Emergency Flashcards
What age do Acute Life Threatening Events more commonly occur in?
What are the main features? (4)
<10wks
Apnoea
Colour change
Muscle tone change
Choking/gagging
What are the common causes of ALTEs? (5)
And less common causes? (6)
Common: Seizures Infections (RSV, pertussis) Upper airway obstruction Reflux Idiopathic
Uncommon: Cardiac arrhythmia Breath-holding Anaemia Heat stress Central hypoventilation syndrome Cyanotic spells (intrapulm shunt)
How are ALTEs managed?
Detailed Hx/Ex (any probs with baby/care giving)
Admit overnight: baseline Ix + sats/resp/ECG
Teach parents resuscitation
FU appt (paed nurse/paediatrician)
List the DDx for acute upper airway obstruction (10)
Viral croup Epiglottitis Foreign body Anaphylaxis Bacterial tracheitis Smoke inhalation Retropharyngeal abscess Infectious mononucleosis (severe LN swelling) Measles Diphtheria
What is the basic management for acute upper airway obstruction (5)
DO NOT examine throat
Stay calm - reduce anxiety
Observe any signs of hypoxia/deterioration
Severe - neb adrenaline
Resp failure - urgent intubation / anaesthetist
What are the 4 main systems / effects of anaphylaxis?
Skin
CV - increased permeability, reduced CV tone, angioedema
Resp - bronchospasm, laryngospasm
GI - poss bloody diarrhoea
What are the RFs for more serious consequences of anaphylaxis? (6)
Younger (smaller airway) Asthmatic Hypotension Bradycardia Chronic GI symps (risk vom) PMH/FH allergies/anaphylaxis
What are the main Dx criteria of anaphylaxis (2)
Acute onset of skin +/or mucosal symps (tingling mouth/ runny nose/ itchy eyes/ flushed)
Signs of end-organ dysfunction (resp compromise/ low BP/ hypotonia/ syncope/ incontinence)
What may be seen in an ABC assessment in anaphylaxis?
A - swelling/ hoarseness/ stridor
B - tachypnoea/ wheeze/ cyanosis/ sats<92
C - pale-clammy/ hypotension/ drowsy-coma
What Ix may be considered to establish cause of ALTE? (4 ASAP + 7)
ASAP: Cardioresp monitoring O2 sats Glucose Blood gases
Other: FBC/ U&Es/ LFTs/ Lactate Urine MC+S EEG ECG (QT abn) Barium swallow/oesophageal pH CXR LP
What are some of the common allergens causing anaphylaxis?
Foods Preservatives/additives Drugs Biologicals (e.g. vaccine/venom) Other (e.g. latex)
Describe the immediate management for anaphylaxis (5)
Describe the medium-long term management (5)
Help → Supine → adrenaline → estab airway + give O2 → IV fluids + steroids → monitor BP/sats/ECG
Epipen for future Avoid allergen Antihistamines (if mild) Steroids (prevent late phase) Immunotherapy (desensitise pt to allergens)
List some common investigations for anaphylaxis (2+4)
Serum histamine (raised) Serum tryptase (raised)
C1INH
Urine VMA
Serum serotonin
Cutaneous antigen testing
Which age group are most at risk of poisoning/ingestion/overdose?
Walking toddlers (2-3y/o) NB may be risk of abuse/neglect
How may paracetamol overdose present?
+ NSAIDs
Older, gastric irritation + liver failure after 3-5d
Mild N+V, elec abns
Large ingestion: Tachypnoea, Multi-Organ Failure, Abdo pain, Seizures, Coma, Tinnitus, Nystagmus
How may Iron overdose present?
Initially: D+V, haematemesis, melaena, acute GI ulcer
Later: drowsy, coma, shock, liver failure, hypogly, convulsions
Long-term: gastric strictures
How may methadone overdose present? (5)
Pinpoint pupils, N+V, constipation, Low BP/HR/RR
How may alcohol overdose/ingestion present? (3)
Hypoglycaemia
Resp failure
Coma
How may detergent ingestion present? (4)
Dyspnoea
Dysphagia / oral+cheek pain
Abdo pain
N+V
Outline the general immediate management of overdose/ingestion (3)
ID poison
Assess agents toxicity (e.g. blood levels)
Removal? Only if <1hr
What options are available for poison removal in ingestion (3)
Activated charcoal Gastric lavage (for large ingestions) Induced vomiting
What other forms of management should be considered (as well as the clinical)
Assess social circumstances
Contact A&E + CAMHS if needed
List some Epidemiological RFs for overdose/ingestion (3)
List some clinical RFs (6)
Epidem:
Social class/ Living alone/ Men
Clinical: Psychiatric illness Alc dependance PMH self-harm FH depression/alc/suicide Chronic physical illness Recent adverse events eg bereavement
List the infantile causes of SIDS (5)
List the parental causes (3)
List the environmental causes (2)
1-6m Male Low birth wt / preterm Multiple births GI reflux
Poor/overcrowded
Mum <20/single/high parity
Maternal smoking during preg
Face down
Overheating
What advice can be given to parents about avoiding SIDS (4)
Put sleep on back
Avoid overheating
Feet at foot of bed (so don’t slip under covers)
Stop smoking
What are the RFs for burns/scalds (7)
Low economic status Household crowding High population density Low maternal education levels Psychological stress in fam Single/younger mums (esp unemployed) <5yrs (thinner skin)
What features may be seen in burns/scalds? (5)
Blisters Pain Peeling skin Shock Airway obstruction
Describe the initial management for burns/scalds in ED
Assess severity
Assess depth of burn (deep req skin graft + burns unit)
What are the main principles of burns/scald management (5)
Pain relief IV fluids Wound care (ongoing) Psych support Consider safeguarding
How are electrical burns different to normal burns/scalds? (2)
Most occur hands/mouth
Injuries also from being thrown from electrical source (if AC)
What things are assessed in paediatric trauma ABCD
A+B: airway obstruction/ wheeze/ stridor/ RR + effort/ bilateral air entry
C: HR/ BP/ CRT/ Sats+cyanosis
D: Consciousness/ Posture (tone)/ Pupils
How is paediatric ACB managed in trauma?
A: Jaw thrusts/ Neck collar (only immobilise after normal cervical Xray/neuro Ex)
B: High flow O2 mask/ ventilate
C: Stop any bleeding/ Fluid bolus/ FBC+Cross-Match
In a head injury, what 4 things may indicate Potentially Severe / Severe?
Persisting coma
Deteriorating GCS
Seizures (w/o full recovery)
Focal neurological signs
What is the management for Mild / Potentially Severe / Severe head injuries?
Mild → discharge home w. written advice
Potentially → monitor to avoid secondary damage
Severe → resus/CT/neurosurg
