Emergencies

Question 1

Definition of anaphylaxis

Answer 1

Severe life threatening hypersensitivity reaction characterised by:
Rapid onset
Airway, breathing or circulatory compromise

Question 2

Skin symptoms of anaphylaxis

Answer 2

Itching
Urticaria
Angioedema
Flushing

Question 3

Resp symptoms of anaphylaxis

Answer 3

Wheeze
Stridor
SOB
Cough
Tachypnoea

Question 4

GI symptoms of anaphylaxis

Answer 4

N+V
Diarrhoea
Abdo pain

Question 5

CVS symptoms of anaphylaxis

Answer 5

Hypotension
Shock 
Dizziness 
Tachycardia 
Prolonged cap refill

Question 6

CNS symptoms of anaphylaxis

Answer 6

Headache
Irritability
Low GCS

Question 7

Chemical mediators of anaphylaxis

Answer 7

Histamine
Tryptase
Prostaglandin
Interleukin
Leukotriene

Question 8

Acute management of anaphylaxis

Answer 8

A-E assessment
IM adrenaline
Remove trigger
Lie supine if CV compromise, sit up if only respiratory compromise present 
Oxygen
Fluids 
Antihistamines
Steroids

Question 9

Red flags for appearance

Answer 9

Mottled/ashen/cyanosis/non blanching rash

Question 10

Red flags for RR in different age groups

Answer 10

RR equal to or greater than...
<1: 60
1-2: 50
3-4: 40
5: 29
6-7: 27
7+: 25

Question 11

Breathing red flags (not RR)

Answer 11

<5 years: apnoea, grunting, O2 sats <90%

5-11: O2 sats <90%

12+: new need for oxygen to maintain >92%

Question 12

Red flags for HR in different age groups

Answer 12

HR <60
Or HR equal to or greater than...
<1: 160
1-2: 150
3-4: 140
5: 130
6-7: 120
7-11: 115
12+: 130

Question 13

Circulation red flags (not HR)

Answer 13

12+:
Systolic BP equal to or less than 90
Diastolic BP drop by 40 or more 
Passing <0.5ml/kg/hour urine 
Passing no urine for 18 hours

Question 14

Demeanour red flags

Answer 14

<5 years: no response to social cues, doesn’t wake, or roused doesn’t stay awake, weak cry or continuous cry

5-11: evidence of altered behaviour/mental state, doesn’t wake, if roused doesn’t stay awake

12+: evidence of altered behaviour/mental state

Question 15

Exposure red flags

Answer 15

Temperature <36 degrees

If <3 months old, temperature >38 degrees

Question 16

Sepsis 6 bundle for <5 years

Answer 16

Oxygen aiming for >94%
Blood culture
Blood gas - lactate, glucose
Bloods - FBC, CRP, coag screen, U+Es
LP unless contraindicated 
Give IV/IO abx 
Consider fluid challenge 
Review by ST4 or above 
Consider ionotropic support if parameters not normal after x2 challenges

Question 17

Sepsis 6 bundle for 5+ years

Answer 17

Oxygen aiming for >94%
Blood culture
Blood gas - lactate, glucose
Bloods - FBC, CRP, coag screen, U+Es 
Give IV/IO abx 
Consider fluid challenge 
Review by ST4 or above 
Consider ionotropic support if parameters not normal after x2 challenges

Question 18

What is a paediatric fluid challenge

Answer 18

20ml/kg of 0.9% normal saline over 5-10 minutes

Maximum of 500ml