Common Paediatric Presentations To Secondary Csre

Question 1

Rapid assessment scheme - what are we looking for

Answer 1

Airway and breathing:
- Airway obstruction or respiratory distress
- Work of breathing
- RR
- Stridor, wheeze
- Cyanosis
- O2 stats
* Circulation:
- HR
- Pulse volume
- Cap refil
- Blood pressure

Observe and note:
- Level of consciousness (AVPU)
- Posture
- Pupil size and reactivity

• Exposure

Resuscitate if necessary

Question 2

Shock conditions children could present with

Answer 2

Hypovolaemia (sepsis, dehydration (gasteroenteritis), DKA, blood loss (trauma)

Maldistribution of fluid (sepsis, anaphylaxis)

Cardiogenic (arrhythmias, heart failure)

Neurogenic (spinal cord injury)

Question 3

Respiratory distress conditions children could present with

Answer 3

Upper airway obstruction (croup/epiglottitis, foreign body, congenital malformation, trauma)

Lower airway disorders (asthma, bronchiolitis, pneumonia, pneumothorax)

Question 4

Conditions children could present with when drowsy/unconscious/seizing

Answer 4

Post-ictal Infection (Meningitis/encephalitis)

Metabolic (DKA, hypoglycaemia, electrolyte disturbances (Ca+, Mg+, Na+), inborn error of metabolism

Head injury - (trauma/NAI)

Drug/poison ingestion

Intracranial haemorrhage

Question 5

Surgical emergencies in children

Answer 5

Acute abdomen (appendicitis, peritonitis)

Intestinal obstruction (intussusception, malrotation, bowel atresia/stenosis

Question 6

Management of catastrophic major haemorrhage

Answer 6

Presence of external, exsanguinating haemorrhage (direct pressure if compressible haemorrhage

Tourniquet if extremity, packing with haemostatic dressing if available)

Question 7

Airways and cervical spine management in children in the ED

Answer 7

Presume cervical spine injury (jaw thrust to open airway. Avoid neck extension

Immobilization with manual in-line stabilization, then head block and strapping)

C-spine clearance only with clinical and radiological evidence

Question 8

Breathing and ventilatory support management in children in the ED

Answer 8

Give high- flow oxygen. Bag- mask then mechanical ventilation if needed

If asymmetry consider pneumothorax or haemothorax and if present then drain

Question 9

Circulation and haemorrhage control management in children in ED

Answer 9

Apply pressure if superficial bleeding

Shock = possible internal bleeding
- FAST scan
- chest and pelvis x rays

Group and cross match
Give crystalloid (NaCl, Hartman’s, 5% dextrose in water) then reassess