Emergency Paediatrics Flashcards
Most common cause of cardio respiratory arrest in children
Respiratory problem
Causing prolonged hypoxia
Leading to cardiac arrest
Causes of cardio resp arrest
Prolonged hypoxaemia Birth asphyxia Inhalation of foreign body Acute asthma Bronchiolitis Neurological dysfunction, opiates
Risk factors for aspiration
Decreased GCS Underlying cardiac condition Anaphylaxis Drug ingestion Neuromuscular disorder Respiratory pathology Foreign body Post-cardiac surgery Drowning Trauma Non accidental injury Anatomy
DD to cardio resp arrest
Choking
Opiate ingestion
Decreased level of consciousness due to neuromuscular disorder/ head injury
Hypoglycaemia
BLS algorithm
Unresponsive Shout for help Open airway Not breathing normally 5 rescue breaths No signs of life 15 chest compressions (HR<60~) 2 rescue breaths and 15 chest compressions 1min CPR then call rhesus team
3Ss for BLS
Safety
Stimulate
Shout
When should chest compressions be commenced?
No signs of life
No pulse
HR<60
Normal HR
0-2: <160
3-5: <140
6-12: <120
Normal BP
0-2: >70
3-5: >75
6-12: >80
Normal RR
0-2: <60
3-5: <35
6-12: <30
Adequate urine output
0-2: 1.5-2ml/kg
3-5: 1ml/kg
6-12: 0.5-1ml/kg
No signs of increased resp effort despite hypoxia
Reasons
Fatigue/ exhaustion
Neuromuscular disease
Central respiratory depression: RICP, poisoning, encephalopathy
Breathing assessment
For potential respiratory failure
Effort of breathing
Efficacy: air entry, pulse oximetry, chest expansion
Effect of respiratory inadequacy: hypoxia, tachycardia, bradycardia
Resuscitation fluid
20ml/kg NaCl
Intraosseous access
10ml/kg for DKA to reduce cerebral oedema risk
Bubbling sound
Diagnosis and treatment
Excessive secretions
Suctioning
Harsh stridor and barking cough
Diagnosis and treatment
Croup
Oral dexamethasone
Nebulise budesonide and adrenaline in severe cases
Soft stridor, drooling and fever in a sick looking child
Diagnosis and examination
Bacterial tracheitis or epiglottitis
Intubation by anaesthetist followed by IV ax
Sudden onset stridor with history of inhalation
Diagnosis and treatment
Inhaled foreign body
Laryngoscopes for removal
Bronchial breathing
Diagnosis and treatment
Pneumonia
IV ax
Congenital heart disease
Duct dependent lesion
Mx to keep ducts open
IV dinoprostone
SVT mx
Vagal manoeuvres
IV adenosine
Or synchronous DC shock
Posture in potential central neurological failure
Decorticate: bad
Decerebrate: worse
Risk factors for choking
Playing with small parts
Unsupervised play and eating
Children with decreased consciousness
Clinical features choking
Playing with toys that have small parts Unsupervised play/ eating Eating prior to event Poor swallow/ poor coordination of suck Previous episodes of aspiration/ choking
Choking infant management
5 back blows
5 chest thrusts
Choking child management
5 back blows
Heimlich 5 times
DKA features
Ph<7.3 or HCO3<15mmol/L
And ketones >3mmol/L
Glucose>11mmol/l
DKA complications
Cerebral oedema: observe neurological status
Hypokalaemia
Aspiration pneumonia: reduced GCS
Hypoglycaemia:
DKA symptoms
General unwell
Lethargic
Nausea
Vomiting
Abdominal pain
Cerebral oedema: headache, irritability, progressing to confusion, drowsiness or collapse
Features of infection: fever, cough, diarrhoea, dysuria
Examination of DKA
Kussmaul breathing
Tachypnoea
Subcostal and intercostal recessions
Shock: tachycardia, hypotension, increased CRT
Dehydration: dry mucous membranes, sunken eyes/
