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Paediatrics > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Vital signs Infants

A

RR 30-40
HR 110-160
BP 80-90

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2
Q

Vital signs Young Children

A

RR25-35
HR 95-150
BP 85-100

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3
Q

Vital signs Older Children

A

RR 20-25
HR 80-120
BP 90-110

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4
Q

Causes of shock

A

Hypovolaemia .e.g. sepsis, dehydration, DKA, blood loss
Maldisription.e.g. sepsis, anaphylaxis
Cardiogenis .e.g. arrythmia, heart failure
Neurogenic .e.g. spinal cord injury

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5
Q

Causes of Respiratory distress: Upper airway (stridor)

A 
Croup
Epiglottits
Foreign Body
Congenita Malformation
Trauma
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6
Q

Causes of Respiratory distress: Lower airway (wheeze)

A

Asthma
Bronchiolitis
Pneumonia
Pneumothorax

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7
Q

Causes of unsconsciousness

A 
Post-ictal
Status epilepticus
Infection .e.g. meningitis
Metabolic .e.g. DKA< hypoglycaemia, electolyte disturbance, inborn error of metabolism
Head Injury .e.g. trauma, NAI
Drug/Poison Ingestion
Intracranial Haemorrhage
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8
Q

Surgical emergency

A

Acute abdomen .e.g. appendicitis, peritonitis

Intestinal obstruction .e.g. intussusception, malrotation, bowel atresia/stenosis

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9
Q

Indicators of respiratory distress (Moderate)

A 
Tachycardia
RR >50
Nasal flaring
Use of Accessory muscles
Inter/subcostal recession
Head retraction
Unable to feed
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10
Q

Indicators of respiratory distress (Severe)

A 
Cyanosis
Tiring
Reduced GCS
Saturation <92% despite oxygen
Rising pCO2
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11
Q

Indications for intubation

A 
Severe respiratory distress
Tiring due to work of breathing
Progressive hypoxaemia
Reduced consciousness level
Progressive muscle weakness
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12
Q

Supportive therapy in respiratory failure

A

Oxygen SpO2 <92% (Max conc 0.60)
Noninvasive ventilation (CPAP and BPAP)
Invasive ventilatory support

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13
Q

Airway positioning

A

Infants: neutral position, avoid overextension
Children: sniffing position + jaw thrust

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14
Q

Chest compression positioning

A

Infant: 2 thumbs on lower sternum, hands round thorax
Small child: heel of hand, lower half of sternum
Large child: hands lower half of sternum

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15
Q

Endotracheal tube sizing

A

Internal diameter(mm) = (age/4) + 4
Length oral tube (cm) = (age/2) + 12
Length nasal tube (cm) = (age/2) + 15

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16
Q

Placement of intraosseous access

A

18 gauge trochlar with needle
Anterior surface
2-3cm below tibial tuberosity

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17
Q

Reversible causes of cardiac arrest

A 
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia
Tension pneumothorax
Thrombosis
Cardiac tamponade
Toxic/therapeutic disturbance
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18
Q

Factors in childhood dehydration

A

Unable to take oral fluids
Additional losses .e.g. diarrhoea, fever, tachypnoea
Loss of retaining mechanism .e.g. burns, urinary

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19
Q

Presentation shock (Early)

A 
Tachypneoa
Tachycardia
Decreased skin turgor
Sunken eyes and fontanelle
Delayed cap refil >2s
Mottled, pale and cold skin
Cold-peripheral temp gap >4'c
Decreased urinary output
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20
Q

Presentation Shock (Late)

A 
Acidotic (Kussmal breathing)
Bradycardia
Confusion
Depressed cerebral state
Blue peripheries
Absent urine output
Hypotension
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21
Q

Initial fluid resuscitation

A

0.9% saline 20ml/Kg

Repeat twice if no response

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22
Q

Maintenance Fluid Requirments

A

First 10Kg 100ml/kg/24h
Second 10Kg 50ml/Kg/24h
Subsequent Kg 20ml/Kg/24h

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23
Q

Clinical features Sepsis

A 
Fever
Poor feeding
Miserable, irritabilit, lethargic
History of focal infection
Tachycardia
Tachypnoea
Low BP
Pupuric rash
Shock
Multi-organ failure
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24
Q

Common Organisms Spesis

A

Coagulase negative Staph
Gram negative N.meningitidis/E.coli
HiB, meningococcus and pneumococcus non-immunised
Neonates: Group B strep and E.coli

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25
Q

Mx Sepsis

A 
Antibiotics
Fluids
Circulatory support: ionotropic
FFP , cryoprecipitate and platelet transfusion in DIC
Transfer to ICU
26
Q

Mx anaphylaxis

A 
ABCDE
IM Adrenaline
High flow Oxygen
IV fluids
Chlorpheniramine
Hydrocortisone
Salbutamol
27
Q

IM Adrenaline Doses (1:1000)

A

> 12y 500mcg
6-12y 300mcg
<6y 150mcg

28
Q

IV Chlorphenamine Dose

A

> 12y 10mg
6-12y 5mg
6m-6y 2.5mg
<6m 250mcg/Kg

29
Q

IV Hydrocortisone Dose

A

> 12y 200mg
6-12y 100mg
6m-6y 50mg
<6m 25mg

30
Q

Mx Status Epilepticus

A

ABCDE
High flow O2
Blood Glucose
5m Lorazepam
15m Lorazepam
25m Anaesthetic help, rectal paraldehyde, phenytoin over 20m/phenobarbitone over 5m
45m rapid sequence induction anaesthesia with thiopental

