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Y4 paeds > Emergencies > Flashcards

Emergencies Flashcards

1
Q

What signs may suggest an airway is partially obstructed and how is each managed?

A
  • Harsh stridor- dexamethasone, ?adrenaline neb and secure airway (croup, epiglottis, anaphylaxis)
  • soft stridor, drooling: intubate and IV abx
  • wheeze: salbutamol nebs
  • grunting: CPAP
  • sudden stridor and cough: manage as foreign body
  • sudden stridor + allergen: IM adrenaline
  • gurgling: suction/ recovery position
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2
Q

How should breathing be assesed in A-E

A
  • Effort: RR, posturing, recessions, acessory muscle use, nasal flaring
  • Effectiveness; chest expansion, air entry, pulse oximetry
  • Effects of inadequacy: HR, skin colour, mental sate
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3
Q

What are high resp rates for children of different ages?

A

Neonate: RR >60
Infant: RR: >50
Young child >40
Older child >30

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4
Q

How do you calculate volume needed for a fluid bolus in a pt thats in shock?

A

10-20mls/ kg of 0.9%normal saline.

If >40mls/kg is given then call ICU for inotropic support

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5
Q

What is stiff posturing and what does it suggest

A
  • decorticate= arm flexed
  • decerebrate= arms extended
  • suggests serious brain dysfunction
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6
Q

what dose of IV dextrose is given to treat child with a hypo

A

up to 500mg/kg 10% dextrose

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7
Q

Define a brief resolved unexplained event

A

An episode, frightening to the observer, involving a combination of apnoea, choking or gagging, colour change, altered responsiveness and change in tone in a child <1 year

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8
Q

What could cause a brief resolved unexplained event?

A
  • GORD is most common
  • seizures
  • CNS infection
  • URTI/ resp infection
  • breath holding
  • sleep apnoea
  • arrrhythmias
  • congenital cardiac disease
  • electrolyte errors
  • meningitis / sepsis
  • suffocation
  • shaken baby syndrome
  • factitious induced illness
  • ingestion of toxins/ drugs
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9
Q

How should brief resolved unexplained events be investigated

A
  • Low risk pts require only an ECG and prenasal swabs for pertussis as it could be whooping cough. Low risk pts are: age >2months, >32 gestation, no previous BRUE, event lasting <1min, no CPR by healthcare professional, no concerning features in hx or examination
  • High risk pts would also get a CXR, blood gas, lab bloods (FBC, U&E, blood film, crp, bone profile and glucose)
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10
Q

How should higher risk BRUE pts be managed?

A

Admit for overnight sats and vital signs monitoring as a minimum. If stable overnight they can generally be discharged home with advice and BLS training. If there is particular concern they may get consultant outpt follow up

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11
Q

How should anaphylaxis be managed?

A
  • Sit up if airway/ breathing problems
  • lie flat and raise legs if circulatory problems
  • give adrenaline IM
  • establish airway, give high flow O2, give fluid challenge
  • give chlorphenamine and hydrocortisone
  • monitor sats, ECG and BP
  • do mast cell tryptase as 1hr and 24hrs
  • observe for 6 hrs due to risk of biphasic reaction, give antihistamines for 3 days and an autoinjector
  • f/u allergy clinic
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12
Q

What dose of adrenaline should be given to children of different ages in anaphylaxis

A

All 1:1000, given IM
Adult and child >12: 500 micrograms (0.5ml)
6-12 yrs: 300micrograms (0.3ml)
<6yrs: 150micrograms (0.15ml)

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13
Q

What doses of chlorphenamine should be given to children of different ages in anaphylaxis

A 
IM or slow IV
Adult or >12: 10mg
6-12: 5mg
6 months- 6yrs: 1.5mg
<6months: 150micrograms/ kg
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14
Q

What doses of hydrocortisone should be given to children of different ages in anaphylaxis

A 
IM or slow IV
adult or >12: 200mg
6-12: 100mg
6months- 6yrs: 50mg
<6months: 25mg
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15
Q

Describe the clinical features of encephalitis

A
  • Fever, headache, altered mental status
  • Altered behaviour
  • Altered cognition
  • Reduced consciousness
  • New onset seizures
  • New focal neurological signs
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16
Q

Give 4 differentials for encephalitis

A
  • meningitis
  • intracranial haemorrhage
  • hypo/ hyperglycaemia
  • uraemia
  • hyperammonia
  • wernikes encephalopathy (alcohol abuse)
  • concussion
  • intoxication
  • SLE
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17
Q

How do meningitis and encephalitis differ

A
  • rarely get photophobia and neck stiffness in encephalitis
  • seizures more common in encephalitis
  • always get focal neurological signs in encephalitis, this is less common and occurs later in meningitis
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18
Q

What can cause encephalitis?

A
  • viral: herpes simplex virus is most common, cmv, adenovirus, influenza, polio, rabies
  • bacterial: tb, mycoplasma, listeria
  • fungal: cyrptococcus, taxoplasmosis
  • autoimmune: vasculitis, SLE
  • renal or hepatic encephalopathy
  • tumours, paraneoplastic limbic encephalitis
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19
Q

How should suspected encephalitis be investigated?

