Emergency Flashcards
What is acute life-threatening event (ALTE)
Sudden Often apnoea Colour change Alteration in muscle tone Choking Gagging
Most commonly in infants <10 weeks old - may reoccur
(potentially serious disorder or no cause)
Prognosis of ALTE
Most cases, brief episode with rapid recovery
Baseline investigations and overnight monitoring for Oxygen sats, RR, and ECG normal
Common causes of ALTE
Infections (RSV, pertussis)
Seizures
GORD (1/3 of infants)
Upper airway obstruction (natural or imposed)
Immediate management of an acutely ill child
Stimulation or resuscitation to reinitiate regular breathing
Detailed history and thorough examination
Admission to hospital
Teach resuscitation to parents
Follow up from specialist paeds nurse or paediatrician
Investigations in ALTE
Blood glucose Blood gas and lactate O2 sats monitoring Cardiorespiratory monitoring EEG Oesophageal pH monitoring Barium swallow FBC Urea and electrolytes LFTs Urine - toxicology, culture
ECT (QTc prolongation?)
CXR
Lumbar puncture
Pathophysiology of anaphylaxis
IgE mediated reaction: a previously sensitized B lymphocyte produces IgE against a specific antigen
activation of mast cells and basophils igniting a cascade that results in the release and production of severe inflammatory and vasoactive substances:
histamine, tryptase, heparin, prostaglandins, leukotrienes and cytokines
Physiological processes involved in anaphylaxis
Angioedema Bronchospasm Bronchorrhoea Laryngospasm Increased vascular permeability Decreased vascular tone Bloody diarrhoea
Common agents that cause anaphylaxis in young children
milk egg wheat soy fish shellfish tree nuts
Vaccines Antibiotics (penicillin, cephalosporin) Localanaesthetics Aspirin NSAIDs Opiates Latex Perservatives
Risk factors for anaphylaxis
Younger - smaller airway Asthma Chronic GI symptoms (increases risk of vomiting) Hypotension Bradycardia FHx
Primary diagnostic criteria of anaphylaxis
‘The acute onset of skin and/or mucosal symptoms along with either respiratory compromise and/or reduced blood pressure or associated symptoms of end-organ dysfunction eg. hypotonia, syncope and incontinence’
Very variable:
80% have cutaneous symptoms (eg. hives)
Can also just present with low SBP for age
Skin - urticarial and angioedema
Resp - acute airway obstruction with laryngeal oedema and bronchospasm
GI - severe abdo cramping and diarrhoea
Systemic - hypotension and shock
Onset may be minutes to hours
Management of anaphylaxis (acute)
ABCDE Diagnose the problem: Airway - swelling, hoarseness, stridor Breathing - tachypnoea, wheeze, cyanosis Circulation - pale, clammy, hypotension, drowsy, coma
Put in supine position (30°) with legs raised
Give IV normal saline for hypotension
Adrenaline 1:1000 (give IM unless IV experience)
0.01ml/kg every 15 minutes
Give nebulized salbutamol every 15 min if required (2.5mg if <30kg, otherwise 5mg)
Anti-histamine
Steroid - IV BOLUS methylprednisolone (2mg/kg).
Follow with IV methylprednisolone 2mg/kg/day or oral 2mg/kg/day
Medium term management of anaphylaxis
IV fluid - 20ml/kg crystalloid
Monitor: Pulse oxymetry, ECG, BP
Establish airway and high-flow oxygen
Investigations for anaphylaxis
Serum histamine (rise quickly, then fall after 30-60 min) Serum tryptase levels (peal at 60-90 minutes)
Radioallergosorbent test or cutaneous antigen after recovery to try to identify cause
Role of patient-held medication for anaphylaxis
Epipen
Epinephrin autoinjector. Provided to all people who have had anaphylaxis
Administered IM when signs and symptoms begin.
Can be life-saving
Epidemiology of poisoning
Thousands of admissions per year
Most do not develop serious symptoms
- small quantity or relatively non-toxic
Small percentage become seriously ill
Very few die each year
90% of ingestion occurs in the child home - inadequate supervision/anticipation