31
Q

Neuroprtective strategies to prevent 2’ brain injury

A 
Midline head positioning
Tilt head 20-30'
Fluid restriction with isotonic fluids
Intubation and ventilation GCS<9
Maintain normocapnia (4.5-5.3kPa)
Osmotic diuretics .e.g. mannitol
Maintain high/normal BP
Maintain normothermia
Avoid hypotension/hypoxaemia
32
Q

GCS Older children/Teens Eyes

A

4 opens spontaneously
3 sound
2 pressure
1 none

33
Q

GCS Older children/Teens Verbal

A 
5 Orientated
4 Confused
3 Words
2 Sounds
1 None
34
Q

GCS Older children/Teens Motor

A 
6 Obeys commands
5 Localising
4 Normal flexion
3 Abnormal flexion
2 Extension 
1 None
35
Q

GCS Children <4 Eyes

A

4 opens spontaneously
3 sound
2 pressure
1 none

36
Q

GCS Children <4 Verbal

A 
5 Talks normall/interacts
4 Words
3 Vocal sounds
2 Cries
1 None
37
Q

GCS Children <4 Motor

A

6 Obeys commands
5 Localising
4 Normal flexion
3 Abnormal flexion (decorticate posturing)
2 Abnormal Extension (decerebrate posturing)
1 None

38
Q

Pupillary signs in coma

A

Pinpoint fixed: opiates, barbituates, pontine lesion
Fixed, dilated: severe hypoxia, during/post-siezure, anticholinergics, hypothermia
Unilateral dilated: expanded ipsilateral lesion, tentorial herniation, 3rd nerve lesion, seizures

39
Q

Features of apparent life threatening event

A 
Cyanosis or pallor
Absent, decreased or irregular breathing
Change in tone
No concerning features or detailed history
Normal examination
40
Q

Mx Apparent life threatening event

A 
Period of observation
ECG 
Perinasal swab for pertussis
Brief monitoring with continuous pulse oximetry
Reassurance of parents
Parental training in BLS
41
Q

Likely underlying disorder of apparent life threatening event

A 
Age <60d
Gestation at birth <32w
Duration >1m
Repeat event
CPR given by trained medical professional
Concerning feature of history
Abnormality on examination
42
Q

Risk factors for SIDS

A 
Age 1-6m (Peak 2-4m)
Low birth weight and preterm
Male
Illness in last 24h
Lying prone (Main risk factor)
Co-sleeping
Overheating
Infant pillow use
Infant swaddling
Low family income
No maternal education
Poor/overcrowded housing
Maternal age <21y
High maternal parity
Maternal smoking in pregnancy/post-natally
Maternal alcohol or drug use
43
Q

Prevention of SIDs

A

Sleeping on back
Avoiding heavy wrapping and high room temp
Head uncovered
Blanket height max to shoulders
Feet to foot of cot
No smoking
Urgent medical advice for unwell infant
Baby in bedroom for first 6m
Avoiding baby in bed esp. with alcohol or drugs
Breastfeeding
Avoid sleeping with infant on sofa/armchair

44
Q

dDx Encephalopathy

A 
Infection
Status epilepticus
Trauma
Intracranial tumour/haemorrhage/infarct/abscess
Diaetes mellitus
Hypoglycaemia
Inborn error of metabolism
Hepatic Failure
Acute renal failure
Poisoning
Shock
Hypertension
Respiratory failure
45
Q

Ix Meningitis

A

FBC
Culture: blood, urine, infective sites, CSF
Acute phase reactants
Rapid bacterial antigen/PCR

46
Q

Features meningitis

A 
Fever
Irritability, lethargy, drowsiness
Poor feeding/vomiting
Rash
Seizures
Neck stiffness and pain
Bulging fontanelle
Overseas travel
47
Q

Features status epilepticus

A 
Hx of seizures
Neurocutanrous lesions on the skin
Developmental delay
Ongoing seizure activity
Focal neurology
48
Q

Ix Status epileptics

A 
Blood Glucose
Electrolys: Na+, K+, Ca+, Mg+
Drug levels (esp. anticonvulsants)
EEG
CT scan
49
Q

Ix Trauma

A

Radiology

Consider NAI work up

50
Q

Features Trauma

A 
Hx accident
Bruising/haemorrhage
Fractures .e.g. cervical spine
Focal neurology
Retinal haemorrhages
51
Q

Ix Intracranial lesion

A

Cranial CT/MRI

Coagulation screen

52
Q

Ix Diabetes Mellitus/Hypoglycaemia

A

Blood Glucose
Plasma electrolytes
Urine glucose and ketones
Blood gas

53
Q

Ix Inborn error of metabolism

A 
Blood Glucose
Blood gas
Blood amonia, lactate
Urine amino and organic acids
Plasma amino acids
54
Q

Features metabolism encephalitis

A 
Hx loss of consciousness
Sudden collapse
Consanguinity
Death/illness siblings
Developmental delay
Hepatomegaly
55
Q

Ix Hepatic falilure

A

Abnormal LFTs

Prolonged prothrombin

56
Q

Ix Acute Renal Failure

A

Abnormal creatinine

57
Q

Ix Posioning

A

Toxicology screen

Plasma level paracetamol and salicylates

58
Q

Ix Shock

A 
FBC
Cultures
Urea
Electrolytes
Blood gas
59
Q

Ix Hypertension

A

Left ventricular hypertrophy on ECG or echo
Creatinine and electrolytes
Fundoscopy

60
Q

Ix Respiratory Failure

A

Chest Xray

Arterial blood gas- hypoxia, hypercarbia

Paediatrics (22 decks)

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