Emergency Medicine Flashcards
what risk factors are there for neonates for sepsis?
prematurity
prolonged rupture of membranes
maternal intrapartum pyrexia
maternal colonisation of group B strept
what are some risk factors of sepsis in children?
immunocompromised - chemo, drugs for autoimmune disorders
history of fever
Non-specific symptoms such as lethargy, nausea and vomiting, headache and abdominal pain also occur commonly.
what are some signs of sepsis ?
hypotension, tachycardia, cool peripheries, confusion
Signs of the source of infection, such as crackles on chest auscultation or an area of cellulitic skin
non-blanching rash is suggestive of meningococcal disease
what are some DD of sepsis ?
uncomplicated infection leukaemia aplastic anaemia malignancy autoimmune disorder (JIA) Kawasaki disease
what lab tests should be done for sepsis ?
blood gas FBC CRP blood culture urinanalysis stool culture
CXR
Abdo US
LP
what should lab testing be done on an under 5 yr?
if there are any red features present
state some red features ?
pale mottled blue skin no response to social cues weak high pitched cry grunting tachypnoea chest indrawing reduced skin turgor non blanching rash bulging fontanelles neck stiffness focal near signs
what are children prone to during sepsis/infection?
hypoglycaemia
how should hypoglycaemia be treated in children?
2ml/kg bolus of 10% dextrose if blood sugar is <3mmol/L.
during sepsis what would th blood gas results show?
metabolic acidosis
what are 3 characteristics of DKA?
acidosis pH <7.3 or HCO3 <18
ketonaemia blood ketones >3
hyperglycaemia >11mmol/l
what is the chemical name of ketones ?
beta-hydroxybutyrate
what three complications can occur with DKA?
cerebral oedema, hypokalaemia and aspiration pneumonia.
what is the mortality for cerebral oedema?
25%
what breaks down to form ketones?
adipose tissue
what are some risk factors for DKA in children?
Non-compliance with insulin treatment or a high sugar diet
Intercurrent illness, especially infection
Rapidly changing insulin requirements during puberty
Failure of insulin pump
what is the breathing described as in DKA?
Kussmauls respiration
what are DD for DKA?
Hyperosmolar Hyperglycaemic State
dehydration
sepsis
new presentation of T1DM
what investigations should be done for DKA?
bedside blood glucose and ketones
venous blood gas
FBC, U&Es, Creatinine
12 lead ECG
what pH is classed as acidosis ?
<7.3
what pH is classed as severe DKA?
<7.1
what are children at a higher risk of developing compared to adults following DKA?
cerebral oedema
what fluid bolus should DKA shock children receive ?
fluid bolus of 10ml/kg 0.9% sodium chloride.
how do you calculate fluid deficit for a child?
body weight x %fluid deficit x 10
what are the fluid maintenance for children with DKA
<10kg
10-40kg
>40kg
If the child weighs less than 10kg, give 2ml/kg/hour
If the child weighs between 10 and 40 kg, give 1ml/kg/hour
If they weigh more than 40kg, give a fixed volume of 40ml/hour
what dose of IV insulin should be given for DKA?
0.05 – 0.1 units/kg/hour of a soluble insulin
what monitoring should be done during K replacement ?
ECG
when can IV insulin be changed to subcutaneous insulin can then be started and IV insulin stopped one hour later?
blood ketones are less than 1mmol/litre or pH is normal.
what are some complications of DKA?
cerebral oedema
hypokalaemia
aspiration pneumonia
hypoglycaemia
what is the leading cause of death of children presenting with DKA?
cerebral oedema
what signs and symptoms can be suggestive of cerebral oedema?
Headache, confusion, irritability, increasing drowsiness, hypertension with bradycardia and focal neurological signs such as cranial nerve palsies and papilloedema
what could cause decreased fluid intake or increased fluid loss in children?
structural malformation
discomfort
respiratory distress
neglect
D/V
excessive sweating
polyuria
burns
what are some red flags of dehydration ?
Appears unwell or deteriorating Altered responsiveness Sunken eyes Reduced skin turgor Tachycardia Tachypnoea
what fluid bolus should be used in shocked children?
20ml/kg 0.9% saline
in what circumstances should children be given IV fluid?
shock is suspected
red flag symptoms present despite oral rehydration
child is vomiting oral rehydration
what is fluid maintenance for children after dehydration ?
100ml/kg for first 10kg bodyweight
50ml/kg for second 10kg bodyweight
20ml/kg for every kg above 20kg bodyweight
what is the initial bolus for children with DKA?
10ml/kg due to the risk of cerebral oedema.
what medication can be given if a duct dependent lesion is suspected?
IV dinoprostone
what is the most common arrhythmia seen in children?
SVT
what is the management of SVT?
trial of vagal manoeuvres followed by a rapid bolus of IV adenosine or synchronous DC shock
over how long should fluids be corrected for children
over 48hrs
