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4.4. Child Health > Emergencies > Flashcards

Emergencies Flashcards

1
Q

How should near drowning be Mx?

A
  • Pt in prone position when out of water
  • Give 100% oxygen
  • Suspect hypothermia
  • CPR against hard surface
  • Maintain c-spine immobilisation
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2
Q

What are the causal theories of sudden infant death syndrome?

A

Most common at 2-3m

Obstructive apnoea:

  • inhalation of milk
  • airway oedema
  • passive smoking

Central apnoea:

  • faulty CO2 drive
  • prematurity
  • brainstem gliosis

Others:

  • long QT interval
  • staph infection
  • overheating
  • increased vagal tone or Magnesium increase
  • immature diaphragm
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3
Q

What are burns and scalds, how do they present and what is a DDx?

A

Burn = damage to the skin or other body parts caused by extreme heat, flame, contact with heated objects, or chemicals

Scald = burn with hot liquid or steam

S+S =

  • superficial 1st = red without blisters
  • partial thickness 2nd = red, yellow/white, blister
  • full thickness 3rd = stiff, white/brown, no blanching
  • 4th = black, charred

DDx = accidental injury, child abuse

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4
Q

Outline the aetiology of meningitis

A

0-3m = group B strep, e.coli, listeria

3m-6y = strep pneumonia, Neisseria meningitidis, H.influenza

6-60y = strep pneumonia, Neisseria meningitidis

> 60y = strep pneumonia, Neisseria meningitidis, listeria

Viral (2/3) = enterococcus, EBV, adenovirus, mumps

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5
Q

What are the signs and symptoms of meningitis?

A

Early:

  • Headache
  • Leg pains
  • Cold hands/feet
  • Abnormal skin colour
  • Fever

Later:

  • Meningism = stiff neck, photophobia
  • Kernigs sign (pain + resistance on passive knee extension with hip fully flexed)
  • Brudzinski’s sign = +ve when passive forward flexion of the neck causes involuntarily raising of knees or hips in flexion
  • Decreased conscious level, coma
  • Seizures
  • Petechial rash - non-blanching
  • Sepsis = slow cap refill, decreased BP, increased temp, increased pulse
  • Bulging fontanelle
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6
Q

How would you investigate meningitis?

A

Bloods = FBC, U+Es, LTF, glucose, coag (on LP don’t want the pt to bleed), BM

Blood cultures, throat swabs, rectal swabs

LP (do not perform in RICP) = CSF for microscopy, biochem, culture, PCR

CT head

CXR

VBG

Ophthalmoscopy

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7
Q

How would you manage meningitis?

A

A-E assessment

Dexamethasone 4-10mg/6h IV = reduced RICP/inflam

Start Abx

  • <3m = IV cefotaxime + oral amoxicillin
  • 3m-50y = IV cefotaxime
  • > 50y = IV cefotaxime + oral amoxicillin

Viral = 3w acyclovir

IV fluids

Isolate for 1st 24h

Careful monitoring

Household/close contacts = rifampicin or oral ciprofloxacin

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8
Q

What are the complications of meningitis?

A

Encephalitis

Residual paralysis/focal neurology

Hearing loss

Cerebral abscess

Sepsis - DIC

Death

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9
Q

Outline the immune mechanism of an allergic reaction

A

Allergen 1st exposure - TH2 response

Allergen 2nd response = IgE cross-linking BY ALLERGEN

= mast cell degranulation

= increased vascular permeability, vasodilation, bronchial constriction

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10
Q

Describe the manifestations of anaphylaxis

A

Systemic activation of mast cells =

CVS = hypotension, tachy, syncope

Skin = angioedema, urticaria

Resp = cough, wheeze, dyspnoea, bronchospasm, hypoxia, stridor

Digestive = N+V, abdo pain, diarrhoea

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11
Q

How is anaphylaxis managed?

A

A-E

Epipen = adrenaline = vasoconstriction

Remove the trigger if possible.

Oxygen, IV fluid 20 mL/kg

Following initial resuscitation:

  • Give slow IM/IV chlorphenamine
  • Give slow IM/IV hydrocortisone (especially in people with asthma)
  • Consider neb salbutamol/ipratropium if the person is wheezy
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12
Q

What is status epilepticus, its causes and presentation?