A
  • LP
  • CT head if LP contraindicated, then do LP if no brain shift
  • MRI after LP
  • CSF tested for: opening pressure, differential WCC, RCC, microscopu, culture and sensitivities, protein, lactate, glucose (compare to plasma glucose), virology, PCR for HSV1&2, VZV and enterovirus, TB culutres and antibody testing
  • rectal swabs for enterovirus
  • sputum samples if resp infection
  • HIV test
  • blood cultures and film and routine
20
Q

What is the difference between bacterial and viral encephalitis/ meningitis on LP?

A

Bacterial: generally higher opening pressures, neutrophil predominant, very high WCC (>1000, normal is <5), high protein levels, decreased CSF glucose
Viral: only midly high opening pressures, high WCC (<1000)- mainly lymphocytes, CSF glucose is normal

21
Q

How is encephalitis managed?

A
  • urgent admission
  • IV abx and sepsis 6 as ?meningitis
  • aciclovir infusion started if CSF and / or imaging findings suggest viral encephalitis
  • no role for steroids
  • anticonvulsants and sedatives for agitation
  • ICU and ventilation may be needed to reduce brain swelling
22
Q

Where can information be found on antidotes to specific poisions

A

toxbase or phone NPIS for advice if severe or complex

23
Q

What poisons require serum monitoring to guide management?

A

carbocyhaemoglobin, digoxin, ethanol, Ethylene, iron, lithium, methanol, paracetamol, salicylate (aspirin), theophylline, valproate

24
Q

When can activated charcoal be used?

A

to prevent absorption if they present within an hour of ingestion AND there is a potentially toxic amount of drug that absorbs to charcoal has been taken, in the absence of contraindications

25
Q

When can whole bowel irrigation be used?

A

in children thatve taken potentiall toxic amounts of iron or of sustained release or enterically coated medicines and present within 2 hrs

26
Q

Name the antidote for paracetamol, digoxin, benzos, insulin, betablockers, opiates, iron salts and ethylene glycol and methanol

A 
Paracatamol= N- acteylcysteine
Digoxin- digoxin specific antibody fragments
Benzos- flumazenil
Insulin and BB- glucagon
opiates- naloxone
iron salts= desferrioxamine mesilate 
Ethylene glycol and methanol= fomepizole
27
Q

give 4 riskfactors for neonatal sepsis

A
  • prem
  • prolonged rupture of membranes (24hrs)
  • intrapartum pyrexia
  • maternal colonisation of group B strep
28
Q

What domains are assessed in the traffic light system for identifying risk of serious illness?

A
  • Colour (of skin, lips, tongue)
  • Activity (response to social cues, smiling, waking, crying)
  • Respiratory (signs of distress)
  • Circulation and hydration (HR, cap refill, skin turgor, membranes, UO, feeding)
  • other (fever, rigors, joint swelling, meningitis signs, neurological signs)
29
Q

Give 5 indicators that a child is at high risk of serious illness

A
  • pale/ mottled/ ashen/ blue skin
  • no response to cues, appears ill, doesnt wake/ rouse
  • high pitched, weak or continious cry
  • grunting
  • RR >60
  • chest indrawing
  • reduced skin turgor
  • age <3 months and temp >38
  • meningitis signs
  • focal neuro signs and seizures
30
Q

Give 5 indicators that a child is at intermediate risk of serious illness

A
  • pallor reported by parent
  • not responding normally to cues, no smile, wakes with prolonged stimulation, decreased activity
  • nasal flaring, tachypnoea, low sats, crackles
  • tachycardia
  • CRT >3
  • dry
  • poor feeding and UO
  • age 3-6 months and temp >39
  • fever for >5 days
  • rigots
  • joint swelling
31
Q

Whats involved in the paediatric sepsis 6

A
  • O2
  • Iv access + cultures, glucose
  • blood gas
  • IV/ IO abx
  • fluid resus
  • call snr
  • consider inotropes
  • monitor BMs as prone to hypos
32
Q

What are the common causes of shock in paediatrics

A
  • Vomiting, diarrhoea or both +shock= hypovolaemic due to gastroenteritis
  • Blunt or penatrive trauma + shock= hypovolaemic due to haemorrhage
  • Infants under 3 have serious bacterial infection unless proven otherwise
  • Neonates with hepatomegaly, precordial heave or increased JVP or a murmur and shock have a duct dependant lesion unless proven otherwise (cardiogenic shock)
33
Q

What is definition of shock for different ages

A

neonate: <60mmHg
Infant: <70mmHg
Child (1-10): < 70 + 2 x age (yrs) mmHg
Older child (>10): 90mmHg

34
Q

describe the management of status epilepticus

A

0-5mins: check ABC, high flow O2 if available, check BM and remove hazards, don’t restrain
5mins: midazolam 0.5mg/kg buccal or lorazepam 0.1mg/kg IV
15mins: lorazepam 0.1mg/kg IV, call for sr help, prepare phenytoin
25 mins: phenytoin 20mg/kg IV infusion over 20 mins, paraldehyde 0.8ml/kg may be given after phenytoin infusion as direct by sr staff. Inform ICU and/ or sr anaesthetist
45 mins: rapid sequence induction of anaesthesia using thiopental sodium 4mg/kg IV and transfer to paeds ITU

35
Q

give 4 red flags for syncope

A
  • lack of prodrome
  • palpitations or chest pain
  • exercise induced
  • past cardiac history
  • fhx early cardiac death, arrhythmia or sudden death
36
Q

how should syncope be investigated?

