Emergency Flashcards
Features of an ALTE? (4)
- Apnoea
- Colour change
- Alteration in muscle tone
- Choking/gagging
Brief in most
Usually <10w
Common causes of ALTEs? (5)
- Infection – RSV, pertussis
- Seizures
- GORD
- Upper airway obstruction – natural or imposed
- No cause identified
Uncommon causes of ALTEs? (6)
- Cardiac arrhythmia
- Breath-holding
- Anaemia
- Heavy wrapping/heat stress
- Central hypoventilation syndrome
- Cyanotic spells from intrapulmonary shunting
2 Ix to do ASAP in an ALTE?
Blood glucose
Blood gas
Common causes of anaphylaxis in children? (5)
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
RFs for anaphylaxis/ more serious attack? (8)
- 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
Clinical features of anaphylaxis? (6)
- 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
Treatment for anaphylaxis?
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)
Common Ix for anaphylaxis? (7)
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
RFs for accidental ingestion/poisoning? (3)
- Poor parental input
- Risk of abuse/neglect
- Toddlers who can walk
RFs for self harm?
Anxiety Depression Heavy alcohol use Smoking Cannabis use
Most common age of SIDS?
2-4m
Infant RFs for SIDs? (4)
- Age 1–6m, peak at 12w
- Low birthweight and preterm (yet 60% normal birthweight term infants)
- Sex (boys 60%)
- Multiple births
Parental RFs for SIDS? (7)
- 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
Environmental RFs for SIDs? (2)
- Infant sleeps lying prone
- Infant overheated from high room temp and too may clothes and covers, esp when ill
Advice to parents to avoid SIDS? (8)
- 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
RFs for burns/scalds? (8)
- Low economic status
- Low education levels of mother
- High population density
- Household crowding
- Psychological stress in the family
- Single parent
- Younger mother
- Unemployment
Classification of depth of burns? (3)
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
When should irrigation of burns with cold water be used?
Superficial or partial thickness burns covering <10% SA
- For at least 5m
- May cause rapid cooling so not larger SA/full thickness
Largest cause of death in children >1y?
Injury
- RTAs make up majority
ABCD assessment after trauma?
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
