Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paeds > Emergencies > Flashcards

Emergencies Flashcards

1
Q

What is sepsis?

A

Life-threatening organ dysfunction caused by a dysregulated response to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the criteria to diagnose sepsis?

A

2 or more of the following: (temp/WCC must be one)

  1. Abnormal temp (<36/>38.5)
  2. Abnormal HR
  3. Abnormal WCC
  4. Raised RR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is neonatal sepsis?

A

Sepsis within the first 28d of life.
EOS = <72hrs
LOS = 7-28d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the most common causes of neonatal sepsis?

A

Overall = GBS and E.coli
EOS = GBS
LOS = CoNS e.g. staph epidermidis
Also = staph aureus, strep pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the RFs for sepsis?

A
  • Premature
  • LBW
  • Mother who had previous baby with GBS infection
  • Maternal evidence of chorioamnionitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the S/S of sepsis?

A

Respiratory = grunting, nasal flaring, use of accessory respiratory muscles, tachypnoea, apnoea, cyanosis

CNS = Infant: bulging fontanelle, irritability / Child: headache, photophobia, neck stiffness, seizures, decreased GCS

CVS = tachycardia, hypotension

GI = jaundice, V/D, abdominal pain, poor feeding, abnormal distention

General = lethargy, fever, hypothermia, purpuric rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the investigations for sepsis?

A

PAEDIATRIC SEPSIS 6:

  • Give high flow oxygen
  • Obtain IV or IO access - blood cultures, blood glucose (treat), blood gas (+FBC, CRP, lactate)
  • Give IV or IO antibiotics (broad spectrum cover as per local policy)
  • Consider fluid resuscitation (20ml/kg isotonic fluid over 5-10mins)
  • Involve seniors early
  • Consider inotropic support early (adrenaline or dopamine)

+ Urine MC&S
+/- LP
+/- CXR / abdo USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management of sepsis?

A

EMERGENCY, ABCDE approach

  1. IV fluids and high-flow O2
  2. +/- inotropes e.g. adrenaline
  3. IV abx within 1hr
    EOS (<72hrs) = benzylpenicillin + gentamicin
    If <3m = ceftriaxone + ampicillin / amoxicillin
    Up to 17yrs = ceftriaxone
    If <40w corrected age = cefotaxime
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the causes of meningitis?

A

Neonates = GBS, E.coli, listeria monocytogenes

1m-6yrs = strep pneumoniae, n. meningitidis, h influenzae type B

> 6yrs = n. meningitidis, strep pneumoniae

Viral = enteroviruses, CMV, arbovirus

TB = most common 6m-6yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the RFs for meningitis?

A

Immunodeficiency

  • HIV, young age, asplenia secondary to sickle cell

Environmental

  • Crowding, poverty, foreign travel, unvaccinated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the symptoms of meningitis?

A

Neonates = decreased activity, irritability, lethargy, seizures, fever or hypothermia, poor feeding

Children = headache, photophobia, neck stiffness, fever, non-blanching rash, lethargy, drowsiness, leg pain, N/V, alteration in consciousness, seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the signs O/E of menigitis?

A
  • Bulging fontanelle
  • Opisthotonos (hyperextension of neck and back)
  • Kernig’s sign (pain on leg straightening)
  • Brudzinski’s sign (supine neck flexion causes knee/hip flexion)
  • Non-blanching rash (characteristic of meningococcal infection)
  • HR starts high (compensate brain ischaemia), HR then drops (baroreceptors on heart sense high BP)
  • Raised ICP (late sign)
  • CUSHINGS TRIAD > high BP, low HR, irregular RR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the investigations for meningitis?

A

Blood cultures x2

Bloods (FBC, CRP, U&E, coagulation profile)

VBG (glucose, lactate)

Urine (dip, MC&S, culture)

LP = high polymorphs, high protein, low glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the contraindications for LP?

A

Signs of raised ICP (coma, high BP, low HR), thrombocytopenia, meningococcal septicaemia, cardiorespiratory instability, focal neurological signs, coagulopathy, local infection at LP site, causes undue delay in starting abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the management of meningitis?

