Emergency med Flashcards
deaths per year anaphylaxis
20
type of reaction anaphylaxis
type 1 hypersensitivity
type 1 hypersensitivity
1st exposure - Th2 cells primed, IL4 released causes B cells to switch IgM to IgE..bind to mast cells and basophils..sensitised to allergen
2nd exposure - IgE crosslinks and causes mast cell degranulation and release of mediators…vasodilation, bronchoconstriction, permeability of endothelium
triggers of anaphylaxis
drugs - abx, NSAIDS
injections
venom
food - shellfish, nuts, peanuts, eggs
exercise induced anaphylaxis
idiopathic
higher risk anaphylaxis
existing comorbidities - asthma, CVD
exposed to same allergen again - food triggers
increased severity anaphylaxis
exercise
fever
acute infection
premenstrual status
emotional stress
ddx anaphylaxis
life threatening asthma
septic shock
hereditary angioedema
vasovagal episode
adult and children >12 adrenaline
IM 500 micrograms
child 6-12 adrenaline
300 micrograms
6mths to 6yrs adrenaline
150 micrograms
<6mths adrenaline
100-150 micrograms
management anaphylaxis
give IM adrenaline very 5 mins until infusion started
A to E
Take a blood sample for mast cell tryptase testing immediately after starting treatment to support diagnosis
paeds - biphasic response can occur so must be admitted (within 72 hrs)
febrile seizure definition
“A seizure associated with a febrile illness not caused by an infection of the central nervous system, without previous neonatal seizures or a previous unprovoked seizure and not meeting the criteria for other acute symptomatic seizure, which occurs in children aged 6 months to 6 years”
most common neurological condition in paeds
febrile convulsions
risk factors febrile convulsions
pathophysiology unknown
family hx - twins tudies
viral infections (URTI, LRTI nad otitis media most common)
socio economic class
seasonal prevalence
zinc and iron deficiency
hx febrile seizure
> 38 degrees
6 mths to 6yrs
tonic-clonic seizure
constitional sx suggesting infection
simple v complex seizures
simple
<15 mins
generalised tonic clonic
isolated event
complex
>15 mins
focal or focal with secondary generalisation
recurrence within 24hrs
may suffer from todd’s paresis after
febrile status epilepticus
a subgroup of complex febrile seizure where the seizure duration exceeds 30 minutes, or there are multiple seizures lasting a total of 30 minutes without recovery between each one
red flags of CNS infection
History of lethargy, irritability or decreased feeding
Prolonged post-ictal altered consciousness or neurological deficit (lasting >1 hour)
Any physical signs of meningitis/encephalitis e.g. bulging fontanelle, neck stiffness, photophobia, focal neurological signs (in children younger than 18 months, symptoms and signs of meningeal irritation, such as meningism and photophobia, may be absent)
Previous/current treatment with antibiotics which may have masked full clinical presentation of meningitis
Incomplete immunisation in children 6-18 months against Haemophilus influenzae B and Streptococcus pneumoniae
prolonged febrile seizure
ecurrent seizure without complete resolution in between must be treated (8). A seizure longer than 5 minutes should be treated as it is unlikely to spontaneously resolve
management febrile seizure
<5 mins - not require meds
>5 mins - benzo
midazolam paeds
neonate - 300 micro/kg
1-2 mths - 300 micro/kg ip tp 2.5mg
3-11 mths -2.5 mg
1-4 yrs - 5mg
5-9 yrs - 7.5 mg
10-17 - 10-20 mg
diazepam paeds
neonate - 1.25-2.5mg
1mth - 1yr - 5mg
2-11 yrs - 5-10mg
12-17yrs - 10-20mg
risk factors for recurrent febrile seizures
Age at onset under 18 months.
Shorter duration of fever before seizure (<1 hour).
Relatively lower grade of fever associated with seizure (<40C).
Multiple seizures during the same febrile illness.
Day nursery attendance.
Family history of febrile seizure in a first degree relative.
3 predictors for epilepsy
Family history of epilepsy.
Complex focal seizure.
Neurodevelopmental impairment.
risk factors for paeds shock
Sepsis: Beware viral sepsis
Immunocompromised
Very young children
Anaphylaxis:
Personal or family history of allergies or atopy
Recent history of new medication (7)
Dehydration:
Young children (<6 months)
Warm weather
Concurrent illness (gastroenteritis, N+V and diarrhoea)
Use of diuretics
Cystic fibrosis
Hirschsprung’s disease
complications secondary to ischaemia from shock
Central nervous system failure
Respiratory failure (from muscle fatigue or acute respiratory distress syndrome)
Acute kidney injury
Gastrointestinal ischemia
Disseminated intravascular coagulation (DIC)
Metabolic derangements
Death
risk factors paeds sepsis
neonates and babies under 3mths
prematurity
hx of prolonged rupture of membranes
maternal intrapartum pyrexia
maternal colonisation with group B strep
immunocompromised children
sepsis 6 paeds
Take blood cultures
Check blood lactate
Monitor urine output (with catheterisation if necessary)
Give high flow oxygen
IV/IO fluid
IV/IO antibiotics
Children are particularly prone to hypoglycaemia when unwell and this should be promptly corrected with a 2ml/kg bolus of 10% dextrose if blood sugar is <3mmol/L.
sepsis complications
developmental delay
audiological issues
limb ischaemia
choking prevalence
most common 1 to 4 age group mortality
peak frequency in 1-2 yrs
ddx choking
acute epiglottis
croup
laryngomalacia
whooping cough
management choking
do not do finger sweep
head tilt chin lift
encourage coughing
five back blows, check after each one
chest thrusts
brief resolved unexplained event
: ‘An event occurring in an infant younger than 1 year when the caregiver reports a sudden, brief, and now resolved episode of ≥1 of:
Cyanosis or pallor
Absent, decreased, or irregular breathing
Marked change in tone (hyper- or hypotonia)
Altered level of responsiveness (3)’
prevalence BRUE
more in boys
mean age 8 weeks
pathophysiology BRUE
50% cause identified - GORD most common
others -
head injuries, URTI, arrhytmias, electrolyte disturbances, meningitis, suffocation
risk factors BRUE
infants <2 mths old
infants <30 day old
prematurity
hx BRUE
clear description of event
relation to feeding
previous episodes
sleep
systems enquiry
pmhx in births, immunisations, development
fhx
social history - ie non accidental injury
examination BRUE
general exam - in dysmorphic features, any bruises or skin marks
resp, CVS, abdo and neurological
investigaitons BRUE
ECG, pernasal swab for pertussis
CXR
blood gas
lab profile
BRUE management
BLS
admission
