detect cytopenia - ITP / leukaemia U+E - If think HSP or HUS - HSP more purpura on buttock - HUS if recent diarrhoea CRP / ESR - If think sepsis Coag screen - DIC from sepsis
Blood culture Meningococcal PCR LP BP Urine dip
How do you manage
Any child with non-blanching rash needs urgent referral
Child vitals
OK
See surgery
Assessment
ABCDE
If unwell baby coming in, <3 months, with resp distress and off vitals what are your DDX
Sepsis = top of list Bronchiolitis / pneumonia Duct dependent cardiac Metabolic NAI - head Congenital
What happens
SENIOR HELP ABCDE - Oxygen, airway or breathing - May get RSI + intubate - IV or IO - Take bloods and gas - Fluid volus - Inotrope - Ax - CXR / USS / CT
What is rare but think
Cardiology
- Prostaglandin infusion will keep the duct open
Child fallen onto abdo, bruised and very unwell what is Dx
Ruptured spleen until proven otherwise as big blood supply and less protection
Could be anything
What are red flags in children to refer
Parental concern Co-morbid Cold hand / feet Decreased urine No fluid intake No source of fever Cold / clammy / patchy Non-blanching rash Lethargic
