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Laura Paediatrics > Emergencies > Flashcards

Emergencies Flashcards

1
Q

What is anaphylaxis?

A

Anaphylaxis is a severe, life-threatening generalised or systemic hypersensitivity reaction

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2
Q

What is the most common cause of anaphylaxis in children?
What is the pathophysiology behind this?
What age group does it most commonly occur in?
In what age group is it most fatal?

A

Food allergies cause 85% of anaphylaxis reactions

Pathophysiology - Type 1 IgE mediated reactions. Release of histamine and other agents causes capillary leak, wheeze, cyanosis, oedema and urticaria.

Most anaphylaxis reactions occur in children <5 however the more fatal anaphylaxis occurs in adolescents with an allergy to nuts

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3
Q

What are some of the signs and symptoms that may present in a patient with an acute anaphylaxis reaction?

A

A - Airway - swelling, hoarseness, stridor
B - Tachypnoea, wheeze, cyanoisis, sats <92%
C - pale, clammy, hypotension, drowsy, coma
Skin - urticaria/angioedema usually but not always present

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4
Q

What is the treatment of anaphylaxis?
Where is it administered?
What is the dose?

A

IM adrenaline

Administered anterolateral aspect of the middle 1/3 of the thigh

Dose is dependent on the age of the child.
For all adrenaline administration the dose is 1 in 1,000.

<6 months: 150 micrograms (0.15ml)
6M-6Y: 150 micrograms (0.15ml)
6-12Y: 300 micrograms (0.3ml)
>12 years: 500 micrograms (0.5ml)

all 1 in 1000 adrenaline

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5
Q

What is meningitis?

A

-

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6
Q

What test confirms meningitis?

A

-

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7
Q

What types of organisms can cause meningitis?

Which causative organism is the most serious?

A

-

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8
Q

What are the mortality and morbidity figures for meningitis?

A

-

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9
Q

What is the pathophysiology behind the symptoms of meningitis?

A

-

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10
Q

What signs may be suggestive of neck stiffness?

A

-

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11
Q

What things may make up the history of a child with meningitis?

A

-

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12
Q

What things may you see on examination of a child with meningitis?

A

-

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13
Q

What investigations may you consider carrying out if you suspect meningitis?

A

-

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14
Q

What are some contraindications for performing a lumbar puncture in a child who is suspected to have meningitis?

A

–
Focal neurological signs
Papilloedema
Significant bulging of the fontanelle
Disseminated intravascular coagulation
Signs of cerebral herniation
For patients with meningococcal septicaemia a lumbar puncture is contraindicated

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15
Q

If a lumbar puncture is unable to be performed how may the diagnosis of meningitis be obtained?

A

–
Blood cultures and PCR

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16
Q

What is the preferred antibiotic of choice in the treatment of meningitis?

A

-

17
Q

What are 6 cerebral complications of meningitis?

A

-

18
Q

What prophylactic treatment may be given to household contacts of those with meningitis?

A

-

19
Q

What is the difference between meningitis and encephalitis?

A

-

20
Q

What can encephalitis be caused by?

A

-

21
Q

What symptoms do children with encephalitis usually present with?

A

-

22
Q

What signs may be seen on CT/MRI or a child with encephalitis? When may the changes be seen?

A

-

23
Q

What is the treatment for encephalitis thought to be due to herpes simplex virus?

A

-

24
Q

What approach should be taken in terms of basic life support in the management of children?

A 
Check for danger 
Check airway - if not breathing normally:
5 rescue breaths
Check for signs of life
15 chest compressions
2 rescue breaths: 15 chest compressions
25
Q

In terms of performing chest compressions of a child what should you do in different age groups?

A

<1 year old: 2 fingers - compress chest 1/3 of the chest

>1 year old: 1-2 hands dependent on the size of the child. 1/3 depth

26
Q

How should rescue breaths be delivered in children <1 year old?
State the head position and how the breathes should be delivered.

A

If <1 year old ensure the head is in a neutral position - carry out chin lift and open the mouth slightly. Your mouth should cover the mouth and nasal apertures of the infant.
Blow steadily into the infant’s mouth and nose over 1 second sufficient to make the chest rise visibly.

27
Q

How should rescue breaths be delivered in children >1 year old?
State the head position and how the breathes should be delivered.

A

Ensure head tilt and chin lift.
Pinch the soft part of the nose.
Open the mouth a little but maintain the chin lift.
Take a breath and place your lips around his mouth, making sure that you have a good seal.
Blow steadily into his mouth over 1 second sufficient to make the chest rise visibly.

28
Q

In BLS For both infants and children, if you have difficulty achieving an effective breath what should you consider?

A

The airway may be obstructed:

  • Open the child’s mouth and remove any visible obstruction (blind finger sweep should not be performed)
  • Ensure there is adequate head tilt and chin lift but also that the neck is not over extended.
  • If head tilt and chin lift has not opened the airway, try the jaw thrust method.
  • Make up to 5 attempts to achieve effective breaths. If still unsuccessful, move on to chest compression.
29
Q

What are the main risk factors for sudden infant death syndrome?

A 
Prone sleeping
Parental smoking
Bed sharing 
Hyperthermia (e.g overwrapping)
Head covering (blanket accidentally moves)
Prematurity
30
Q

At what age is sudden infant death syndrome most common?

A

2-4 months of age

31
Q

What are protective factors against sudden infant death syndrome in children?

A

Breastfeeding
ROOM sharing (until at least 6 months of age)
Use of dummies

32
Q

If it is difficult to establish whether a patient has had a true episode of anaphylaxis what blood test may you carry out?

A

Serum tryptase levels

33
Q

After administration of adrenaline how is anaphylaxis treated?
What are the doses in ADULTS?

A

IV access should be secure then chlorphenamine and hydrocortisone are administered IV. Doses are dependent on age in children.

In adults the doses given are chlorphenamine 10mg and hydrocortisone 200mg

IVI infusion of saline

34
Q

How regularly can IM adrenaline be administered in anaphylaxis?

A

Every 5 minutes if needed - as guided by BP, pulse and respiratory function, until better.

Laura Paediatrics (20 decks)

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