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Paediatrics > Emergency > Flashcards

Emergency Flashcards

1
Q

What are some possible causes of an acute limp in a child younger than 3 years?

A

Fracture/trauma

Developmental dysplasia of the hip

Septic arthritis

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2
Q

What are some possible causes of an acute limp in a child aged between 3 and 10?

A

Transient synovitis

Fracture/trauma

Perthe’s disease

Septic arthritis

Juvenile idiopathic arthritis

Malignancy

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3
Q

What are some possible causes of an acute limp in a child aged between 10-18 years?

A

Fracture/trauma

Slipped upper femoral epiphysis

Septic arthritis

Juvenile idiopathic arthritis

Malignancy

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4
Q

What questions should be asked when assessing a child with an acute limp?

A
  • Duration and progression
  • Preceding viral infection?
  • Nature, location, severity, timing
  • Any associated muscle weakness
  • Birth and developmental history
  • Family history
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5
Q

What are some risk factors for DDH?

A 
Female
Family history
Breech presentation
Oligohydramnios
Firstborn child
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6
Q

What is Perthe’s disease?

A

An idiopathic avascular necrosis of the developing femoral head

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7
Q

What are some red flags in a child with acute limp?

A 
Fever
Pain waking at night
Weight loss
Unexplained rash or bruising
Limp and stiffness worse in the morning
Unable to bear weight
Palpable mass
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8
Q

What is sepsis?

A

Life-threatening organ dysfunction caused by a dysregulated host response to infection

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9
Q

How does Kawasaki disease present?

A

Rash, fever, cervical lymphadenopathy, conjunctivitis, cracked lips

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10
Q

How is Kawasaki disease treated?

A

IVIG and aspirin

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11
Q

What are some causes of inadequate fluid intake?

A

Structural malformations, discomfort (eg sore throat), respiratory distress, neglect

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12
Q

What are some causes of excessive fluid loss?

A

Diarrhoea, vomiting, excessive sweating, polyuria, burns

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13
Q

What are some features of clinical dehydration?

A

Irritable, lethargic, decreased urine output, sunken eyes, dry mucous membranes, tachycardia, tachypnoea, reduced skin turgor

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14
Q

What are some features of clinical shock?

A

Decreased level of consciousness, pale or mottled skin, cold extremities, tachycardia, tachypnoea, weak peripheral pulses, prolonged CRT and hypotension

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15
Q

What are some clinical features of hypernatraemic dehydration?

A

Jittery movements, hypertonia, hyperreflexia, convulsions, drowsiness, coma

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16
Q

What should you do if a child is in shock?

A

Give a rapid 20ml/kg fluid bolus of normal saline

17
Q

How do you work out the fluid deficit if there are signs of clinical dehydration?

A

Weight (kg) x % replacement x 10

The % replacement can be assumed to be 10% if dehydrated

Given over 48 hours with 0.9% sodium chloride and 5% dextrose

18
Q

How much resuscitation fluids should be given in DKA?

A

10 ml/kg bolus of 0.9% sodium chloride

Risk of cerebral oedema

19
Q

What is the emergency treatment of a harsh stridor and barking cough?

A

Oral dexamethasone
Nebulised budeosinde and adrenaline in severe cases

(croup)

20
Q

What is the emergency treatment of a soft stridor, drooling and fever in a sick looking child?

A

Intubation by anaesthetist followed by IV antibiotics

Epiglottitis or tracheitis

21
Q

What is the definitive management of choking in an infant?

A

Give 5 back blows (check after each one)

Then 5 chest thrusts

22
Q

What is the definitive management of choking in children?

A

5 back blows then Heimlich manoeuvre (abdominal thrusts)

23
Q

What is a brief resolved unexplained event (BRUE)?

A

An event occurring in an infant younger than 1 year when the caregiver reports a sudden, brief, and now resolved episode of 1 or more of:

  • Cyanosis or pallor
  • Absent, decreased or irregular breathing
  • Change in tone
  • Altered level of responsiveness
24
Q

What is DKA characterised by?

A

1) Acidosis (pH below 7.3 or bicarbonate below 15)
2) Ketonaemia (above 3)
3) Generally high blood glucose levels

25
Q

What are the three complications which account for the majority of deaths in children with DKA?

A

Cerebral oedema, hypokalaemia and aspiration pneumonia

26
Q

What is the pathophysiology of DKA?

A

T1DM - high blood glucose due to absolute deficiency of insulin leading to a rise in counter-regulatory hormones including glucagon, cortisol, catecholamines and growth hormone.

The increase in these gluconeogenic hormones not only raises the blood glucose concentration further, but also leads to accelerated break down of adipose (fatty) tissue, resulting in rising levels of acidic ketone bodies

The hyperglycaemia and subsequent glycosuria causes an osmotic diuresis and the patient becomes polyuric, resulting in dehydration

Vomiting is common in DKA and further compounds the dehydration and stress, resulting in a perpetuating cycle of worsening acidosis and dehydration.
Unless insulin is given, this process continues to spiral out of control and can be fatal.

27
Q

What are the main symptoms of DKA?

A

Lethargy, malaise, N+V, abdominal pain, irritability, confusion, fruity breath

28
Q

What are some differentials of DKA?

A

Hyperosmolar Hyperglycaemic State, new presentation of T1DM, dehydration from other cause eg gastroenteritis, sepsis, appendicitis, intussusception

29
Q

What investigations are required in DKA?

A

Bedside blood glucose and urinary ketones, blood gas, laboratory blood glucose, U+Es, FBC, creatinine, ECG

30
Q

What are the severities of DKA and how do they relate to % dehydration?

A

Mild - pH between 7.20 and 7.29 = 5% dehydration

Moderate - pH 7.10-7.19 = 7% dehydration

Severe - pH less than 7.10 = 10% dehydration

31
Q

How do you work out deficit fluids for DKA?

A

Initial bolus - 10ml/kg over 1 hour

% dehydration x kg x 10

(use mild/moderate/severe class to work out %dehydration - 5, 7 or 10%)

then subtract initial bolus from deficit

Replace over 48 hours

32
Q

How do you work out maintenance fluids for DKA?

A

100ml/day for 1st 10kg
50ml/day for 2nd 10kg
20ml/day for >20kg

33
Q

What is the management of DKA?

A

Fluids

IV insulin - should be delayed for 1-2 hours after beginning fluid therapy - 0.05-0.1 units/kg/hour

Potassium placement

34
Q

What are the signs of hypokalaemia on ECG?

A

U and T wave inversion

35
Q

What criteria is used to determine the likelihood of septic arthritis?

A

Modified Kocher criteria (fever, WCC, CRP, inability to weight bear)

36
Q

How is anaphylaxis managed?

A

High flow oxygen, IM adrenaline 1:1000 repeated every 5 mins, IV hydrocortisone, nebuliser salbutamol

37
Q

What drug is used to treat absence seizures?

A

Ethosuximide

38
Q

What does it show on the EEG with infantile spasms?

A

Hypsarrhythmia

Paediatrics (7 decks)

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