Emergency Flashcards
What is meant by Bell’s palsy?
Acute, unilateral, idiopathic facial nerve paralysis
When would you normally see Bell’s palsy?
Peak incidence is 20-40 years and the condition is more common in pregnant women.
What are the features of Bell’s palsy?
Lower motor neuron facial nerve palsy- forehead is affected
Patients may also notice post auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis.
What is the treatment for Bell’s palsy?
Prednisolone 1mg/kg for ten days should be prescribed within 72 hours of onset of Bell’s palsy
Eye care is also important and therefore artificial tears and eye lubricants should be considered
How would you be able to tell whether Bell’s palsy is an upper or lower motor neuron lesion?
an upper motor neuron lesion would spare the upper face
What are the reversible causes of cardiac arrest?
4Ts
Tamponade, toxins, thrombus,
4Hs
Hypoxia, hypovolaemia, hypo/hyperkalaemia, hypo/hyperglycaemia, hypothermia
4Ts
Thrombosis (coronary or pulmonary), tension pneumothorax, tamponade (cardiac), toxins
What questions should you ask about dehydration?
Is the child producing wet nappies?
Is the child thirsty
Do they produce tears when they cry
What are the clinical features of dehydration?
The clinical features can be split into interstitial volume depletion and intravascular volume depletion.
Interstitial volume depletion…
Sunken anterior fontanelle Dry mucous membranes Dry tongue Sunken eyes and decreased tears Reduced skin turgor (pinch the skin on abdomen or thigh)
Intravascular volume depletion
Altered consciousness/ responsiveness Reduced urine output Tachypnoea Tachycardia +/- weak pulse pressure Increased cap refill time Falling blood pressure
When sending a child home who is at risk of progression to hypovolaemic shock, it is important to make parents aware of the features that the child is moving to this point, what would you tell them to look out for?
. Pale/ mottled skin Cool extremities Weak peripheral pulses Increased capillary refill time Hypotension (lastly)
Where does an epistaxis originate from?
Kiesselbachs plexus, located in Littles area, this is an area of the nasal mucosa at the front of the nasal cavity which has lots of blood vessels. when the mucosa is disrupted in this area the blood vessels are exposed and are prone to bleeding.
What are the causes of epistaxis?
Allergic rhinitis
Picking the nose
URTI
Foreign body
When would you consider posterior bleeding in epistaxis?
If there is bleeding from both nostrils.
What advise would you give to a parent who’s child is having a nose bleed?
Sit up and tilt the head forwards
Squeeze the soft part of the nostrils together for 10-15 minutes
Spit out any blood In the mouth rather than swallowing
What should be done if a nosebleed does not stop after 10-15 min/is severe/both nostrils?
Nasal packing using nasal tampons or inflatable packs
Nasal cautery using silver nitrate sticks
What May you consider prescribing after an acute nosebleed?
Naseptin four times daily for ten days, this reduces inflammation/crusting/infection
Contraindicated in peanut or soya allergy
What are febrile convulsions?
Type of seizure that occur in children with a high fever. They are not caused by epilepsy or other underlying neurological pathology such as meningitis or tumours
By definition febrile convulsions only occur between ages of 6 months and 5 years
What are simple febrile convulsions?
Generalised tonic clonic seizures, last less than 15 mins and only occur once during a single febrile illness.
What is a complex febrile convulsions?
This is when they consist of partial or focal seizures, they last more than 15 mins or occur multiple times during the same febrile illness
How do you diagnose a febrile convulsions?
In order to make a diagnosis of febrile convulsions, other neurological pathology must be excluded . Epilepsy . Encephalitis . Meningitis . Trauma . Electrolyte abnormalities . Syncopal episode
What is a typical presentation of a complex febrile child?
The first stage is to identify and manage the underlying source of infection and control the fever with simple analgesia such as: paracetamol and ibruprofen.
Parental advice if further seizure:
. Put the child in a safe place like a carpeted floor or a pillow under their head
. Place them in the recovery position and away from potential sources of injury
. Dont put anything in their mouth
. Call an ambulance if the seizure lasts for more than 5 minutes
What is the risk of developing epilepsy after a febrile convulsions?
1.8% for the general population
2-7.5% for a simple febrile convulsions
10-20% after a complex febrile convulsion
What is the pathophysiology of hypothermia?
Neonates have thin skin, little adipose tissue and a large body surface area comparative to their body weight and therefore they are very susceptible to heat loss and consequently hypothermia.
What are the risk factors for hypothermia?
Prematurity
Systemic illness
Low birthweight
Diabetic mother
How do you manage hypothermia?
Using incubator Warm mattress/skin to skin with mum
. Keeping room temp warm and avoiding droughts
. Wrapping baby, including hats and socks
What are the symptoms of hypoglycaemia in the newborn?
Jitteriness Irritability Apnoea Lethargy Drowsiness Seizures
Hypoglycaemia is particularly likely in the first 24 hours of life, what are the reasons for it?
IUGR Preterm Born to mothers with diabetes mellitus Large for dates Hypothermic, polycythaemic or ill for any reason
Why would growth restricted babies have hypoglycaemia?
Growth restricted and preterm infants have poor glycogen stores