Core management Flashcards
1
Q
Someone with a generalised allergic reaction, how do you manage?
Symptoms are urticarial rash
7 things here, think broader than just managing the immediate/obvious problem
A
- Anti-histamines
- Cool compress
- Observation
- Identify trigger
- Allergy action plan
- Education
- Referral
2
Q
Patient presents with difficulty breathing, swollen tongue and hoarse voice. They report having eaten satay.
Management?
Long term management?
A
- Adrenaline
- IM 0.01mg/kg (max 0.5mg)
- Anterior-lateral thigh
- Repeat after 5 mins if not improving
- DRS
- D - remove the antigen
- R - –
- S - Send for help
- ABC’s
- Airway
- Nebulised adrenaline (5mL of 1:1000)
- Early intubation
- Breathing
- High flow oxygen
- Cardiovascular
- Posture - prevent an exacerbating collapse
- Supine or 45 degrees, elevate the legs
- IV access with large gauge cannula
- 20mL/kg 0.9% saline fluid bolus (may need > 1)
- Adrenaline infusion (0.05-1mcg/kg/min)
- Posture - prevent an exacerbating collapse
- Airway
- Adjunctive treatment
- Corticosteroids and salbutamol
- Treat the bronchospasm
- Antihistamine
- Manage the pruritis
- Use a 2nd gen
- Corticosteroids and salbutamol
Long term
- Referral to allergy service and advice
- Call ambulance if happens again
- Carry epipen at all time, ensure they know how to use it
- Action plan for accidental exposure
- Consider an epipen, medicalert bracelet
- Yearly reviews
3
Q
Burns emergency Mx
A = Airway + ____________
- ____________
- Use somebody, not straps or tapes because it is an irritant
- Consider intubation
- Reduced _______ state
B = Breathing + ___________
- Expose ______
- Want equal movement
- Ventilation
- Dictated by SaO2 and RR, oxygen delivered via mask
- Worried about __________
- Consider escharotomy
- Mid axillary lines +/- transverse
- Consider escharotomy
C = Circulation + ___________
- Pulses + CRT
- Where? _____
- IV access
- Commence __________
- Circumferential limb burn management?
- If _______ elevate +/- escharotomy
D = Disability
- AVPU
- ______. ______. ______. ______
- Pupils
- Size, symmetry
- Are you missing something?
- ___________ (injury and infection)
E = __________
- ________
- ________
A
A = Airway + cervical spine control
- Cervical spine control
- Use somebody, not straps or tapes because it is an irritant
- Consider intubation
- Reduced conscious state
B = Breathing + supplemental O2
- Expose chest
- Want equal movement
- Ventilation
- Dictated by SaO2 and RR, oxygen delivered via mask
- Worried about circumferential chest burn
- Consider escharotomy
- Mid axillary lines +/- transverse
- Consider escharotomy
C = Circulation + haemorrhage control
- Pulses + CRT
- Where? Central + all 4 limbs
- IV access
- Commence fluid resus
- Circumferential limb burn management?
- If resctricting perfusion, elevate +/- escharotomy
D = Disability
- AVPU
- Alert, Voice, Pain, Unresponsive
- Pupils
- Size, symmetry
- Are you missing something?
- Head injury
- Tetanus status
E = Exposure + environment
- Exposure
- Clothing/jewellery, front + back
- Environment
- Keep them warm, cover the wound
4
Q
Burns Mx (FATT)
- F - in detail
- A
- T
- T
A
- Fluids
- % TBSA used to guide resus
- Hartmann’s of 4mL x weight (kg) x TBSA (%) = volume / 24hrs in mL
- Aim for half in the first 8 hours from time of injury
- Eg. if it was 3 hours ago, divide by 2, then divide by 5 (8-3) to get hrly rate
- Will need to add dextrose for maintenance
- % TBSA used to guide resus
- Analgesia
- Tests
- Truama blood panel, trauma XR
- Tubes
- Gastric tube + IDC if > 10% TBSA
5
Q
When do we do a sepsis workup in paeds?
What does this involve?
A
Done if…
- Under 3 months with rectal temp > 38c
- or over 3 months if child is unwell, temp > 38c and no clear focus of infection
Involves
- FBE/film
- Blood culture
- Urine culture
- Supra pubic aspirate
- +/- CXR
- Only done if respiratory symptoms or signs
- +/- LP
- Do not perform in child with impaired conscious state, focal neurological signs, or who is haemodynamically unstable
6
Q
What is maintenance rate in a well child?
