Emergency Flashcards by Owen Vineall

cMost common cause of death in 4-52 weeks

SIDS

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Most common cause of death 1-5 years old

Congenital abnormality

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Most common cause of death 5-14

Neoplasm

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Causes of cerebral depression resulting in reduced resp drive

Raised ICP
Poisoning
Encepahlopathy

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Causes of NM disease leading to reduced effort of breathing

Poison
Drugs
Spinal muscular atrophy
Muscular dystrophy

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What is the triad of shaken baby syndrome

Encephalopathy
Retinal haemorrhages
Subdural bleeds

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How to assess consciousness in a child

AVPU
Alert
Responds to VOICE
Responds to PAIN
Unresponsive

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Difference in compression technique in children

For infants- 2 thumb encircling technique
Children over 1- 1 hand compressing lower half of sternum

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Most common fracture in physical child abuse

Humeral

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What are the life threatening red signs of febrile illness

CNS infection signs
Severe dehydration
pneumonia

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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

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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

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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

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Traffic light system for feverish child, tachycardia amber criteria

Infant- over 160
1-2 years- over 150
2-5 years- over 140

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Traffic light system for feverish child, tachypnoea amber criteria

6-12 months- over 50
Over 12 months- over 40

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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

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Traffic light system for feverish child, ‘other’ red criteria

Non-blanching rash
Bulging fontanelle
Neck stiffness
Focal neurology
Seizures

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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

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