A

EMERGENCY, ABCDE approach

  1. High flow O2 and fluid resus
  2. IV abx
    <3m = cefotaxime + amoxicillin
    >3m = cefotaxime / ceftriaxone
  3. Dexamethasone (considered if LP shows purulent CSF, WBC>1000, raised WCC with protein>1, or bacteria on gram stain)
  4. Prophylaxis of close contacts with ciprofloxacin within 24hrs
  5. Notify PHE
  6. Respiratory isolation for 48hrs after starting abx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the follow-up for meningitis?

A

RV 4-6wks after discharge and discuss potential long-term complications

  • Hearing loss (offer formal audiological assessment)
  • Neurological/developmental problems
  • Renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe viral meningitis

A
  • Most commonly = Coxsackie group B, echovirus
  • Discharge home (after excluding bacterial causes) with supportive therapy e.g. fluids
  • Safety net
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of encephalitis?

A
  • HSV
  • VZV
  • EBV
  • CMV
  • Enterovirus
  • Resp viruses (influenza)
  • Measles, mumps, rubella
19
Q

What are the symptoms of encephalitis?

A

Same as meningitis

+++ Fever, altered consciousness, seizures

May not be able to differentiate clinically so begin tx for both (differentiate potentially by behavioural change)

20
Q

What are the signs O/E of encephalitis?

A

Reduced GCS
Kernig sign
Cranial nerve and motor abnormalities
Ataxia (varicella-associated encephalitis)

21
Q

What are the investigations for encephalitis?

A

Same as meningitis

+ MRI = hyperintense lesions, oedema, BBB breakdown

+ PCR = for viruses e.g. HSV

22
Q

What is the management of encephalitis?

A

Medical emergency, ABCDE approach

  • High-dose IV acyclovir (within 6hrs of admission, for 3w)
  • Supportive care = fluids, ventilation etc.

CMV > add ganciclovir and Foscarnet
VZV > acyclovir/ganciclovir

23
Q

What is anaphylaxis?

A

Type 1 hypersensitivity reaction (antigen cross-linking with IgE membrane bound antibody of mast cell or basophil)

24
Q

What are the risk factors for anaphylaxis?

A

Parental atopy
Atopic eczema
Asthma
Allergic rhinitis

25
Q

What are the S/S of anaphylaxis?

A

Airways = swelling, hoarseness, stridor

Breathing = high RR, wheeze, cyanosis, SpO2 <92%, SOB

Circulation = pale, clammy, low BP, drowsy, coma, tachycardia

Skin = urticaria/angioedema (usually lips, tongue and throat)

26
Q

What is the management for anaphylaxis?

A

EMERGENCY, ABCDE APPROACH, 2222 for PERI-ARREST CRASH CALL

A – check for obstruction / speaking in full sentences / stridor

1. IM adrenaline 1:1000
(in anterolateral aspect of middle third of thigh)
<6m = 100-150mg
6m-6y = 150mg
6-12y = 300mg
>12y = 500mg

2. +/-intubate if necessary

B – check breathing, listen to chest, check sats, RR

3. BLS if unresponsive/not breathing normally
4. High flow oxygen via 15L non-rebreathe mask

C – check pulse, BP, cap refill for circulatory collapse

5. Insert large bore cannula (yellow for children) and give IV fluids

D – check GCS

E – check skin and inside mouth for urticaria and angio-oedema / abdomen SNT?

Position > sitting up if breathing difficulty, lying flat +/- leg elevation if low BP/feeling faint, recovery position if breathing but unconscious

Reassess response after 5 mins (ABCDE)
> repeat adrenaline if needed (5 min intervals)

Also:
IV chlorpheniramine (10mg)
Salbutamol (if wheeze)
IV hydrocortisone (200mg)

27
Q

What is refractory anaphylaxis?

A

Resp and/or cardio problems persist despite 2 doses of IM adrenaline

IV fluids given for shock

Expert help for consideration of an IV adrenaline infusion

28
Q

What is the discharge approach for anaphylaxis?

A

2h after sx resolution if:

  • Good response to single dose of adrenaline
  • Complete resolution of sx

6h after sx resolution if:

  • 2 doses of adrenaline needed or,
  • Previous biphasic reaction

12h after sx resolution if:

  • Severe reaction requiring > 2 doses
  • Pt has severe asthma
  • Possibility of ongoing reaction
  • Pt presents late at night
  • Pt in area where access to emergency access care difficult

EVERYONE

  • Given autoinjector / trained how to use it
  • Adequate supervision following discharge
29
Q

What is Cushing’s Triad?

