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Paeds > Emergency > Flashcards

Emergency Flashcards

1
Q

Features of an ALTE? (4)

A
  • Apnoea
  • Colour change
  • Alteration in muscle tone
  • Choking/gagging

Brief in most
Usually <10w

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2
Q

Common causes of ALTEs? (5)

A
  • Infection – RSV, pertussis
  • Seizures
  • GORD
  • Upper airway obstruction – natural or imposed
  • No cause identified
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3
Q

Uncommon causes of ALTEs? (6)

A
  • Cardiac arrhythmia
  • Breath-holding
  • Anaemia
  • Heavy wrapping/heat stress
  • Central hypoventilation syndrome
  • Cyanotic spells from intrapulmonary shunting
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4
Q

2 Ix to do ASAP in an ALTE?

A

Blood glucose

Blood gas

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5
Q

Common causes of anaphylaxis in children? (5)

A

Food (85%) - milk, eggs, wheat, fish, soy

Medicine - abx, local anaesthetic, analgesics, opiates, radio contrast

Biologicals - venoms, vaccines

Presevatives/additives - MSG

Other - latex, unknown/idiopathic

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6
Q

RFs for anaphylaxis/ more serious attack? (8)

A
  • Younger (smaller airway)
  • Adolescent – higher risk of death
  • Asthma
  • Nut allergy – higher risk of death
  • Chronic GI sx (increased risk vomiting)
  • Hypotension
  • Bradycardia
  • Personal/ FH of allergies +/or anaphylaxis
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7
Q

Clinical features of anaphylaxis? (6)

A
  • Acute onset of skin +/or mucosal sx (hives, facial swelling etc)
  • +/- Respiratory compromise (bronchospasm, SOB, stridor)
  • +/- Persistent GI sx (crampy abdo pain, vomiting)
  • +/- Reduced BP
  • Associated sx of end-organ dysfunction (hypotonia, syncope, incontinence)
  • May → shock and DIC
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8
Q

Treatment for anaphylaxis?

A

Adrenaline 1:1000 IM

  • <6y = 150 micrograms (0.15ml)
  • > 6y = 500 micrograms (0.5ml)

PLUS

  • High flow O2 (establish airway 1st)
  • IV fluid (20ml/kg)
  • Chlorpheniramine (IM or slow IV)
  • Hydrocortisone (IM or slow IV)
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9
Q

Common Ix for anaphylaxis? (7)

A

Serum histamine
- Rises quickly, fall after 30-60m

Serum tryptase
- Peak at 60-90m, remain raised for 5h

Others:

  • C1 inhibitor functional assay (C1INH)
  • Urine vanillylmandelic acid (VMA)
  • Serum serotonin levels
  • Radio-allergosorbent test (RAST)
  • Cutaneous antigen testing
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10
Q

RFs for accidental ingestion/poisoning? (3)

A
  • Poor parental input
  • Risk of abuse/neglect
  • Toddlers who can walk
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11
Q

RFs for self harm?

A 
Anxiety
Depression
Heavy alcohol use
Smoking
Cannabis use
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12
Q

Most common age of SIDS?

A

2-4m

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13
Q

Infant RFs for SIDs? (4)

A
  • Age 1–6m, peak at 12w
  • Low birthweight and preterm (yet 60% normal birthweight term infants)
  • Sex (boys 60%)
  • Multiple births 

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14
Q

Parental RFs for SIDS? (7)

A
  • Low income
  • Poor or overcrowded housing
  • Maternal age (mother aged <20y has 3x risk of mother aged 25–29y, but 80% of affected mothers are >20y)
  • Single unsupported mother (twice the rate of supported mothers)
  • High maternal parity
  • Maternal smoking during pregnancy (1–9 
cigs/day doubles risk: >20/day 5x risk)
  • Parental smoking after birth 

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15
Q

Environmental RFs for SIDs? (2)

A
  • Infant sleeps lying prone

- Infant overheated from high room
temp and too may clothes and covers, esp when ill

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16
Q

Advice to parents to avoid SIDS? (8)

A
  • Infant sleep on back
  • Prevent overheating (not overwrap)
  • ‘Feet to foot’ position (bottom of cot)
  • Don’t smoke during preg or near infant after
  • Have baby in parents room for 1st 6m
  • Avoid bringing baby into bed when tired/alcohol/sedated
  • Avoid sleeping with baby on sofa
  • Seek prompt advice if baby is unwell
17
Q

RFs for burns/scalds? (8)

A
  • Low economic status
  • Low education levels of mother
  • High population density
  • Household crowding
  • Psychological stress in the family
  • Single parent
  • Younger mother
  • Unemployment
18
Q

Classification of depth of burns? (3)

A

Superficial burns
→ Skin epithelialised from surviving cells

Partial thickness burns
→ Some damage to dermis with blistering, and skin is pink or mottled

  • Regeneration for superficial and partial thickness burns is from margins of wound and from residual epithelial layer surrounding hair follicles deep within dermis

Deep (full thickness) burns
→ Skin destroyed down to and inc dermis and looks white or charred, is painless and involves hair follicles, hence skin grafting often required
- Deep burns need assessment and treatment in hospital

19
Q

When should irrigation of burns with cold water be used?

A

Superficial or partial thickness burns covering <10% SA

  • For at least 5m
  • May cause rapid cooling so not larger SA/full thickness
20
Q

Largest cause of death in children >1y?

A

Injury

- RTAs make up majority

21
Q

ABCD assessment after trauma?

A

Airway and breathing

  • Assess for airway obstruction
  • Work of breathing/effort
  • Resp rate
  • Stridor, wheeze, auscultation for air entry
  • Cyanosis

Circulation

  • Heart rate
  • Pulse volume
  • Capillary refill time
  • BP
  • Control any bleeding

Disability

  • Consciousness
  • Posture (hypotonia, decorticate, decerebrate)
  • Pupil size and reactivity

Paeds (15 decks)

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