CAH- Emergencies

Question 1

What are the symptoms of anaphylaxis?

Answer 1

• Difficult or noisy breathing
• Swelling of tongue
• Generalised oedema
• Rash or urticaria
• Tightness of throat, difficulty swallowing and speaking
• Dizziness or collapse
• Floppy baby
• Pruritis
• Abdominal pain, vomiting, nausea, diarrhoea
• Headache
• Flushing

Question 2

What are the signs of anaphylaxis?

Answer 2

• Tachycardia –> Bradycardia
• Hypotension
• Wheeze
• Accessory muscle use
• Skin changes –> rash, redness, swelling
• Altered GCS

Question 3

What is the management of anaphylaxis?

Answer 3

• Adrenaline (0.01mg/kg), repeat after 5 minutes if not improving
• ABCD: nebulised adrenaline, early intubation and high flow O2; large bore IV with fluid bolus; position supine with legs elevated
• Adjunctive treatments: corticosteroids and salbutamol for bronchospasm, anti-histamines for pruritis

Question 4

When do you admit a child who has had anaphylaxis?

Answer 4

If >1 dose of adrenaline, fluid bolus required or inadequate response

Question 5

History for anaphylaxis

Answer 5

• HOPC (what, how much, cooked?)
• Previous similar event?
• Triggers? Other allergies?
• Other atopic diseases? FHx?
• Management plan?
• Education: symptoms and signs of asthma, what to do if having an attack (how to use an Epipen)
• Advise to see GP next day with OPD appointment in 6 weeks

Question 6

Examination in DKA

Answer 6

• Assessment of degree of dehydration
• Conscious state (GCS)
• Temperature: ?hypothermic
• Look for a cause, eg/ infection
• Acetone breath

Question 7

What is the initial management of DKA?

Answer 7

• Resuscitation: ABCDE
• Fluid resuscitation to correct shock
• Insulin infusion (aim = 5-12mmol/L) with KCl
• Consider bicarbonate (ICU advice)
• Monitor BGLs (2-4hrly), Na+/K+/Ca2+, pH and osmolality

Question 8

What investigations are required for the assessment of DKA?

Answer 8

• Blood glucose and ketones, UEC
• ABGs
• Urinalysis (ketones) and MCS

Question 9

If DKA is the first presentation of DM, what Ix are required?

Answer 9

• Islet cell Ab
• Insulin Ab
• GAD Ab
• Total IgA
• Anti-endomyseal IgA gliadin
• tTg antibodies
• TFTs

Question 10

Full fontanelle in infants is indicative of what disease?

Answer 10

Meningitis

Question 11

Definition of DKA?

Answer 11

Hyperglycaemia >14mmol/L

Metabolic acidosis pH

Question 12

History features in DKA

Answer 12

Polyuria, polydipsia, LOW and lethargy (1-3w if newly diagnosed)
Vomiting
Kussmaul respiration
FHx of DM and autoimmune disease

Question 13

Complications of DKA

Answer 13

Hypernatraemia
Hypoglycaemia
Hypokalaemia
Cerebral oedema (0.5-3%)