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Child Health > Emergency > Flashcards

Emergency Flashcards

1
Q

What age do Acute Life Threatening Events more commonly occur in?
What are the main features? (4)

A

<10wks

Apnoea
Colour change
Muscle tone change
Choking/gagging

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2
Q

What are the common causes of ALTEs? (5)

And less common causes? (6)

A 
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)
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3
Q

How are ALTEs managed?

A

Detailed Hx/Ex (any probs with baby/care giving)
Admit overnight: baseline Ix + sats/resp/ECG
Teach parents resuscitation
FU appt (paed nurse/paediatrician)

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4
Q

List the DDx for acute upper airway obstruction (10)

A 
Viral croup
Epiglottitis
Foreign body
Anaphylaxis
Bacterial tracheitis
Smoke inhalation
Retropharyngeal abscess
Infectious mononucleosis (severe LN swelling)
Measles 
Diphtheria
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5
Q

What is the basic management for acute upper airway obstruction (5)

A

DO NOT examine throat
Stay calm - reduce anxiety
Observe any signs of hypoxia/deterioration
Severe - neb adrenaline
Resp failure - urgent intubation / anaesthetist

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6
Q

What are the 4 main systems / effects of anaphylaxis?

A

Skin
CV - increased permeability, reduced CV tone, angioedema
Resp - bronchospasm, laryngospasm
GI - poss bloody diarrhoea

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7
Q

What are the RFs for more serious consequences of anaphylaxis? (6)

A 
Younger (smaller airway)
Asthmatic
Hypotension
Bradycardia
Chronic GI symps (risk vom)
PMH/FH allergies/anaphylaxis
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8
Q

What are the main Dx criteria of anaphylaxis (2)

A

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)

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9
Q

What may be seen in an ABC assessment in anaphylaxis?

A

A - swelling/ hoarseness/ stridor
B - tachypnoea/ wheeze/ cyanosis/ sats<92
C - pale-clammy/ hypotension/ drowsy-coma

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10
Q

What Ix may be considered to establish cause of ALTE? (4 ASAP + 7)

A 
ASAP:
Cardioresp monitoring
O2 sats
Glucose 
Blood gases
Other:
FBC/ U&amp;Es/ LFTs/ Lactate
Urine MC+S
EEG
ECG (QT abn)
Barium swallow/oesophageal pH
CXR
LP
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11
Q

What are some of the common allergens causing anaphylaxis?

A 
Foods 
Preservatives/additives
Drugs
Biologicals (e.g. vaccine/venom)
Other (e.g. latex)
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12
Q

Describe the immediate management for anaphylaxis (5)

Describe the medium-long term management (5)

A

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)
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13
Q

List some common investigations for anaphylaxis (2+4)

A 
Serum histamine (raised)
Serum tryptase (raised)

C1INH
Urine VMA
Serum serotonin
Cutaneous antigen testing

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14
Q

Which age group are most at risk of poisoning/ingestion/overdose?

A 
Walking toddlers (2-3y/o)
NB may be risk of abuse/neglect
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15
Q

How may paracetamol overdose present?

+ NSAIDs

A

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

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16
Q

How may Iron overdose present?

A

Initially: D+V, haematemesis, melaena, acute GI ulcer
Later: drowsy, coma, shock, liver failure, hypogly, convulsions
Long-term: gastric strictures

17
Q

How may methadone overdose present? (5)

A

Pinpoint pupils, N+V, constipation, Low BP/HR/RR

18
Q

How may alcohol overdose/ingestion present? (3)

A

Hypoglycaemia
Resp failure
Coma

19
Q

How may detergent ingestion present? (4)

A

Dyspnoea
Dysphagia / oral+cheek pain
Abdo pain
N+V

20
Q

Outline the general immediate management of overdose/ingestion (3)

A

ID poison
Assess agents toxicity (e.g. blood levels)
Removal? Only if <1hr

21
Q

What options are available for poison removal in ingestion (3)

A 
Activated charcoal
Gastric lavage (for large ingestions)
Induced vomiting
22
Q

What other forms of management should be considered (as well as the clinical)

A

Assess social circumstances

Contact A&E + CAMHS if needed

23
Q

List some Epidemiological RFs for overdose/ingestion (3)

List some clinical RFs (6)

A

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
24
Q

List the infantile causes of SIDS (5)
List the parental causes (3)
List the environmental causes (2)

A 
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

25
Q

What advice can be given to parents about avoiding SIDS (4)

A

Put sleep on back
Avoid overheating
Feet at foot of bed (so don’t slip under covers)
Stop smoking

26
Q

What are the RFs for burns/scalds (7)

A 
Low economic status
Household crowding
High population density
Low maternal education levels
Psychological stress in fam
Single/younger mums (esp unemployed)
<5yrs (thinner skin)
27
Q

What features may be seen in burns/scalds? (5)

A 
Blisters
Pain
Peeling skin
Shock
Airway obstruction
28
Q

Describe the initial management for burns/scalds in ED

A

Assess severity

Assess depth of burn (deep req skin graft + burns unit)

29
Q

What are the main principles of burns/scald management (5)

A 
Pain relief
IV fluids
Wound care (ongoing)
Psych support
Consider safeguarding
30
Q

How are electrical burns different to normal burns/scalds? (2)

A

Most occur hands/mouth

Injuries also from being thrown from electrical source (if AC)

31
Q

What things are assessed in paediatric trauma ABCD

A

A+B: airway obstruction/ wheeze/ stridor/ RR + effort/ bilateral air entry
C: HR/ BP/ CRT/ Sats+cyanosis
D: Consciousness/ Posture (tone)/ Pupils

32
Q

How is paediatric ACB managed in trauma?

A

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

33
Q

In a head injury, what 4 things may indicate Potentially Severe / Severe?

A

Persisting coma
Deteriorating GCS
Seizures (w/o full recovery)
Focal neurological signs

34
Q

What is the management for Mild / Potentially Severe / Severe head injuries?

A

Mild → discharge home w. written advice
Potentially → monitor to avoid secondary damage
Severe → resus/CT/neurosurg

Child Health (14 decks)

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