A
  • Lying standing BP
  • Cardiac and neuro exam
  • ECG in all, can do 24-72 hr recordings
  • Echo if ? Murmur or ecg abnormal
  • Tilt testing for neurally mediated syncope
  • BM if seen just after event
  • FBC if ?anaemia
  • Consider pregnancy test
37
Q

how is orthostatic syncope (induced by sudden or sustained standing) managed?

A
  • drink lots
  • eat lots of salty foods
  • exercise training
  • then can used medications to raised BP (specialist)
38
Q

Give 4 risk factors for sudden infant death syndrome

A
  • low birth weight
  • prem
  • 1-3 months age
  • exogenous stressors eg sleeping prone
  • maternal smoking
  • alcohol and drug abuse
  • age <20
  • poverty
  • single mum
  • bed sharing
  • soft bedding
39
Q

How can sudden infant death syndrome be prevented

A

Putting children to sleep on their back
Avoid overheating due to heavy wrapping, high room temp or covering head
Place infants with feet at foot end of cot
Don’t smoke near the infant
Parents should keep the baby in their bedroom (not bed) for first 6 months
Avoid sleeping with the baby
Breast feed
Sleep baby on firm mattress with no sheets or duvet

40
Q

How can a childs weight be estimated in an emergency?

A

age +4 x2 = weight in kg
there are more accurate estimations based on different ages but this is easiest to remember and will do, works up to age 10 ish

41
Q

Describe the paediatric life support pathway for cardiac arrest management

A
  • CRP: 5 initial breaths then compressions at 15:2 ratio
  • attach leads and assess rhythm
  • If shockable: shock at 4 J/Kg
  • then CPR for 2 mins
  • if not shockable go back to CPR for 2 mins and reassess
  • give adrenaline 10micrograms/ kg ASAP and every 3-5 mins for shockable and non shockable
  • give amiodarone 5mg/kg after 3rd and 5th shock and if VT/VF persists after circulation returns (not for non shockable)
  • consider 4Hs and 4Ts and reverse cause
42
Q

Whats the difference between bacterial meningitis, meningococcal disease and meningococcal septicaemia?

A

Bacterial meningitis= menigitis of any bacterial cause - PHOTOPHOBIA, STIFF NECK, HEADACHE, BULGING FRONTANEL, KERNIGS SIGN, BRUDZINSKI sign,
Meningococcal disease= mengococcal infection (may be causing menigits and/ or sepsis)
Mencococcal septicaemia= meningitis infection of blood causing sepsis- RASH, HYPOTENSION, PROLONGED CAP REFILL, COLD PERIPHERIES

43
Q

How should meningococal disease be managed?

A
  • LP if no signs of raised ICP- if so CT first and LP if no brain shift
  • Inital investigations (gas, culture, swabs, routine bloods, urine, PCR)
  • Empirical IV abx (<1 mo= ceftriazone+ amox+ gent, 1-3 mo= ceftriazone+ amox, >3 mo= ceftriazone)
  • Steroids if >3 months, <12 hrs since abx, LP suggests bacterial (150mcg/kg dex 6days QDS)
  • IV fluid resus and ITU
  • notify public health, side room, neuro and PEWS 30 minsly for 4 hrs then 2hrly for 8 then 4hrly, hearing test 6 weeks after, change abx based on sensitivity results
44
Q

Give 4 complications of meningococcal disease

A
  • hearing impairment
  • cerebral infarction or abscess
  • hydrocephalus
  • cerebral palsy (<2 mo)
  • seizures/ epilepsy
  • resp failure
  • DIC
  • shock
  • brain herniation
  • metabolic disturbances
45
Q

what are the 7 signs of redflag sepsis?

A
  • looks ill/ mottled/ cyanosis/ non blanching rash
  • grunting/ apnoea
  • spO2 <90
  • RR>60/50/40/30
  • HR <60 or >160/50/40/30/20
  • altered mental state/ reduced GCS
  • temp <36 or >38 @<3 months
46
Q

Describe management of paeds sepsis inc empiric abx

A
  • Oxygen
  • fluid bolus 10-20mls/kg
  • lactate
  • blood culture, urine culture, CXR, LP, fbc, clotting, u&e
  • IV/ IO abx: <1 mo= gent+amox+ cefotaxime, 1-3 mo= amox + cefotaxime, >3 mo= ceftriazone, tazocin + teicoplanin if haem/ onc pt
  • escalate to ST4+ or cons/ ITU if lactate >4 or no improvement after 2 bolus
  • inotrope support early
  • monitor bms as v prone to hypos

Y4 paeds (14 decks)

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