Day 3 Revision Session

Question 1

Anaphylaxis

• what is it
• most common cause
• What type of hypersensitivity

Answer 1

Paed Emergency.

• 80% food related
• IgE Type 1

Question 2

Anaphylactoid

Answer 2

Present similar but not allergic (not IgE)

Question 3

Main cause of death

Answer 3

Laryngeal oedema. Obstruction

Question 4

Clinical features

Answer 4

Hx:
General: N&V, palpitations, collapse
Skin: rashes, itchy (urticaria)
Airway: tingling around lips, SOB (wheeze)
End stage: cyanosis, shock

Question 5

D.D

Answer 5

Asthma

Question 6

Management

Answer 6

ABCDE
IV Fluid challenge:
20mls per kg Bolus
Remove the allergen

Adrenaline 1:1000 IM 
Give epiden 
> 12: 500 micrograms
6-12: 300 micrograms
< 6 years: 150 micrograms

Repeat after 5 mins

Chlorophenamine 
After rhesus 
IM or IV SLOWLY
> 12 10mg 
6-12: 5mg
<6: 2.5mg 
<6 months: 250 micrograms/kg

Hydrocortisone 
IM or IV SLOWLY
> 12: 200mg 
> 6: 100mg
6-12: 50mg 

Wheeze:

• Salbutamol
• Ipratropium bromide

Hx
Drugs chart, wrist bands

Question 7

Septicaemia

• most common type
• Neonate most common cause
• children

Answer 7

Meningococcal

• group B strep
• Neiserria Meningitis & pneumococcus

Question 8

Pathophysiology

Answer 8

Inflammatory cytokines, active endothelial cells, capillary leakage -> hypovolaemia & rash

Question 9

Describe the rash

Answer 9

Petechial/purpuric non-blaching rash

Question 10

Septicaemia clinical feature

Answer 10

Fever
irritable 
lethargic 
poor feeding 
↑ HR ↑ RR
↓ BP
Recent Hx of infection: URTI, UTI
DIC: abnormal clotting, thrombocytopenia & coaguloapthy

Question 11

Investigations

Answer 11

Find source:

• IV access: FBC, U&E, LFT clotting (PT), CRP, ESR, cultures
• VBG or capillary (lactate)
• pharyngeal swab
• LP (not CI: ↑ ICP: focal neuro, spinal cord trauma, infection around site, unresolved coagulopathy)
• Urine sample
• exposure: cannula, cellulitis

Question 12

Management

Answer 12

ABCDE
< 94% : high flow O2
Large bore cannula ACF
Temp: ↑: antipyretics (paracetamol 15mg per kg)
Metabolic state: Blood glucose: ↓ : give sugar
signs of acidosis
↓ BP: NaCl 20mg/kg

Consider escalation of care: ICU
- Inotropes

Antibiotics:
Bebnzylpenicilin 10mg IM

Hospital
Consult trust guideline
Cephlosporin, cefuroxime, ceftriaxone
< 8 weeks: group B: ampicillin

DIC
FFP & transfusion

Question 13

When give inotropes:

Answer 13

Not responding to fluids

Already fluid overloaded Pulmonary oedema

Question 14

Which inotrope

Answer 14

Dobutamine: does increase rate, just force .

HR is already fast.