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Paediatrics > Emergency > Flashcards

Emergency Flashcards

1
Q

What is the AVPU score?

A

A - alert

V - voice

P - pain

U - unresponsive

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2
Q

What is warm shock?

A

Hyperdynamic shock

High cardiac output, low peripheral resistance

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3
Q

What is cold shock?

A

Hypodynamic shock

High systemic vascular resistance and low cardiac output

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4
Q

Why do patients have a narrow pulse pressure in cold shock?

A

Systolic: low due to low CO

Diastolic: high due to catecholamines that increase systemic vascular resistance to increase venous return

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5
Q

Why do patients with warm shock have a wide pulse pressure?

A

Lowered diastolic BP

Cytokines increase vascular permeability and cause systemic vasodilation, lowering the systemic vascular resistance

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6
Q

Which vasopressor is used for cold shock?

A

Adrenaline

Strong B1 activity - increases CO

​Given if fluid resuscitation is inadequate

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7
Q

Which vasopressor is used for warm shock?

A

Noradrenaline

Acts on alpha 1 and beta 1 receptors, producing potent vasoconstriction and a modest increase in cardiac output

Given if fluid resuscitation is inadequate

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8
Q

Is cold or warm shock more common in infants/neonates?

A

Cold shock

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9
Q

What is the difference between SJS and TEN?

A

Extent of spread

<10% SJS

>30% TEN

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10
Q

What is the most common cause of SJS?

A

Drugs (80%)

Antibiotics (sulfonamides), corticosteroids, antiepileptics, alllopurinol, antiretrovirals

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11
Q

What is the pathophysiology of SJS?

A

Delayed type IV hypersensitivity

Cytotoxic t cells → keratinocyte damage

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12
Q

How does mucous membrane involvement differentiated SJS from staphylococcal scalded skin syndrome?

A

Involved in SJS

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13
Q

How is SJS treated?

A

Cease offending drug

Supportive

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14
Q

How is Kawasaki disease diagnosed?

A

Fever + 4 of

  1. Fever lasting > 4 days
  2. Bilateral conjunctival injection (non-exudative)
  3. Erythematous rash
  4. Dry/red fissured lips or strawberry tongue
  5. Oedema of hands/feet
  6. At least once cervical lymph node > 1.5cm
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15
Q

How are the points in the GCS distributed?

A

Eye - 4

Verbal - 5

Motor - 6

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16
Q

How are eye responses scored for the GCS?

A

4 - spontaneous

3 - verbal command

2 - pain

1 - no eye opening

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17
Q

How are verbal responses scored for the GCS?

A

5 - orientated

4 - confused

3 - inappropriate words

2- incomprehesible sounds

1 - no verbal response

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18
Q

How is motor response scored for the GCS?

A

6 - obeys commands

5 - localises pain

4 - withdraws from pain

3 - flexion to pain

2 - extension to pain

1 - no motor response

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19
Q

How is DIC from meningococcal treated?

A

Antithrombin

(thrombotic/organ failure type)

Antithrombin inhibits thrombin and other coagulation factors

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20
Q

What is the empirical treatment for suspected meningococcal sepsis?

A

Benzylpenicillin IV or IM

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21
Q

How is adrenaline dosed in childhood?

A

10 micrograms/kg

0.01mL/kg of 1:1000

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22
Q

What doses are children defibrillated with?

A

4 J/kg

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23
Q

What is the definition of hypoglycaemia in a child?

A

BGL < 2.6 mmol/L

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24
Q

What fluid type is given for resuscitation/bolus?

A

0.9% NaCl

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25
Q

How is a child’s fluid bolus calculated?

A

20mL/kg

0.9% NaCl

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26
Q

How are a child’s replacement fluids calculated?

A

Weight x % deficit x 10mL

(only replace to 5% in the first 24 hours)

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27
Q

How do you calculate a child’s daily fluid requirements for maintenance?

A
28
Q

What % body weight loss corresponds with mild, moderate and severe dehydration?

A

3% mild

5% moderate

10% severe

29
Q

When is supplemental oxygen used in an asthma attack?

A

SaO2 < 94%

Maintain > 94%

30
Q

When is Ipratropium used for acute asthma?

Include timing and dose

A

Severe +/- moderate asthma

Every 20 minutes x 3 with salbutamol

< 6 years: 4 puffs

6+ years: 8 puffs

31
Q

What is third space loss?

A

Too much fluid moves from the intravascular space into the interstitial space

  • Three spaces:*
    1. intracellular*
    1. intravascular*
    1. interstitial*
32
Q

What BSL should be maintained in DKA treatment before insulin is infused?

A

10-15

So insulin can be administered and resolve ketoacidosis

33
Q

What serum potassium level is a contraindication to insulin in DKA?

