Emergency Care Flashcards
Describe the BLS algorithm for paediatric resuscitation
Shout for help
Open airway
5 rescue breathes if not breathing normally
Then 15 chest compressions if no signs of life
Continue rescue breaths + chest compressions at ratio of 2:15
Which position should the head be in for optimal airway opening?
Infants ( < 1 year) –> neutral position
Older children –> ‘sniffing’ position
What are the indications for commencing chest compressions/?
No signs of life
No pulse
HR < 60
Where should you palpate the pulse in children?
Carotid, brachial or femoral
In infants –> brachial (carotid difficult due to short neck)
What should be done if there are signs of circulatory compromise in a child?
Establish venous access rapidly
Give a 20ml/kg bolus of normal saline (10ml/kg in DKA)
What should be done if rapid venous access is not possible in a child (can be very difficult to cannulate)?
Intraosseous access
- rapid, effective and should be considered early
If you hear bubbling sounds on assessment of a sick child’s breathing, what should be done?
Suctioning for excessive secretions
If you find a harsh stridor and a barking cough on examination, what is the emergency management?
Oral dexamethasone
Nebulised budesonide + adrenaline in severe cases
(croup)
If you find a soft stridor, drooling + fever in a sick looking child, what is the diagnosis + emergency management?
Bacterial tracheitis or epiglottitis
–> intubation by anaesthetist followed by IV antibiotics
If you suspect an inhaled foreign body, what would be the emergency management?
Laryngoscopy for removal
If you hear bronchial breathing on examination of a sick child, which diagnosis should be considered and what is the emergency management?
Pneumonia –> IV antibiotics if severe
When would you suspect a duct dependent lesion in an unwell neonate?
May be subtle when duct starting to close:
- poor feeding, sleepiness + slightly fast breathing
Or collapsed baby in cardiogenic shock
If you suspect a duct dependent lesion e.g. PDA, what is the emergency management?
IV dinoprostone
- keeps duct open until definitive management from cardiologist
What is the most common arrhythmia seen in children?
SVT
What is the emergency management for SVT in children?
Vagal manoeuvres
If clinically unstable:
- rapid bolus of IV adenosine or DC shock
What is the initial management of a choking child and when is further intervention required?
Encourage coughing
Further intervention if:
- child cannot speak, cry or breathe
- evidence of cyanosis
- decreased consciousness
What is the definitive management of choking in an infant?
5 back blows
- holding infant face down on forearm with hand supporting jaw to keep airway open
Then 5 chest thrusts
- infant turned over, thrusts with 2 fingers at lower edge of sternum
What is the definitive management of choking in an older child?
5 back blows
Then 5 abdominal thrusts (Heimlich manoeuvre)
If a choking child becomes unconscious, what should be done?
Follow BLS algorithm
open airway, 5 breaths, start CPR
What are the 3 characteristics of DKA?
- Acidosis –> pH < 7.3 or bicarbonate below 18
- Ketonaemia –> blood ketones > 3
- Hyperglycaemia –> blood glucose usually > 11 (although some children with T1DM can develop DKA with normal glucose levels)
What are the 3 main complications causing death in DKA?
Cerebral oedema
Hypokalaemia
Aspiration pneumonia
What are the symptoms of DKA?
Generally unwell + lethargic
Nausea, vomiting + abdominal pain
Early cerebral oedema –> headache, irritability, confusion, drowsiness, collapse
Concurrent infection which may have precipitated DKA
If undiagnosed DM –> weight loss, polyuria, polydipsia
What are the signs of DKA?
Resp: - deep, sighing breathing (Kussmaul breathing) - tachypnoea - subcostal + intercostal recessions Circulation: - shock - dehydration GI: - abdominal pain which may be severe, mimicking a surgical abdomen Other: - ketotic breath
Which investigations should be done for suspected DKA?
Bedside blood glucose + ketones
Blood gas
Bloods: glucose, U&Es + creatinine
12 lead ECG (potassium)
Why does management of DKA differ between children and adults?
Children at a much higher risk of developing cerebral oedema in the rehydration phase of treatment
What is the management for DKA in children?
ABCDE
IV fluid replacement
Followed by addition of IV insulin infusion
Which fluid is used for replacement in DKA?
0.9% sodium chloride with 20mmol of potassium in each 500ml bag
When should insulin be given in the management of DKA?
Delay IV insulin for 1-2 hours after beginning IV fluid therapy
Which electrolyte abnormality is it vital to monitor for in DKA?
Hypokalaemia
Which investigations should be done for a baby < 3 months with a fever?
FBC CRP Blood culture Urine testing Stool culture if diarrhoea present Lumbar puncture if looks unwell
What is the initial management for suspected sepsis in a child?
Sepsis 6:
- blood cultures
- lactate
- urine output
- high flow oxygen
- IV/IO fluid
- IV/IO antibiotics
Children prone to hypoglycaemia when unwell –> if glucose < 3, give 2ml/kg blue of 10% dextrose
What are the most common causes of dehydration in children?
Excessive fluid loss:
- diarrhoea +/- vomiting (most common)
- excessive sweating
- polyuria (T1DM, diabetes insipidus)
- burns
Inadequate fluid intake:
- structural malformation e.g. tongue tie
- discomfort e.g. ulcers, tonsilitis
- respiratory distress
- neglect
What are the red flag signs/symptoms for dehydration?
Appears unwell or deteriorating Altered responsiveness Sunken eyes Reduced skin turgor Tachycardia Tachypnoea
How is rehydration carried out in a dehydrated child?
Oral rehydration solution (ORS) 50ml/kg fluid deficit + maintenance fluids
- oral or NG tube
IV fluids
When are IV fluids indicated for rehydration?
Shock is suspected or confirmed
Red flag symptoms or signs
Deteriorating despite oral rehydration therapy
A child persistently vomits the ORS
