Emergencies

Question 1

Sepsis vs septic shock

Answer 1

• sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection
• septic shock: a more severe form sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’*

Question 2

qSOFA score: ≥2 means heightened risk of mortality

Answer 2

Respiratory rate > 22/min
Altered mentation
Systolic blood pressure < 100 mm Hg

Other in full scoring: PaO2, platelets, BR, CV (MAP, dopamine/epinephrine), GCS, creatinine, UO

Question 3

Red and amber flag criteria: risk stratification of sepsis

Answer 3

High risk for children under 5 years

Transfer IMMEDIATELY to an acute hospital setting if there are signs of severe illness or if immunity is impaired

Question 4

Paediatric Sepsis 6

Answer 4

Question 5

Paediatric sepsis management

Answer 5

Question 6

Paediatrics

Question 7

Paediatric BLS

Answer 7

Question 8

What is the most common cause of paediatric arrest?

Answer 8

Respiratory arrest

e.g. hypoxia is likely due to a choking episode due to the child’s age and the lack of a clear history for another cause. Choking episodes are common causes of collapse and arrest in young ambulant children, particularly toddlers.

Question 9

Neonatal Resuscitation Guidelines

Answer 9

TONE, BREATHING, HEART RATE, COLOUR

Question 10

Why do we not perform airway suction on newborn baby?

Answer 10

Airway suction should not be performed unless there is obviously thick meconium causing obstruction, as it can cause reflex bradycardia in babies

Question 11

When do we perform chest compression and CPR in newborn

Answer 11

Chest compressions if HR <100

CPR if HR <60

Question 12

Anaphylaxis S+S and mx

Answer 12

oedema, urticaria, shock, oedema, wheezy, respiratory distress

repeated dose IM adrenaline 5 minute gap

• start to think about adrenaline infusion after 2 doses

oxygen = 15L O2 via non-rebreathe bag

Question 13

(From ALL) Febrile neutropenia → neutropenic sepsis definition and management

Answer 13

Neutropenic sepsis = neutropenia, neutrophil count <0.5 x 10^9/L, and either >38 dc or symptoms consistent with significant sepsis

Pseudomonas bacteraemia is the worry as high mortality risk associated with neutropaenic sepsis in cancer patients

mx:

• BS abx = tazocin monotherapy, gentamicin for unstable
• physical exam, blood cultures, urine sample, CXR for symptomatic children
• after 48 hours if child improves (negative cultures, correction of neutropenia) = empirical abx discontinued or changed to oral BS abx such as oral co-amoxiclav