Emergencies Flashcards
What do you do if a child has NICE traffic light
a) amber signs
b) red signs
a) can go home with strict safety netting or refer to hospital
b) immediate transfer to hospital
What are the NICE traffic light amber signs?
- pale
- reduced activity, wake with stimulation
- nasal flaring, sats <95%
- poor feeding, reduced UO
- temp >39
What are the NICE traffic light red signs?
- blue, mottled
- not rousable, high pitched cry
- grunting or chest indrawing or RR >66
- reduced skin turgor
- temp >38 if <3 months old
- bulging fontanelle, non blanching rash, seizures
What are the paediatric doses of adrenaline?
<6 is 150mcg (0.15ml)
6-12 is 300mcg (0.3ml)
>12 is 500mcg (0.5ml)
What are some paediatric signs of RICP?
- bulging fontanelle
- vomiting
- headaches
- seizures
- LOC
- muscle flaccidity
At what spinal level is an LP done?
L3-L4
What are some contraindications to a LP?
- signs of RICP
- invasive meningococcal septicaemia
- bleeding tendency including DIC
- GCS <13
- focal neurology
What should you rule out in a child that is seizing?
hypoxia and hypoglycaemia
What is the stepwise management of status epilepticus in a child?
1) buccal midazolam
2) IV lorazepam x2
3) IV phenytoin or phenobarbital
4) RSI
What is meningitis?
inflammation of the pia and arachnoid meninges
What organisms commonly cause meningitis in
a) <3 months
b) infants
c) older than 6 years
a) GBS, listeria, e. coli
b and c) h. influenza, strep. pneumoniae, n. meningitidis
What are the signs and symptoms of meningitis?
- petechial rash
- fever
- headache
- neck stiffness
- photophobia
- vomiting
- bulging fontanelle
- LOC
- Kernig’s and Brudzinski’s
Describe Kernig’s and Brudzinski’s sign
Kernig’s: whilst lying supine with the hip flexed there is extreme back pain if the knee is extended
Brudzinski’s: whilst lying supine if the neck is passively flexed the hips will flex
What are the characteristic CSF findings in
a) bacterial meningitis
b) viral meningitis
a) glucose <2/3 that of blood glucose, neutrophils, raised protein
b) high lymphocytes
What shape and stain are
a) listeria
b) GBS
c) e.coli
a) gram +ve rod
b) gram +ve cocci
c) gram -ve rod
If you see ?meningitis in a primary care setting what is given immediately?
IM benzylpenicillin
Which antibiotics are given in
a) <3 months
b) >3 months
c) confirmed listeria
d) allergy to above abx
a) cefotaxime and amoxicillin
b) cefotaxime
c) amoxicillin and gentamicin
d) chloramphenicol
Aside from antibiotics to the patient, what other pharmacological management is needed in meningitis?
Ciprofloxacin for 7 days to all household contacts
Dexamethasone to the patient if >3 months, not septic, not immunocompromised
What are the complications of meningitis?
a) short term
b) long term
a) seizures, DIC, RICP, hydrocephalus, acidosis
b) sensorineural hearing loss, limb loss, poor memory and concentration, epilepsy, renal failure
What are the signs and symptoms of encephalitis?
fever + altered mental status + headache
Generally presents as meningitis
What would CSF analysis show in encephalitis?
High lymphocyte count
High protein
May be HSV +ve if viral PCR done
What is the immediate management of encephalitis?
Treat as per meningitis + IV aciclovir
Define sepsis
Life threatening organ dysfunction due to a dysregulated host immune response to infection
What organisms commonly cause neonatal sepsis?
GBS and e.coli
What are the risk factors for neonatal sepsis?
- previous GBS baby
- maternal GBS
- intrapartum fever >38
- PROM
- premature
How is neonatal sepsis managed?
IV benzylpenicillin and gentamicin
What are some differentials for a collapsed child?
- vasovagal syncope
- hypoglycaemia
- arrhythmias
- HOCM
- anaphylaxis
- seizures
- anaemia
- dehydration
How is the surface area a burn affects calculated?
Can do rule of 9’s but Lund and Browder chart is more accurate
Describe a burn affecting
a) epidermal
b) superficial dermal
c) deep dermal
d) full thickness
a) red, painful
b) blistered, painful, wet appearance
c) white, reduced sensation, large blisters
d) black, no sensation or pain, no blisters
How are burns managed in the community (i.e. first aid)
cold water for 30 minutes then layer (not wrap) clingfilm on the burn
How are burns managed once in hospital?
Fluids: 4 x %SA of burn x weight (kg) given over 24 hours with half in first 8 hours
Analgesia + O2 + tetanus/ abx as necessary
When should a referral to specialist secondary care be made for burns?
Any deep dermis or full thickness 2% superficial dermis Complex areas eg face and groin NAI Inhalation, electrical, chemical
What are some differentials for a petechial rash?
HSP TTP Meningococcal septicaemia Post-pertussis cough ALL
What ratio of compressions to ventilations is used in child life support?
15:2
Describe the steps in new born life support
10 inflation breaths then 30 seconds of ventilations
CPR if HR <60
What volume of fluid is used for paediatric fluid resuscitation?
20ml/kg over 10-15 minutes