A

Seizures lasting more than 5 minutes or more than 3 seizures in one hour

S+S = tonic-clonic, tonic, clonic or myoclonic seizures, LOC

Causes =
- Intake of substance accidental/intentional, meds
- Infection = bacterial meningitis, encephalitis (travel - malaria)
- Hypoglycaemia = DM (insulin over use, illness), new-borns, metabolic disorders
- Febrile convulsion (common 6m-6y, generalised tonic-clonic short, swift recovery, complex/atypical) - usually triggered by the initial rise in temp
SOL = AV malformation, bleed, hypotensive encephalopathy, tumour
- Electrolyte abnormalities = hypoCa, hyperNa, hypoNa, hypoMg, hypoGly (SAIDH, fluid loss, Ca metabolism)
- Epilepsy = not associated with fever, but at higher risk of seizure when ill
- Vascular = stroke (MRI, MR angiogram)
- Cerebral hypoxia = significant resp/cardio failure
- Hepatic encephalopathy, renal encephalopathy, metabolic encephalopathy (mitochondrial)
- Congenital brain abnormalities
- Jaundice - kernicterus

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13
Q

What is paediatric trauma/injury, how does it present and what is its DDx?

A

Traumatic injury that happens to an infant, child or adolescent

S+S = bleeding, wound, LOC, N+V, impaired movement, balance, and/or coordination, dizziness, fatigue, headache

DDx =

  • Non-accidental injury (NAI) (infants)
  • Falls (toddlers)
  • RTAs and sports injuries (older, adolescents)

Mx = primary survey, initial resuscitation, secondary survey, emergency treatment, definitive care

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14
Q

What are the types of poisoning in children?

A

1 = accidental ingestion of poisonous substance

2 = deliberate ingestion (overdose) of a mentally destressed child needing help

3 = deliberate poisoning of children (type of child abuse), safeguarding

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15
Q

What are the S+S of overdose/poisoning?

A
  • feeling and being sick
  • diarrhoea
  • stomach pain
  • drowsiness, dizziness or weakness
  • high temperature of 38C (100.4F) or above
  • chills (shivering)
  • loss of appetite
  • headache
  • irritability
  • difficulty swallowing (dysphagia)
  • breathing difficulties
  • producing more saliva than normal
  • skin rash
  • blue lips and skin (cyanosis)
  • burns around the nose or mouth
  • double vision or blurred vision
  • mental confusion
  • seizures (fits)
  • loss of consciousness
  • coma, in severe cases
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16
Q

How should overdose/poisoning be assessed?

A

Hx - what, where, when, how much/estimate

Exam

A-E - ?time critical (LOC, hypotension, arrhythmias, hypothermia/hyperthermia)

Blood paracetamol levels

17
Q

Outline the Mx of overdose/poisoning

A

Remove the source of chemical

Alcohol = oral glucose for hypoglycaemia

TCA = ECG monitoring, charcoal, sodium bicarb, benzo for fits

Iron = charcoal contraindicated, bowel irrigation, chelation

Paracetamol = IV/IM naloxone to reduce respiratory depression

18
Q

What is paediatric pyrexia, its causes and how does it present?

A

An infant or child is considered to have a fever if their temperature is 38°C or higher

Causes = bacterial, viral infection, Kawasaki disease, malignancy

S+S = >38, seizures, sweating, chills and shivering, headache, muscle aches, loss of appetite, irritability, dehydration, general weakness.

19
Q

How should paediatric pyrexia be Ix?

A

Hx = addition Sx, perinatal complications, immunisations, recent antipyretic/Abx, prematurity,

Assess using traffic light system = colour, activity, respiratory, hydration, red flags

Electronic/infrared thermometers

20
Q

Outline the management for paediatric pyrexia

A

Oral fluids

Paracetamol

Ibuprofen

Abx

The majority of fever is caused by self-limiting viral infection

21
Q

What is sepsis, its causes and presentation?

A

Sepsis is a dysregulated response to infection which may result in organ damage and death

Causes = N. meningitides (meningococcus), strep pneumoniae (pneumococcus), staph aureus, group A and B streptococcus, E. coli

S+S = fever, lethargy, N+V, headache, abdo pain

22
Q

How should suspected sepsis be Ix?

A

Exam =

  • shock (hypotension, tachycardia, tachypnoea, cool peripheries, confusion)
  • non-blanching rash
  • fever
  • signs of = meningitis/encephalitis, pneumonia, UTI, abdo pain/distention

Ix =

  • FBC, CRP, lactate, glucose, U+Es, blood culture and urine testing
  • stool culture is diarrhoea
  • urine output
  • LP (before Abx if time)

Use traffic light system in febrile children

23
Q

What is a DDx for sepsis?

A

Leukaemia
Aplastic anaemia
Malignancy = lymphoma
Autoimmune = juvenile idiopathic arthritis
Kawasaki disease (children with prolonged fever)

24
Q

How should sepsis be Mx?

