Emergency med paeds

Question 1

Anaphylaxis dosages in children?

Answer 1

Under 6 months - 100 to 150 mcg
6 months to 6 years - 150 mcg.
6-12 years - 300 mcg.
> 12 years - 500 mcg

Question 2

Where do you inject adreanline?

Answer 2

Anterolateral aspect of middle 1/3rd of thigh

Question 3

Criteria for a severe asthma attack in children

Answer 3

SpO2 < 92%
PEF 33-50% of best or predicted.
Too breathless to talk/feed.
HR > 140 if ages 1-5 or > 125 if over 5y.
Resp rate > 40 if aged 1-5 or > 35 if over 5y.
Use of accessory neck muscles.

Question 4

Criteria for a life threatening asthma attack in children?

Answer 4

SpO2 < 92%.
PEF < 33% of best or predicted
Silent chest
Poor resp effort
Agitation
Altered consciousness
Cyanosis

Question 5

Management of a mild/moderate exacerbation of asthma in children?

Answer 5

1. Bronchodilator therapies: B2 agonist via spacer or closing fitting mask if child < 3 years old.
2. All children require steroid therapy for 3-5 days. 1-2mg/kg once daily.

Question 6

Management of asthma in children aged 5-16?

Answer 6

Very similar to adults:
1. SABA
2. Add paediatric low dose inhaled corticosteroid if not controlled on SABA or newly diagnosed asthma with symptoms >3/week or night time waking.
3. SABA, ICS and LTRA
4. SABA, ICS and LABA (remove LTRA if not helped)
5. SABA + MART
6. SABA + moderate dose ICS MART.
7. SABA and one of following: Increase ICS, trial additional drug eg, theophylline, or seek advice

Question 7

Management of asthma in children under 5 years

Answer 7

1. SABA
2. SABA and 8-week trial of paediatric moderate dose ICS. If symptoms do not resolve in trial then consider alt diagnosis. If symptoms resolved then reoccur within 4 weeks of stopping then restart low dose ICS. If resolved then reoccure beyond 4 weeks repeate trial.
3. SABA + low dose ICS + LTRA.
4. Stop LTRA and refer to specialist.