What about an unwell child? Why?
A
- 4/2/1 rule per hour - to a max of 100 ml/hr (60kg)
- 4 ml/kg for first 10kg
- 2 ml/kg for second 10kg
- 1ml/kg for every kg thereafter
- i.e. 60ml/kg for first 20kg, then add 1ml/kg every kg thereafter
- In sick children it is 2/3 4/2/1 rule. This is because the sick kids secrete ADH leading to fluid retention
7
Q
What is fluid resus rates in a child?
A
10-20ml/kg normal saline bolus
8
Q
- What is the most concerning respiratory sign in a seriously ill child?
- How does this differ from normal?
- What is the most common CV symptom?
- What does pulse poressure tell us in kids?
A
- Apnoea with desaturation or bradycardia
- Most commonly bronchiolitis, followed by sepsis/pertussis
- Periodic panting followed by extended stopping of breathing
- Normal, especially in premature babies
- Tachycardia
- Hypotension is a late sign
- Narrow pulse pressure with dropping BP = dehydration
- Widening pulse pressure = sepsis, aortic regurgitation, PDA, anaphylaxis, severe anaemia
9
Q
CNS screening
- What are 4 things a normal newborn should do?
- What if parents are complaining that their baby sleeps all the time?
A
- All normal newborns should
- Wake regularly for feeds
- Suck strongly on the breast
- Be rousable to activity (random movements of limbs - not stereotyped or lateralised) and have a normal sounding cry
- Have a flexed posture with some tone
- Babies can sleep up to 18 hours per day
- Need to ask if the baby is waking up regularly, namely for feeds
10
Q
Sudden Unexpected Death in Infancy (SUDI)
- Do you write a death certificate for these kids? When would one be appropriate
- How does this differ from SIDS?
A
- Only appropriate if you can determine the cause of death, or if natural causes. Otherwise all need to be referred to the coroners court
- Should always consult senior staff, or coroner if unsure
- SIDS is when the cause of death remains unexplained, even after coroner investigation. Very rare today.
11
Q
- What is enuresis?
- How do we manage it?
A
- Wetting while asleep after the age of 5
- Bedwetting alarms are first line (use 8-12 weeks)
- Second line is desmopressin which is a synthetic ADH
- Does not cure the problem, just controls symptoms
- Second line is desmopressin which is a synthetic ADH
12
Q
Describe management plan for a child with constipation
A
Conservative
- Behaviour modification
- Position
- Keep knees up (with footstool), and lean forward
- Toilet sits
- tds for 5 mins
- Preferably after meals
- Diary
- Reinforce positive behaviour and record frequency
- Delay training until child is passing soft stool
- Position
- Diet
- Fibre
- Good for prophylaxis
- Fluids
- Note that excessive cows milk can exacerbate constipation
- Fibre
Medication
- First line = Stool softener + osmotic laxative
- Coloxyl drops in babies, or paraffin oil if older
- movicol
- Disimpaction
- Increase laxative dose
- Outpatient
- Movicol disimpaction
13
Q
Child resisting treatment
- Can a child’s non-agreement be final? (obvious, but explain the situation)
- How much force/coercian is ethically reasonable to exert on an unwilling child?
A
- Yes, a parents consent overrides the childs dissent
- Use hte least damaging effective method of achieving treatment
14
Q
- Who do you refer to if an < 18 is being abused? What is the organisation called..?
- What are the 4 main types of abuse?
- What is family violence?
A
- Victorian Forensic Paediatric Medical Service
- Physical, emotional, neglect, sexual
- When the child is present while a parent or sibling is subjected to the above
15
Q
How does reporting work?
Child protection agency
- Report to ______________ (which location?)
- Identifying information about the child
- Genogram
- Reasons for concern
Child wellbeing referral
- Report to _____ FIRST
- Support/voluntary
Victoria police
- Partners with child protection to _______ child abuse and neglect
- Collect evidence for ________________ (who?)
A
How does reporting work?
Child protection agency
- Report to region where child usually lives
- Identifying information about the child
- Genogram
- Reasons for concern
Child wellbeing referral
- Report to Child FIRST
- Support/voluntary
Victoria police
- Partners with child protection to investigate child abuse and neglect
- Collect evidence for criminal justice system
