Emergency Flashcards
cMost common cause of death in 4-52 weeks
SIDS
Most common cause of death 1-5 years old
Congenital abnormality
Most common cause of death 5-14
Neoplasm
Causes of cerebral depression resulting in reduced resp drive
Raised ICP
Poisoning
Encepahlopathy
Causes of NM disease leading to reduced effort of breathing
Poison
Drugs
Spinal muscular atrophy
Muscular dystrophy
What is the triad of shaken baby syndrome
Encephalopathy
Retinal haemorrhages
Subdural bleeds
How to assess consciousness in a child
AVPU
Alert
Responds to VOICE
Responds to PAIN
Unresponsive
Difference in compression technique in children
For infants- 2 thumb encircling technique
Children over 1- 1 hand compressing lower half of sternum
Most common fracture in physical child abuse
Humeral
What are the life threatening red signs of febrile illness
CNS infection signs
Severe dehydration
pneumonia
Traffic light system for feverish child, actvity criteria
Amber
Not responding normally to social cues
Walking only with prolonged stimulation
Decreased activity
Not smiling
Red
No response to social cues
Appears ill to healthcare worker
Unable to rouse
Weak high pitched crying
Traffic light system for feverish child, respiratory criteria
Amber
Nasal flaring
O2 less than 95
Crackles
Tachypnoea
Red
Grunting
Tachypnoea over 60
Moderate or severe chest indrawing
Traffic light system for feverish child, circulatory and and hydration
Amber
Poor feeding
Dry mucous membranes
CRT over 3s
Reduced urinary output
Tachycardia
Red
Reduced skin turgor
Traffic light system for feverish child, tachycardia amber criteria
Infant- over 160
1-2 years- over 150
2-5 years- over 140
Traffic light system for feverish child, tachypnoea amber criteria
6-12 months- over 50
Over 12 months- over 40
Traffic light system for feverish child, ‘other’ amber criteria
Fever for 5 days or more
Rigors
Temperature over 39 in children 3-6 months
Swelling of limb or joint
Non-weight bearing or not using a limb
Traffic light system for feverish child, ‘other’ red criteria
Non-blanching rash
Bulging fontanelle
Neck stiffness
Focal neurology
Seizures
Major risk factors for SIDS
Prone sleeping
Bed sharing
Parental smoking
Hyperthermia and head covering
Prematurity
Meningitis organisms if neonate-3 months
Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes
E. coli and other Gram -ve organisms
Listeria monocytogenes
Meningitis organisms if 1 month -6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Haemophilus influenzae
Meningitis organisms if over 6 years
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
BLS for choking
Get them to cough- if coughing effective don’t get them to stop
5 back blows and then 5 chest (infant)/abdo (child) thrusts but ONLY when they are conscious
If lose consciousness do 5 rescue breaths
When would you continue CPR but they have a pulse
If pulse below 60 and peripheral cyanosis
Differences between early and late shock
Hypotension is a late sign of shock.In early shock it is compensated for by tachycardia and tachypnoea, the BP can be normal. In late shock will be hypotensive, acidotic so kussmal breathing, blue skin as opposed to pale and absent urine output
When asssessing hydration status what categories should be used
Normal
Dehydrated
Shock
What factors inficate dehydration as opposed to shock
Warm extremities
No pallor
Sunken eyes
Dry mucous membranes
Normal cap refill
Normal peripheral pulses
Which children are at greater risk of dehydration
Children younger than 1 year, especially those younger than 6 months
infants who were of low birth weight
children who have passed six or more diarrhoeal stools in the past 24 hours
children who have vomited three times or more in the past 24 hours
children who have not been offered or have not been able to tolerate supplementary fluids before presentation
infants who have stopped breastfeeding during the illness
children with signs of malnutrition
When should do stool sample in gastroenteritis
suspect septicaemia
blood and/or mucus in the stool
immunocompromised
Can also consider if
- recently been abroad
- not improved by day 7
- uncertain about the diagnosis of gastroenteritis
Management of gastroenteritis
Depends if normal, dehydrated or in shock
Normal
- continue breastfeeding
- encourage fluid intake
- discourage juices and carbonated drinks
Dehydrated
- 50ml/kg/hr ORS over 4 hours
- continue supplementing with usual fluids
Shock
- admit for intravenous rehydration
Take stool sample in specific scenarios
Management of gastroenteritis fluids
Depends if normal, dehydrated or in shock
Normal
- continue breastfeeding
- encourage fluid intake
- discourage juices and carbonated drinks
Dehydrated
- 50ml/kg/hr ORS over 4 hours
- continue supplementing with usual fluids
Shock
- admit for intravenous rehydration
Take stool sample in specific scenarios
What is infantile colic
At age of 3 months roughly babies start crying uncontrollably and bring knees up to chest or arch back
Typically worse in the evening
CT scan guidelines for head injuries- immediate CT
Immediately do head CT if
- NAI suspected
- post traumatic seizure
- GCS less than 14 on assessment, GCS less than 15 in under 1 YO
- focal neurology
- 2 hours after injury GCS less than 15
- suspected skull fracture
- tense fontanelle
- for children under 1 a bruise or laceration over 5 cm
CT scan guidelines for head injuries- observation or do in under 1 hour
If one of following then observe for 1 hour, if MORE than 1 have to do in less than 1 hour
- LOC over 5 mins
- high velocity impact (RTA, over 3m fall)
- 3 or more vomiting episodes
- amnesia over 5 mins
- abnormal drowsiness
If develop either abnormal drowsiness, vomits again or abnormal drowsiness with 1 of above RFX then do CT in less than 1 hour
What are different ways of opening airway in paeds BLS
Head tilt-chin lift
Jaw thrust with cervical spine control- do if evidence of potential trauma
Anaphylaxis management
Legs elevated
Im adrenaline
Highflow O2
IV fluids
IV chlorphenmaine
IV hydrocortisone
FLACOS
look up doses
What is rate of chest compression in all children
100-120
Features suggesting hypernatraemic dehydration
Jittery movements
Increased muscle tone
Hyperreflexia
Convulsions or coma
Risk factors for non-accidental injury
Domestic violence
Previous history of child maltreatment
Mental health disorders
Drug or alcohol misuse in the carers
Disability or long-term chronic illness
Where feel for pulse in an infant vs child
Child- carotid
Infant- Brachial and femoral
When do chest or abdo thrusts in choking BLS
Infant- chest
Child- abdo
How deep do you go in chest compression on a child
1/3 chest
What do if clinical dehydration but cant tolerate oral rehydration solution
NG rehydration
When consider admission to PICU in sepsis
Need for ionotrope or vasopressins
Lactate high
If on own attending paediatric resus what do
Check danger
Give 1 minute of BLS
Then put out a 2222 call
