Emergency Medicine Flashcards
Shaken baby syndrome characteristics
Head injury: SDH/SAH, parenchymal contusion, vascular infarction, global hypoxic injury
With/without impact: skull edema, skull fracture, contact SDH
Retinal hemorrhage/ocular injury
Tests for child abuse
FBC, U&E, LFT, coag Others depend on presentation. Fractures: bone scan, skeletal survey Abdominal injury: U/S Head injury: immediate head CT and MRI, skeletal survey, ophthal exam Sexual: genital exam, HIV & STD screen Neglect: growth chart, serum protein
Managing child abuse
Seek help from senior staff before referring to outside agency
Mandatory reporting
Contact CPS to give information about the child, family situation, reason for suspicions, assessment of immediate dangers, whether family is aware of report
If child under immediate threat, arrange for immediate assessment of alternative living arrangements/admit to hospital
How to manage when child swallows Disc/button batteries
Monitor progress with chest/abd X-Ray
X-Ray should show that almost all passed within 2 days with no symptoms
Remove the batteries if in oesophagus/signs of disintegration. Some guidelines recommend removal if not passed within 48 hours
How to manage when child has iron poisoning or toxicity
Abdominal X-Ray to count number of tablets
Serum iron levels
Gastric lab age in severe cases if less than an hour after ingestion
IV desferrioxamine for chelation
Managing PCM poisoning
Check plasma concentration 4h after ingestion.
If > 150mg/kg PCM is thought to have been taken, or plasma concentration is high - start IV acetylcysteine
Monitor PTT, LFTs and plasma creatinine
Managing salicylate poisoning
Measure plasma salicylate concentration Gastric lavage if less than an hour Give activated charcoal Monitor fluid and electrolyte balance Correct dehydration, electrolyte imbalance and acidosis Dialysis
Symptoms of iron toxicity
Initial: vomiting, diarrhoea, hematemesis, melena, acute gastric ulcer
Latent period of improvement
Hours later: drowsiness, coma, shock, liver failure with hypoglycemia and convulsions
Long term: gastric strictures
TCA poisoning
Activated charcoal if within one hour Cardiac monitoring If arrhythmia, treat with sodium bicarbonate Correct metabolic acidosis Treat convulsions with diazepam
Management for anaphylaxis
Remove allergen if still present
Do not allow children to stand/walk, can die within seconds. If vomiting can sit upright but monitor BP
IM adrenaline 10 micrograms/kg or 0.01ml/kg of 1:1000 (Max 0.5ml) into lateral thigh, repeat every 5 mins till IV access
High flow O2
Salbutamol if resp distress + wheezing
Antihistamines if pruritus (no promethazine)
Observe for at least 4 hours
Complications of ingesting petrol and clinical features
Aspiration pneumonitis
Cough and resp distress
Drowsiness, ataxia, convulsions
Management of Seriously Ill Child
First 5 minutes
- call for help, attach cardioresp monitoring, address airway and breathing and administer oxygen
First 15 minute
- vascular access
- blood culture, VBG with lactate and glucose
- FBC, CRP, UEC, LFT, Coag, group and hold
- urinalysis and LP once stable
- administer antibiotics via IV push
First 30 minutes
- Iv fluid resus 20ml/kg bolus/10 in neonates
- if needed additions bolus 10ml/kg and repeat to max of 40ml/kg
- repeated assessment of fluid status, perfusion, clinical condition, assessment for signs of fluid overload
- if limited response to fluids, inotropes
First 60 minutes
- for persisting circ failure after 40ml/kg fluid resus, give
- adrenaline 0.05-0.2mcg/kg/min IV/IO
Respiratory support
- if normal consciousness, HFNC/CPAP/BIPAP
- if altered consciousness, consider intubation
Antibiotics for septic child
Benzylpenicillin 60mg/kg IV and cefotaxime 50mg/kg IV
- if 7 days and less 12hr
- if 8-28 days 6-8h
- if 1 to 2 months 4-6h
> 2 months: ceftriaxone 100mg/kg IV daily and fluxocacillin 50mg/kg IV 6H
