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Paediatrics > Childhood emergencies > Flashcards

Childhood emergencies Flashcards

1
Q

High risk ingested FB

A
  1. Button batteries
  2. Magnet + metal/magnet
  3. > 6cm x 2.5cm(width)
  4. Lead based - lead toxicity
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2
Q

Mx of ingested FB

A
  1. Safe after crossing pylorus - out in 3days
  2. Xray mouth to anus
  3. If not out in 3 days, Xray in 1wk
    4 Blunt.. not out in 1 month.. no symptoms
    Laparotomy and removal
  4. Button/disc batteries - endoscopically remove ASAP (perforate mucous membrane in 6 hrs) if not in stomach
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3
Q

Fever >38deg in infant <3months, no septic focus

A

Consider as sepsis/bacteraemia
IV antibiotic

Meningitis
pneumonia
pertusis
UTI

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4
Q

Febrile convulsions

A
  1. Mcc - URTI
  2. 6mo - 5yrs
  3. <2yrs, causes unkown … ?meningitis … LP
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5
Q

Types of febrile seizures

A

●Simple
1. Generalised tonic clonic
2. <15min
3. Full recovery in 1 hr
4. Happens once in same febrile illness

●Complex
1. Focal features
2. >15mins
3. No Full recovery in 1 hr
4. Happens >1 in same febrile illness

●Afebrile seizures
1. Acute infection .. no fever
2. Features si,ilar to febrile seizures

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6
Q

Risk of developing subsequent epilepsy in febrile seizures

A

R/F:
1. Fam h/o
2. Neurodevelopment issues
3. Prolonged/focal febrile seizures
4. Febrile status epilepticus

No r/f : 1% risk of developing epilepsy
R/f+: 10% risk of developing epilepsy

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7
Q

Febrile convulsions

A

No inv req - mostly d/t URTI/other infections

  1. Simple - symptomatic rx
    No EEG req
  2. Complex - no EEG req
  3. Status epilepticus - >15mins
    Midaz IV/IM/intranasal/buccal
    Diazepam IV/per-rectal
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8
Q

Bacterial meningitis

A
  1. Fever + drowsy child
    mainly <12months
  2. Inv: Blood culture
  3. IV antibiotic - immediately
    ●Ceftriaxone/Taxim
    ●If not, penicillin

●<3months - Amoxicillin/ampicillin + taxim

  1. When stable, LP to confirm
  2. Dexa - to avoid complications
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9
Q

Meningococcaemia

A
  1. N meningitidis/Meningococcus
  2. V serious - urgent rx
  3. Meningitis features (fever + drowsy)
    + non-blanchable rash, abd pain, neck rigidity
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10
Q

High risk contacts and mx of meningococcus

A

High risk: 7days before symptoms to 1day of antibiotics

  1. Household/room share
    - Antibiotics and Vaccine
  2. Child care (16-20hrs), kids and carers - Antibiotics and vaccine
  3. Sexual contact - Antibiotics
  4. Passenger >8hrs contact - Antibiotics
  5. Students in same class - Antibiotics
  6. Unprotected healthcare workers esp exposed to air droplets (intubation)
    -Antibiotics

Information given to everyone

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11
Q

Meningococcus rx

A
  1. Ciproflox for
    Adults and kids
    Women on OCP
    Can give during breast feed but causes diarrhoea in infants
  2. Ceftriaxone for
    *Pregnant
  3. Rifampicin
    Young
    *Prophylaxis
    C/I - liver failure, pregnancy

Vaccine

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12
Q

Acute epiglottitis

A
  1. H influenzae - emergency
  2. High fever + Toxic + expiratory stridor
    Drooling of saliva
    No harsh cough
    Prefer to sit in TRIPOD position
  3. DD:
    Croup - viral, runny nose, BARKING/BRASSY cough
    Inspiratory stridor
  4. Avoid throat examination
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13
Q

Acute epiglottitis mx

A
  1. Intubation
  2. Blood for culture
  3. IV ceftriaxone/taxim
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14
Q

Croup mx

A
  1. BARKING/BRASSY cough, inspiratory stridor
  2. Parainfluenza virus/RSV
  3. Mx depends on types:
    Mild: minimal stridor, no retractions
    Mod: stridor + sternal/ches wall retractions
    Sev: Mental state changes, O2 stats drop, cyanosis, tachycardia
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15
Q

*Mx of mild-mod croup

A
  1. Hospitalization
  2. IV steroids- DEXA 0.15-0.3mg/kg/dose
  3. Discharge if stridor comes down
  4. IV steroid 2nd dose, next day if symptoms still +
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16
Q

*Mx of severe croup

A
  1. Nebulised Adrenaline 0.1% (1 in 1000)
    0.5ml/kg/dose
  2. Repeat if no response after 30 mins
  3. IV steroids - Dexa/Budesonide/prednisolone
  4. May need endotracheal intubation
17
Q

Bronchiolitis c/f

A
  1. Dxt asthma only after 12 months age
  2. RSV infection
  3. Worsening cough, hypoxia, tachypnoea, wheezing breathing
  4. =Wheezing in <12month old
  5. Auscultation:
    Inspiratory crackles + expiratory wheeze
18
Q

Bronchiolitis inv

A
  1. Clinical dxt, inv not needed
  2. Can do - RBS as infant not feeding well
  3. CXR - hyperinflated lungs with depression of diaphragm
  4. PCR - nasopharyngeal aspirate
19
Q

Bronchiolitis rx

A
  1. Admit - monitor
  2. O2 if <95% sat
  3. IV fluids if not feeding
  4. No antibiotics/bronchodilators
20
Q

Breath holding attack

A
  1. Dramatic emergency - emotional distress
  2. Pale, blue, LOC, 1min of tonic-clonic seizures (self limiting)
21
Q

Aspirated FB

A
  1. Sudden onset of wheeze after choking
  2. ↓Breath sounds u/l, wheeze u/l
  3. CXR - localise
  4. Mx:
    Encourage coughing it out
    Heimlich maneuvour
    Forceps removal - complete obstruction
    Remove by bronchoscopy
    CPR
22
Q

mcc of stridor in infants and children

A

Laryngomalacia

2wks to 6mo of life

Supprtive rx or
Supraglottoplasty

Paediatrics (12 decks)

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