A

< 3.3 mmol/L

34
Q

How fast should BSL fall in DKA management?

A

4 mmol/L to prevent cerebral oedema

35
Q

What is the proposed pathophysiology of cerebral oedema with DKA?

A

Hyperglycaemia → hyperosmolality

Insulin → reversal of osmolality → fluid moves intracellularly → cerebral oedema

36
Q

What are the clinical features of cerebral oedema in the management of DKA?

A

Headache, vomiting, irritability, lethargy, elevated BP, altered mental status, incontinence, focal neurological deficits

37
Q

During basic life support, for how long do you attempt to feel a pulse before commencing chest compressions?

A

10 seconds

38
Q

Which pulses are most reliable for palpation in children?

A

Carotid, femoral, brachial

39
Q

What is the COACHED approach to defibrillation?

A

C - compressions continue

O - oxygen away

A - all else clear

C - charging

H - hands off/I’m safe

E - evaluate rhythm

D - defibrillation or disarm and dump

40
Q

How much energy should be given in a shock from a defibrillator?

A

4J/kg

41
Q

What is unstable bradycardia?

A

HR < normal PLUS signs of shock

HR < 60 bpm in infants

42
Q

How should unstable bradycardia be managed in a responsive patient?

A
  1. Bag and mask ventilation with high flow oxygen
  2. Volume expansion 20ml/kg 0.9% NaCl
  3. Consider atropine 20mcg/kg IV or IO if vagal cause
43
Q

What gas flow rate should be set for neonates on the neopuff?

A

10L/min

44
Q

What maximal pressure should be set for neonates on the neopuff?

A

50cm H2O

45
Q

What PEEP should be set for neonates on the neopuff?

A

5-8 cm H2O

46
Q

What PIP should be set for neonates on the neopuff?

A

30cm H2O (term)

20-25 cm H2O (preterm)

47
Q

What does a small amount of PEEP do?

A

Prevent end-expiratory alveolar collapse

48
Q

What are 3 paediatric insertion sites for an IO access?

A
  1. Distal femur
  2. Proximal tibia
  3. Distal tibia
  4. Proximal humerus
49
Q

Where is the IO insertion site on the proximal tibia?

A

2cm below the tibial tuberosity

1cm medially

50
Q

Where is the IO insertion site on the distal femur?

A

1-2cm above the superior border of the patella with the leg in extension

51
Q

Where is the IO insertion site on the distal tibia or fibula?

A

1-2cm superior to the melleoli in the bone’s axis

52
Q

Where is the IO insertion site on the proximal humerus?

A

Greater tubercle

53
Q

What are the clinical features of an effective cough?

A

Crying or talking

Loud cough

Able to take a breath before coughing

Fully responsive

Mild airway obstruction

54
Q

What are the clinical features of an ineffective cough?

A

Unable to cry to talk

Quiet or silent coug

Unable to breathe

Cyanosis

Decreased level of consciousness

55
Q

How is an ineffective cough managed in a conscious patient?

A

Call for help

5 back blows, 5 chest thrusts

Assess and repeat

56
Q

What is the effect of adenosine on the heart?

A

Slows heart rate

Suppresses SA node activivation and slows conduction through the AV node

57
Q

How is stable SVT managed?

A
  1. Vagal manoeuvre - ice pack to the face
  2. IV adenosine 0.1mg/kg
58
Q

How is the shocked patient with SVT managed?

A

Synchronised DC cardioversion

1 joule/kg

59
Q

What do the 4 H’s and 4 T’s describe?

A

Reversible causes of cardiac arrest

60
Q

What is involved in a septic workup?

A
  1. Blood cultures
  2. CXR
  3. Lumbar puncture
  4. Urine culture
61
Q

Over what period of time is the fluid deficit in DKA corrected?

A

48 hours

The aim is the achieve sufficient perfusion to avoid acute tubular necrosis but keep the patient relatively hydrated while the metabolic defect is corrected

62
Q

What is the ABCDE approach to a sick child?

A

A - airway

B - breathing

C - circulating

D - disability

E - exposure

(F - fluids)

(G - glucose)

63
Q

What dose of salbutamol is given via a nebuliser in severe asthma?

(nebulised not given in mild/moderate)

A

1-5 years: 2.5 mg

6+ years: 5 mg

64
Q

What dose of nebulised ipratropium is given to children with a severe asthma exacerbation?

(Ipratropium + nebulised bronchodilators are not used in mild/moderate asthma)

A

1-5 years: 250 mcg

6+ years: 500 mcg

65
Q

What are the features of a severe asthma exacerbation?

A

Intercostal/subcostal recession or tracheal tug

Unable to complete sentences in one breath

Obvious respiratory distress

Oxygen saturation 90–94%

Paediatrics (24 decks)

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