A

High BP, low HR, irregular RR

30
Q

What are the types of encephalitis?

A

Primary = direct invasion by neurotoxic virus / reactivation of dormant virus

Secondary = faulty immune system reaction to virus elsewhere in body

31
Q

When are routine maintenance fluids required?

A

If the current oral intake is not sufficient to remain hydrated

  • E.g. if patient is NBM
32
Q

How are maintenance fluids calculated for children >28d?

A
  • 100 ml/kg/day for the first 10kg of weight
  • 50 ml/kg/day for the next 10kg of weight
  • 20 ml/kg/day for weight over 20kg
33
Q

How are maintenance fluids calculated for neonates <28d?

A
  • Birth to day 1: 50-60 ml/kg/day
  • Day 2: 70-80 mL/kg/day
  • Day 3: 80-100 mL/kg/day
  • Day 4: 100-120 mL/kg/day
  • Days 5-28: 120-150 mL/kg/day
34
Q

How do you calculate the infusion rate per hour?

A

Total fluid required / 24

35
Q

What is the usual choice of maintenance fluids?

A

Child (>28d):

  • First line = isotonic crystalloids + 5% glucose (e.g. 0.9% sodium chloride + 5% glucose).

Term neonate (<28d):
Choice depends on the clinical situation:

  • No critical illness = 10% dextrose +/- additives
  • Critical illness (e.g. infantile respiratory distress syndrome, meconium aspiration) = seek expert advice (use fluids with no/minimal sodium initially)
36
Q

When is fluid replacement therapy required?

A

If there is an existing fluid deficit and the oral route is not possible or impractical

  • Prolonged poor oral intake
  • Vomiting / diarrhoea
  • Increased insensible losses (e.g. fever, excessive sweating)
  • DKA
  • Burn injuries
37
Q

How is the percentage dehydration calculated?

A

If weights available:

  • Well weight (kg) - Current weight (kg) / Well weight (kg)

If NO weights available:

  • S/S of dehydration but no red flag features = approximately 5% dehydrated
  • Any red flag features of dehydration present, or child is clinically shocked = assume 10% dehydration
38
Q

How is fluid deficit calculated?

A

Fluid deficit (mL) = % dehydration x weight (kg) x 10

39
Q

How is total fluid requirement calculated?

A

Total fluid requirement (mL) = maintenance fluids (mL) + fluid deficit (mL)

40
Q

When is fluid resuscitation required?

A

If the patient is shocked

Types of shock and their underlying causes include:

  • Hypovolaemic: gastroenteritis, burns, DKA, heatstroke, haemorrhage
  • Distributive: sepsis, anaphylaxis, neurological injury (neurogenic)
  • Cardiogenic: congenital heart disease, arrhythmia
  • Obstructive: cardiac tamponade, tension pneumothorax, congenital heart disease
41
Q

How are resuscitation fluids administered?

A
  • Standard fluid = 0.9% sodium chloride IV or IO (if IV not possible) in a standard bolus of 10-20mL/kg over <10 minutes
  • Smaller boluses may be required in: neonatal period, DKA, septic shock, trauma, cardiac pathology (e.g. heart failure)
  • After bolus administered, volume status should be re-assessed (HR, RR, CRT). If patient still shocked = urgent senior advice
  • After 3 boluses - danger of pulmonary oedema
42
Q

What clinical features suggest dehydration?

A
  • Appears unwell/deteriorating
  • Altered responsiveness (irritable, lethargic)
  • Sunken eyes
  • Tachycardia / tachypnoea
  • Reduced skin turgor
  • Dry mucous membranes (not reliable if the child is mouth breathing or just after a drink)
  • Decreased urine output
43
Q

What features suggest clinical shock?

A

Clinical shock is defined by the presence of one or more of:

  • Decreased level of consciousness
  • Pale or mottled skin
  • Cold extremities
  • Pronounced tachycardia
  • Pronounced tachypnoea
  • Weak peripheral pulses
  • Prolonged capillary refill time
  • Hypotension

Children have a large physiological reserve. They will compensate until they become very unwell and then deteriorate rapidly.

Hypotension is a sign of decompensated shock and indicates that the child is critically unwell

44
Q

What features are suggestive of hypernatraemic dehydration?

A
  • Jittery movements
  • Increased muscle tone
  • Hyperreflexia
  • Convulsions
  • Drowsiness or coma

Paeds (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions