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MBBS 3: Pediatrics > Emergency > Flashcards

Emergency Flashcards

1
Q

What is triage?

A

the preliminary assessment of patients or casualties in order to determine the urgency of their need for treatment and the nature of treatment required

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2
Q

Triage stations?

A
  1. emergency
  2. priority
  3. non-urgent
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3
Q

What is emergency triage?

A

patient must be seen at once may need life saving treatment

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4
Q

What is priority triage?

A

patient needs rapid assessment needs to be seen soon

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5
Q

What is non-urgent triage?

A

patient can safely wait to be seen

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6
Q

Airway and breathing emergency signs?

A
  1. Not breathing
  2. centrally cyanosed
  3. noisy breathing
  4. severe respiratory distress
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7
Q

Airway and breathing emergency treatments?

A
  1. Manage the airway
  2. Give Oxygen
  3. Remove any foreign body
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8
Q

Circulation emergency signs?

A
  1. Cold hands
  2. Capillary refill > 3 secs
  3. Weak fast pulse
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9
Q

Circulation emergency treatments?

A
  1. Stop bleeding
  2. Give Oxygen
  3. Give IV fluids 20ml/kg
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10
Q

Coma, convulsions and confusion emergency signs?

A
  1. Unconscious
  2. Convulsing
  3. Low blood sugar
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11
Q

Coma, convulsions and confusion emergency treatment?

A
  1. Manage airway & give O2
  2. Give 10% glucose IV
  3. Position child
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12
Q

Dehydration emergency signs?

A
  1. Lethargy
  2. Sunken eyes
  3. Skin pinch >2secs
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13
Q

Dehydration emergency treatments?

A

No malnutrition
- Give IV fluids+ oral fluids
Malnutrition present
- Give NGT + oral fluids

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14
Q

Priority signs?
TPR MOB

A

T - tiny (<2 months), temperature (very hot to touch), trauma
P - pain, poisoning, pallor
R - restless, referred, respiratory distress
M - malnourished
O - oedema
B - burn

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15
Q

Whos should be triaged?

A

everyone

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16
Q

Who can triage?

A

all of us

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17
Q

Causes of upper airway obstruction?

A
  1. Foreign body
  2. anaphylaxis
  3. croup
  4. bacterial tracheitis
  5. epiglottitis
  6. congenital malformations
  7. trauma
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18
Q

Causes of lower airway disorders?

A
  1. Asthma
  2. bronchiolitis
  3. pneumonia
  4. pneumothorax
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19
Q

Causes of respiratory depression?

A
  1. Seizure
  2. poisoning
  3. raised intracranial pressure
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20
Q

How to manage the airway in a choking infant? (foreign body aspiration with increasing respiratory distress)

A
  1. lay the infant on your arm or thigh in a head down position
  2. give 5 blows to the infants back with heel of hand
  3. if obstruction persists, turn infant over and give 5 chest thrusts with 2 fingers, 1 finger breadth below the nipple line in midline
  4. if obstruction persists, check infants mouth for any obstruction which can be removed
  5. if necessary, repeat sequence with back slaps again
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21
Q

How to manage the airway in a choking child? (foreign body aspiration with increasing respiratory distress)

A
  1. give 5 blows to the childs back with heel of hand with child sitting, kneeling or lying
  2. if the obstruction persists go behind the child and pass your arms around the child’s body
    - form a fist with one hand immediately below the child’s sternum
    - place the other hand over the fist and pull upwards into the abdomen
    - repeat this Heimlich maneuver 5 times
  3. if the obstruction persists, check the child’s mouth for any obstruction which can be removed
  4. if necessary, repeat the sequence with back slaps again
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22
Q

Airway and breathing exam?
Look, listen, feel and look again

A
  1. Look
    - is he active, alert, talking, obviously breathing?
    - is his chest moving?
  2. Listen
    - are there any breath sounds? Are they normal?
  3. Feel
    - can you feel breath at the nose or the mouth of the child?
  4. Look again
    - is the child centrally cyanosed?
    (remember in anaemia cyanosis is absent)
    - does the child have severe respiratory distress?
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23
Q

Signs of increased work of breathing?

A
  1. increased RR
  2. recessions
  3. grunting
  4. using accessory muscles
  5. flaring nares
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24
Q

Signs of obstructed breathing?

A

Noisy breathing – stridor, wheeze

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25
Q

Problems of a tired child?

A

a tired child stops breathing

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26
Q

Name positions for opening the airway in an infant and older child?

A
  1. infant - neutral position
  2. older child - sniffing position
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27
Q

Management of airway in a child with obstructed breathing if neck trauma is suspected?

A
  1. stabilize the neck with sand bags on the side of the head
  2. inspect mouth and remove foreign body if present
  3. clear secretions from throat
  4. check the airway by looking for chest movements, listening for breath sounds and feeling for breath
  5. open airway with jaw thrust without head lift
    - if child is still not breathing ventilate with bag and mask
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28
Q

Management of airway in a child with obstructed breathing/stopped breathing
Child is conscious and no neck trauma?

A
  1. inspect mouth and remove foreign body if present
  2. clear secretions from throat
  3. let child assume position of maximal comfort
  4. if the child is still not breathing ventilate with bag and mask
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29
Q

Management of airway in a child with obstructed breathing/stopped breathing
Child is unconscious and no neck trauma?

A
  1. tilt head - sniffing position
  2. inspect mouth and remove foreign body if present
  3. clear secretons from throat
  4. check the airway by looking for chest movements, listening for breath sounds and feeling for breath
  5. if child is still not breathing ventilate with bag and mask
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30
Q

How to size adjunct airways?

A
  1. mouth to angle of mandible
  2. nose to base of earlobe
31
Q

Oxygen therapy in management of airway and breathing problems?

A
  1. if still not breathing after clearing the airway for obstruction ventilate with bag and mask
  2. High flow is 2 L/minute per kg for the first 10 kg body weight plus 0.5 L/min per kg for each kg body weight after to a max of 50 L/minute
  3. mask is to be placed over nose and mouth tightly sunctioned
32
Q

Causes of circulatory shock?

A
  1. hypovolemia
  2. maldistribution of fluid
  3. cardiogenic
  4. neurogeneic
33
Q

Hypovolemic causes of shock?

A
  1. Sepsis
  2. dehydration – gastroenteritis
  3. DKA
  4. Blood loss
34
Q

Maldistribution of fluid that causes shock?

A
  1. Sepsis
  2. anaphylaxis
  3. peritonitis
  4. intestinal obstruction
    - intussusception, malrotation, atresia, stenosis
35
Q

Cardiogenic causes of shock?

A
  1. arrhythmias
  2. heart failure
36
Q

Neurogenic causes of shock?

A

spinal cord injury

37
Q

Assessment of circulation?

Signs of shock?

A
  1. Are the hands warm?
  2. Is the capillary refill >3 sec
  3. Is the pulse weak and fast?
    - Abnormal sign is foundSTOP triage and give appropriate Rx
    Note: All the 3 signs must be present to diagnose shock
38
Q

When not to give fluids in circulation management?

A
  1. Fluids harmful in cardiogenic shock
  2. If one or two signs of impaired circulation, do not give rapid infusions
39
Q

If there is no shock do not give rapid infusion in?

A
  1. severe febrile illness
  2. severe pneumonia
  3. severe malaria
  4. Meningitis
  5. Severe acute malnutrition
  6. severe anemia
  7. congestive heart failure with pulmonary oedema
  8. congenital heart disease
  9. renal failure or diabetic ketoacidosis
40
Q

What is intraosseous needle placement?

A

is a procedure for obtaining access to the circulation in an emergency including in some cases of cardiac arrest
- if you cannot cannulate a vein rapidly

41
Q

Management of circulation a shocked child?

A
  1. stop any bleeding
    - apply firm pressure
  2. high flow oxygen
  3. IV fluids
    - RL or Normal Saline 10 -20 mls/kg 30-60min
    OR
    - blood immediately if anemia
  4. reassess > no improvement
    - 10mls/kg in 30 min
  5. reassess > no improvement
    - inotrope infusion : adrenaline or dopamine
  6. reassess > no improvement
    - hydrocortisone
    N.B. If shock has resolved, then provide fluids to maintain normal hydration status only (maintenance fluids).
42
Q

What to check for during fluid infusion?

A
  1. Check blood glucose and correct if low
  2. Monitor the effect of fluid
  3. If, at any time during fluid infusions, there are signs of fluid overload, cardiac failure, or neurological deterioration then the infusion of fluids should be stopped and no further intravenous infusions of fluids should be given until these signs resolve
43
Q

Infection management in circulation?

A

Give antibiotics for bacterial sepsis +/– antimalarial if in malaria endemic area

44
Q

What to give if you see signs of fluid overload or heart failure during circulation management?

A

Diuretic (furosemide 1 mg/kg intravenous)

45
Q

What to give if hypoxaemic or have severe respiratory distress despite oxygen?

A

Positive pressure respiratory support (such as continuous positive airway pressure)

46
Q

Management of circulation in a malnourished child that is in shock?

A
  1. stop any bleeding
    - apply firm pressure
  2. give oxygen
  3. Give IV fluids RL with 5% dextrose
    or ½ N Saline with 5% DS
    or ½ str Darrows with 5%DS 15 mls/kg OVER 1 HOUR
  4. reassess > no improvement
  5. maintenance IV fluids
    AND organize blood 10ml/kg over 3 hours
    AND give F75
47
Q

Describe cardiopulmonary resuscitation?

A
  1. Check pulse (carotid, brachial or femoral pulses) for no longer than 10 s
  2. No pulse or severe bradycardia (heart rate <60 bpm)
    - Commence chest compressions
48
Q

Describe chest compressions in CPR?

A
  1. 15 compressions : 2 breaths in children
  2. 3 compressions : 1 breath in infants
  3. Depth: one-third of the anteroposterior diameter of the chest
  4. Allow chest recoil before next compression
  5. Rate 100–120 per minute
49
Q

Infant CPR techniques?

A
  1. two thumb technique
  2. two finger technique
50
Q

Child CPR techniques?

A
  1. one hand technique
  2. two hand technique
51
Q

Assessment of neurological status?

A
  1. Is the child conscious?
  2. Is the child convulsing?
  3. Is the child confused?
52
Q

Assessment of consciousness?

A

A - Awake
V - responds to voice
P - responds to pain
U - unresponsive

53
Q

Management of neurological problems?

A
  1. Is the child conscious?
  2. Manage the airway
  3. Give oxygen
  4. Check the blood sugar
  5. Position the child (recovery position)
54
Q

Causes of convulsions?

A
  1. Infection
    i.e. Malaria, meningitis or encephalitis
  2. Status epilepticus
  3. Febrile
  4. Ingestion
  5. Hypoxemia
  6. Electrolyte disturbances
  7. Tumor
55
Q

Causes of altered conscousness/seizure?

A
  1. Head injury
    - trauma/non accidental
  2. Increased ICP
    - intracranial abscess, tumor, hemorrhage
  3. Substance abuse
  4. Infection
    - encephalitis, meningitis
  5. Metabolic
    - DKA, hypoglycemia, electrolyte imbalance [Ca, Mg, Na], inborne error of metabolism
  6. Shock
  7. Hypoxemia
56
Q

Treatment of neurological problems?