A

Sepsis 6

  • Give high flow oxygen
  • IV/IO access = b/c, glucose, lactate, FBC, U+Es
  • IV/IO antibiotics = cefotaxime
  • IV/IO fluid = if hypoBP/lactate <2, 20ml/kg (10ml/kg neonates)
  • Monitor UO (with catheterisation if necessary)
  • Consider inotropic support = dopamine, epinephrine

Ensure senior doctor attends

25
Q

What are the causes of paediatric shock and how does it present?

A

Causes:

  • Hypovolemic = blood loss, D+V, burns, DI
  • Cardiogenic = arrhythmia, cardiomyopathies, congenital heart disease
  • Distributive = anaphylaxis, neurologic injury (head injury, spinal shock), sepsis(meningococcal), drug-related
  • Obstructive = acute cardiac tamponade, tension pneumothorax, massive pulmonary embolism

S+S = increased capillary refill, skin turgor, decreased skin temp, pulse characteristics, hyperdynamic precordium, decreased UO, altered level of consciousness, increased respiratory effort, rash, poor feeding

26
Q

How should shock be Ix?

A

Glucose

Arterial (ABG) or venous blood gas (VBG) measurements

Serum lactate levels

FBC

Prothrombin (PT) and partial thromboplastin (PTT) times

Fibrinogen and D-dimer levels

Fluid culture = blood, urine, cerebrospinal fluid

CXR

BNP

Central venous pressure measurement

27
Q

Outline the Mx of shock

A

Oral rehydration

Initial resuscitation =

  • A-E
  • Oxygen
  • IV/IO fluid bolus 0.9% NaCl (20ml/kg, if not improving 40ml/kg)

Hypoglycaemia = IV dextrose 0.5-1 g/kg

Abx

No improvement = ITU, tracheal intubation, mechanical ventilation, invasive BP, vasopressors and cardiac inotropic agents, correct metabolic derangements, support liver/renal failure

28
Q

What is a differential diagnosis of an unconscious child?

A 
Choking
Opiate ingestion
Overdose of toxic substance
Decreased level of consciousness due to neurological disorder/ head injury
Hypoglycaemia
29
Q

How should an unconscious child be assessed and managed?

A

Assess = AVPU

Shout for help –> open airway –> 5 rescue breaths –> (no signs of life, no pulse, HR <60) 15 chest compressions –> 2 rescue breath + 15 chest compressions –> call resus team

30
Q

What can cause a child to suddenly collapse and how does it present?

A

Vasovagal syndrome (neurocardiogenic syncope)

Heart rhythm problem (arrhythmia)

Structural heart disease (muscle or valve defects)

Orthostatic hypotension

S+S = before faint: dizziness, lightheadedness, nausea, changes in vision, cold/damp skin

31
Q

How should sudden collapse be Ix?

A

ECG

24h ECG

Tilt table test

ECHO

32
Q

How is sudden collapse Mx?

A

Acute = After an episode of syncope, your child should lie down for 10-15m

Neurally mediated syncope (NMS), or vasovagal syncope, is the most common cause of syncope in young patients

NMS

  • avoid dehydration, long periods of standing and irregular mealtimes
  • persistent = beta-blocker or fludrocortisone

Long QT syndrome = beta-blocker

33
Q

Outline encephalitis

A

Aetiology = inflam of the brain tissue by: HSV (most common), varicella, enteroviruses, post-infectious encephalopathy, HIV, subacute sclerosing panencephalitis, metabolic abnormality

S+S = fever, altered consciousness, seizures, behavioural changes (can be insidious)

Ix = CSF PCR, EEG, CT/MRI (may show focal changes)

Mx = high dose IV aciclovir 3w (HSV, until excluded)

34
Q

Outline the Mx of status epilepticus

A

Acute = A-E (airway, oxygen, glucose), call for senior help

IV access - (if cant get consider rectal, buccal, IO)

  • Bloods (FBC, CRP, clotting, U+Es)
  • Cultures
  • VBG

IV/IO lorazepam (1st line - quicker, less resp depression) after 10m repeat lorazepam (can only have 2 doses of benzo)

Phenytoin infusion over 20m (whilst waiting for the phenytoin to be prepared: can give rectal paraldehyde) even if the seizure has stopped continue entire dose

Transfer to ICU - anaesthetist involvement (trial IV midazolam, RSI: rapid sequence induction, intubate and muscle relaxant)

Sepsis = start sepsis 6 (cefotaxime, ceftriaxone)
Meningitis = LP if can be performed quickly before Abx, if not then give Abx with no delay then LP later 
PICP = mannitol, furosemide

4.4. Child Health (37 decks)

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