Emergency - ALTE/Anaphylaxis/Poisoning Flashcards
What is an acute life threatening event (ALTE)?
Occur in infants + combination of apnoea, colour change, alteration in muscle tone, choking or gagging
Most common in infants less than 10 weeks old, may occur on multiple occasions
What are the common causes of ALTE?
- Infections – RSV, pertussis
- Seizures
- Gastro-oesophageal reflux (in 1/3 normal infants)
- Upper airways obstruction – natural or imposed
- No cause identified
How should an acute illness in a child be acutely managed?
- detailed history and thorough examination to identify problems
- admit infant
What are the common investigations used in ALTE?
- baseline investigations
- overnight monitoring of oxygen saturations, respiration, ECG
- blood glucose
- blood gas
- oesophageal pH monitoring
- barium swallow
- bloods - FBC, UEs, LFTs, lactate
- Urine - metabolic studies, microscopy and culture, toxicology
- CXR
- LP
What is the pathophysiology of an anaphylactic shock?
IgE mediated reaction with significant respiratory or CV compromise
What are the common causes of anaphylaxis?
- Food allergy
- Insect stings
- Drugs
- Latex
- Exercise
- Inhalant allergens
- Idiopathic
What are the risk factors for a fatal outcome in anaphylaxis?
adolescent age group
coexistent asthma
nut allergy
What are the common presenting features of anaphylaxis?
- cutaneous/ocular: flushing, urticarial, angioedema, cutaneous and/or conjunctival pruritus, warmth & swelling
- respiratory: nasal congestion, rhinoorhea, throat tightness, wheezing, SOB, cough, hoarseness
- CV: dizziness, weakness, syncope, chest pain, palpitations
- GI: dysphagia, N&V, diarrhoea, bloating, cramps
- Neurologic: headache, dizziness, blurred vision, seizure
What are the immediate management stages in anaphylactic shock?
ABCDE
Assess and diagnose where problem is occurring
Call for help
Put patient in supine position with legs raised
Adrenaline 1:1000 IM
if available: establish airway high flow oxygen IV fluid chlorpheniramine - IM or slow IV hydrocortisone - IM or slow IV
monitor:
pulse
ECG
BP
What is the long term management of anaphylaxis?
detailed strategies and training for allergen avoidance
written management plan with instructions for treatment of allergic reactions
provision of adrenaline auto-injectors
What investigations are used in anaphylaxis?
rarely used unless diagnosis is unclear
- plasma histamine or urinary histamine metabolites
- skin testing
- serum tryptase measurements
What is the best out of hospital management for anaphylaxis?
epipen
When is accidental poisoning common in children?
young children with peak age at 30 months
most occur in child’s own home, when supervision inadequate
When is deliberate harm through overdose/self injury most common?
older children
What are the common presenting features of paracetamol overdose?
gastric irritation
liver failure after 3-5 days
What is the management of a paracetamol overdose?
check plasma conc 4 hours after ingestion
start IV acetylcysteine if plasma conc high
monitor prothrombin time, LFTs and plasma creatinine
How does an iron overdose present?
D&V, haematoemesis, melaena, acute gastric ulceration
Latent period of improvement
Later - coma, shock, liver failure
Long term - gastric strictures
How is an iron overdose managed?
Serious toxicity if >60mg/kg elemental iron
AXR to count number of tablets
Serum iron levels
Gastric lavage considered in severe cases if <1 hour after ingestion
IV desferrioxamine for chelation
How does an alcohol overdose present?
Hypoglycaemia
Coma
Respiratory failure
How is an alcohol overdose managed?
Monitor blood glucose
IV glucose if necessary
Blood alcohol levels for severity
How does the ingestion of detergents present?
dyspnoea dysphagia oral pain cheek pain abdominal pain N&V
How is the ingestion of detergents managed?
no emesis /gastric lavage
no chemical antidotes as they produce heat
early endoscopy
How does an NSAID overdose present?
N&V electrolyte abnormalities altered consciousness level tachypnoea even coma may be multiple organ failure and seizures abdo pain with tinnitus and nystagmus
How is an NSAID overdose managed?
assess ABC and stabilise the patient
GI decontamination with activated charcoal
orogastric lavage
How does a methadone overdose present?
Gradual onset that is prolonged
Respiratory depression, CNS depression + pin point pupils
How is a methadone overdose managed?
If comatose + respiratory depression, naloxone
Consider gastric lavage
What resources are available in dealing with children in overdose?
A&E
CAMHS assessment
Social worker involvement
What are the important social family factors in these children?
•Early aggressive behaviour •Lack of parental supervision •Academic problems •Undiagnosed mental health problems •Peer substance abuse •Drug available •Poverty •Peer rejection •Child abuse or neglect - safeguarding issues ***
What is sudden infant death syndrome?
sudden and unexpected death of an infant or young child for which no adequate cause is found after a post mortem
What are the RF for SIDS?
most common at 2-4 months of age RFs - preterm - male sex - multiple births - GI reflux - parents: low income, poor/overcrowded house, young maternal age, smoking - environment - lying face down, overheating
What are the risk factors for adolescents who overdose or self harm?
- male
- living alone
- social class 5
- psychiatric illness
- alcohol dependence
- physical illness
- FH of depression, alcohol dependence
- recent adverse life events
What advice should be given to parents about avoidance of SIDS?
infants should be put on their backs
overheating should be avoided
place infants with feet at bottom of bed so they don’t slip under covers
do not smoke
What happens following an unexplained death of a child?
resuscitation if appropriate care of parents - history baby pronounced dead investigations - NP aspirate, bloods, LP break news to parents parents are able to hold their baby strategy discussion home visit with 24 hours post-mortem case discussion follow up and bereavement counselling