A
  1. Is the child convulsing?
  2. Manage the airway (do not force anything into the mouth)
  3. Give oxygen
  4. Check the blood sugar (if low correct)
  5. Diazepam rectal/i.v (wait 10 min reasses)
  6. Still fitting > Diazepam rectal/i.v (wait 10 min reasses)
  7. Still fitting > Phenobarbitone i.m/iv or phenytoin i.v
  8. Position the child (recovery position)
57
Q

Describe how to put someone in the recovery position?

A
  1. kneel beside the person
  2. straighten their arms and legs
  3. fold the arm closest to you over their chest
  4. place the other arm at a right angle to their body
  5. get the leg closest to you and bend the knee
  6. while supporting the persons head and neck gently take the bent knee closest to you and very gently roll the person away from you
    - adjust the upper leg so both the hip and knee are bent at right angles
    - ensure the person is steady and cannot roll
  7. tilt the head back and make sure the airways are clear and open
58
Q

What is low blood sugar in a normal child?

A

<2 mmol/L

59
Q

What is low blood sugar in a malnourished child?

A

<3 mmol/L

60
Q

How do you manage low blood sugar?

A

10% dextrose

61
Q

Assessment of severe dehydration?

A
  1. Diarrhoea or vomiting?
  2. Sunken eyes?
  3. Skin pinch >3 seconds?
  4. Is he lethargic?
  5. Can he breast feed or drink?
62
Q

What is severe dehydration?

A

Severe dehydration is a Hx of D or/and V + any 2 signs

63
Q

Management of severe dehydration in a well nourished infant?

A

For infants (<12m)
1. Give 30 mls/kg in first hour
2. then 70 mls/kg in next five hours
3. Reassess every hour and adjust fluid rates if necessary
4. If IV or IO fails use NASO-GASTRIC TUBE & give ORS 20 mls/ kg/hr for 6 hrs keep reassessing
5. Give all cases ORAL fluids (ORS) soon as possible 5ml/kg/hr

64
Q

Management of severe dehydration in a well nourished child?

A

For children (12m -5yrs)
1. Give 30mls/kg in first 30 minutes
2. then give 70mls/kg in 2.5 hours
3. Reassess every hour and adjust fluid rates if necessary
4. If IV or IO fails use NASO-GASTRIC TUBE & give ORS 20 mls/ kg/hr for 6 hrs keep reassessing
5. Give all cases ORAL fluids (ORS) soon as possible 5ml/kg/hr

65
Q

Management of severe dehydration in the malnourished child?

A
  1. AVOID IV FLUIDS IF AT ALL POSSIBLE
  2. If IV necessary use: ½ N saline with 5% dextrose solution
  3. Give 15 mls/kg in first hour: 35 mls/kg in next five hours
  4. Reassess every 15 mins
  5. if PR increased 5b/min, or RR increased 5 b/min - stop IV
66
Q

Management of severe dehydration in the malnourished child when better after fluid treatment?

A

NASO-GASTRIC TUBE
1. ReSoMal 5mls/ kg/hr for 2 hrs
2. then 5-10ml/kg/hr for 4-10hrs
- For every stool give 50-100mls extra
3. At 6 hrs & 10 hrs give F75 instead of ReSoMal
4. After 10 hrs give F75

67
Q

Contents of ReSoMal?

A
  1. Water - 2l
  2. WHO-ORS -1l packet
  3. Sucrose - 50G
  4. Electrolyte + minerals - 40mls
68
Q

ReSoMal electrolyte composition?

A

45 mmol Na
40 mmol K
3 mmol Mg

69
Q

ORS electrolyte composition?

A

90 mmol Na, 20 mmol K

70
Q

Ringers lactate electrolyte composition?

A

Na - 130
K - 4
Cl - 109
lactate - 28

71
Q

Normal saline electrolyte composition?

A

Na - 154
K - 0
Cl - 154
Lactate - 0

72
Q

1/2 str Darrows electrolyte composition?

A

Na - 61
K - 18
Cl - 52
Lactate - 27

73
Q

Glucose 5% electrolyte composition?

A

nil

MBBS 3: Pediatrics (43 decks)

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