Emergency

Question 1

Febrile convulsions:
- Definition
- Pathophysiology
- Causes
- Types (2)
- Risk f (4)
- DD (6)
- Investigations
- Management - advice for further episode, in hospital
- Complications (3)
- Extra facts: red flags for CNS infection (6)

Answer 1

Febrile convulsions:

• Definition: a type of seizure which occurs in child aged 6 months to 5 years with a high fever not caused by infection of the CNS without previous neonatal seizures or a previous unprovoked seizure and not meeting the criteria for other acute symptomatic seizure
• Pathophysiology: increase in neuronal excitability + environmental factors
• Causes: viral infections in URTI, LRTI, otitis media, UTIs
• Types:
  Simple: generalised tonic clonic seiz <15 mins and only occur once during illness
  Complex: partial or focal seizures >15 mins or occur multiple times
• Risk factors: fam history, socioeconomic class, winter, zinc/fe def
• DD: epilepsy, mening/encephalitis, space occupying lesions, syncopal, electrolyte abnormalities, non accidental
• Investigations: obs to confirm fever, urine dip, stool culture, bloods (fbc, crp, u+es, glucose), LP, cxr, CT/mri/eeg if complex. History: vaccinations, trauma, toxic ingestion, development). Examinations: (ent for otitis/tonsils, resp exam, fontanelles, kernigs sign, nuchal rigidity, neurology exam)
• Management:
  If further episode: stay with child, put in safe place, recovery position, don’t put anything in mouth, ambulance if >5 mins
  A-E, monitor, cushion head, hydrate, paracetamol. Admit if complex or 1st seizure
  If >15 mins benzodiazepine
• Complications: 2-7% increase in developing epilepsy after complex, recurrence esp if <18 months, multiple
• Extra facts: Red flags: lethargy, altered consciousness >1 hour, bulging fontanelle, neck stiff, photophobia, incomplete immunisation of H influ B and strep pneum in 6-18 months

Question 1

URTI: Croup:
- Definition
- Pathophysiology
- Causes (6)
- Risk factors (3)
- Symptoms (2)
- Signs (4)
- Red flags for respiratory failure (4)
- DD (4)
- Investigations (4)
- Management
- Complications (4)
- Extra facts - Westley croup score

Answer 1

Croup:

• Definition: acute laryngotracheitis/laryngotracheobronchitis is URTI viral infection in 6 months to 3 years
• Pathophysiology: inflammation in supraglottic, glottic, subglottic and tracheal level causes airway narrowing causing turbulent flow causing stridor noise and barking cough due to impaired movement through vocal cords
• Causes: parainfluenza virus, resp syncytial virus, adenovirus, rhinovirus, enterovirus, measles
• Risk factors: male, autumn/spring, genetics
• Symptoms: 1-4 days cough/rhinorrhoea/fever which progresses into barking cough + hoarseness, worse at night
• Signs: stridor, decreased air sounds, tachypnoea, intercostal recession
• Red flags for resp failure: cyanosis, lethargic, laboured breathing, tachycardia
• DD: epiglottitis (differences in word document), inhaled foreign body, anaphylaxis, bacterial tracheitis
• Investigations: clinical diagnosis, bloods (fbc, crp, u+es), cxr to see if foreign body, laryngoscopy
• Management:
  Advise parents, improves in 48 hours, paracet/ibu, fluids. Seek urgent advice if stridor/high fever/HR/resp failure
  Admit if previous airway obstruction , <6 months, immunocompromised, poor response to treatment)
  Single dose oral dexamethasone (0.15mg/kg) or oral pred (1-21mg/kg), neb adren, oxygen, keep them calm
• Complications: lymphadenitis, otitis media, dehydration, pneumothorax

-Extra facts: Westley croup score
Mild: no stridor at rest, happy with barking cough, no/mild intercostal recession
Moderate: easy audible stridor at rest, some agitation, recession at rest
Severe: distress, recession, stridor