Emergencies And BLS

Question 1

4 earlyish signs and symptoms of sepsis in younger kids?

Answer 1

Tachycardia
Pyrexia
Tachypnoea
Raised inflamm markers

Question 2

Airway assessment and management?

Answer 2

Are they talking? Noisy breathing e.g. Stridor, stertor?
If not talking, look in mouth - any obstruction, secretions, drooling etc.
Do they need support? Initially airway manoeuvres head tilt chin lift, jaw thrust, then adjuncts e.g. NP airway, Guedel. Further down line artificial airways incl intubation and ventilation or cricothyroidectomy

Question 3

Assessment and management of breathing?

Answer 3

How fast? How much effort (increased WOB?)
Sats - if less than 92-94% give O2
Listen to chest - any focal consolidation, reduced entry?
Tap chest for pneumothoraces and other consolidation
Treat findings - e.g. Thoracotomy needle, Salb neb if really wheezy/suspect acute asthma

Question 4

Assessment and management of cardiovascular system?

Answer 4

HR, CRT peripheral and central, (BP)
Appearance and feel - warm and well perfused or cool, mottled?
Mucus membranes and skin turgor - hydration
Listen to heart sounds for e.g. Tamponade, valve signs or signs of congenital heart disease
If prolonged CRT, mottled and or high HR consider fluid bolus 20ml/kg unless trauma or DKA
For this you will require IV access - while obtaining send bloods for FBC, U+E, Inflam markers, lactate etc.

Question 5

Assessment and management of disability?

Answer 5

Awareness - AVPU or GCS if appropriate
Temperature
Pupils - PEARL
Blood glucose 
Fontanelles in younger kids

Question 6

Assessment and management of E?

Answer 6

Look for rashes
Passing urine? Cons catheter
Injuries, cuts, bruises etc.

Question 7

Choking management procedure for children?

Answer 7

Clear and obvious obstruction by encouraging cough
If ineffective cough give back slaps then Chest thrusts for infants, Abdo thrusts if child over 1 year
If deteriorate give 5 rescue breaths and commence CPR

Question 8

How to initiate and maintain CPR in children? How does this differ from adults?

Answer 8

Initially as normal, shout for help, try to rouse, open airway and assess
If not breathing normally give 5 rescue breaths
Then 15 chest compressions
Then 2 breaths and continue 15:2
Half the chest compressions as resp failure more likely than cardiac in children

Question 9

What should be performed after resus if a child had had abdominal thrusts for choking?

Answer 9

Full examination +/- CXR or AXR

Question 10

What non-chest management can help children in respiratory distress or with significant obstruction?

Answer 10

Pass NG tube

Question 11

What do NICE guidelines say in terms of pyrexia in under 3m old children?

Answer 11

Need full sepsis work up - blood cultures, inflam markers, fbc etc. Plus CXR, urine dip and cultures, ?LP, ENT exam?

Question 12

What are risk factors for neonatal infection in terms of mother?

Answer 12

Illness in pregnancy
Group B strep carriage
Prolonged rupture of membranes
Prematurity/low birth weight 
Difficult births

Question 13

What is used to calculate the estimated area affected by burns and kids and then the IVT fluid replacement requirements?

Answer 13

Wallace Rule of 9

And then the Parkland Formula