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Paediatrics > Emergency Paediatrics > Flashcards

Emergency Paediatrics Flashcards

1
Q

What do you do if a child has NICE traffic light

a) amber signs
b) red signs

A

a) can go home with strict safety netting or refer to hospital
b) immediate transfer to hospital

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2
Q

What are the NICE traffic light amber signs?

A
  • pale
  • reduced activity, wake with stimulation
  • nasal flaring, sats <95%
  • poor feeding, reduced UO
  • temp >39
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3
Q

What are the NICE traffic light red signs?

A
  • blue, mottled
  • not rousable, high pitched cry
  • grunting or chest indrawing or RR >66
  • reduced skin turgor
  • temp >38 if <3 months old
  • bulging fontanelle, non blanching rash, seizures
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4
Q

What is grunting?

A

Trying to maintain PEEP - creates an end pressure to prevent the alveoli from closing

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5
Q

What are the signs of potential circulatory failure?

A 
Cap refill - sternum for 5 seconds
BP, HR
Urine output
Skin colour/temperature - skin mottling
Look for resp failure, distress, agitation, conscious level, rapid deep breathing due to metabolic acidosis
Drowsy, still child, unresponsive
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6
Q

What are signs of potential central neurological failure?

A

Conscious levels - AVPU, GCS
GCS of 8 - unresponsive that you no longer protect airway, so may need to intubate, aprox P of AVPU

Posture
Pupillary signs

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7
Q

What are red flags in children?

A

Hypoxia - can compensate for long time
Hypotension
Silent chest
Unequal pupils - late sign, raised ICP dilatation pressure on oculomotor means herniation
(fixed and dilated - dead, one reactive - one squished)
Posturing - decorticate vs decerebrate can indicate brain injury or herniation occurring/about to occur

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8
Q

What congenital heart defect is the most common cause of heart failure?

A

VSD

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9
Q

What are the types of poisoning in a child?

A

Accidental
Deliberate by older sibling
Non accidental - abuse
Iatrogenic

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10
Q

What are examples of potential accidental poisonings?

A

Low - COCP, abx, chalk, crayons, washing powder

Intermediate - paracetamol, salbutamol, bleach, disinfectants, foschia

High - alcohol, digoxin, iron, salicylate, TCAs, acids, yew

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11
Q

What are the clinical features of poisons?

A 
Aspirin, CO - tachypnoea
Opiates - resp depression
Alcohol - resp depression
TCA, beta blocks - hypotension
TCA, organophosphates - convulsions
TCA, drugs - large pupils
Organophosphates - small pupils
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12
Q

What is the management of poisoning?

A

Identify agent
Assessment of agent’s toxicity via TOXBASE

Removal of poison:

Activated charcoal, ineffective for iron, insecticides, aspiration can cause pneumonitis
By NG or oral

Gastric lavage, rarely used in children only if large quantity

Induced vomiting with ipecac rare

Investigations:
Blood glucose - alcohol
Blood levels
Toxicology screen

Plan clinical management
Low toxicity - home
Intermediate - observe
High - admit
Specific antidotes

Assess social circumstances

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13
Q

What is the management for button batteries?

A

Monitor progress with chest and abdo x-rays
Almost all pass within 2 days
Remove batteries if in oesophagus or sign of disintegration

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14
Q

What injuries may a child suffer with trauma?

A

Abdominal injuries e.g. ruptured spleen, liver, kidney
Scans, x-rays, observation

Chest injuries - pneumothorax, haemopericardium

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15
Q

What is the management of burns and scalds?

A

Is airway, breathing, circulation satisfactory
Any smoke inhalation
Depth of burn - if full thickness will require graft
Surface area of burn
Involvement of special sites

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16
Q

What primary damage occurs from head injuries in children?

A

Cerebral contusions or lacerations
Dural tears
Diffuse axonal damage

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17
Q

What secondary damage occurs from head injuries in children?

A

Hypoxia from airway obstruction, or inadequate ventilation
Hypoglycaemia
Hyperglycaemia

Reduced cerebral perfusion due to hypotension from bleeding, raised ICP

Haematoma, infection from open wound or CSF leak

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18
Q

What is the primary survey in a head injury?

A

A-E assessment

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19
Q

What indicates a potentially serious head injury?

A

Witnessed LOC >5 mins
Amnesia >5 mins
Abnormal drowsiness
3 or more episodes of vomiting
Clinical suspicion of NAI
post traumatic seizure, but no history of epilepsy
GCS <15
Suspicion of open/depressed skull injury, tense fontanelle
Basal skull fracture signs - panda eyes, battle sign, haemotympanum
Dangerous mechanism e.g. fall, RTA, high speed object

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20
Q

What are signs of secondary damage?

A

Persisting coma
Deteriorating GCS
Seizures without full recovery
Focal neurological signs

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21
Q

What is the immediate management of a potentially serious head injury?

A

Immediate CT head scan
Assess need for cervical spine imaging
Observation

Any evidence of secondary damage, penetrating injury or CSF leak - neurosurgical referral

22
Q

What is wound management from e.g. dog bites?

A 
Copious wound irrigation, debridement
Removal of foreign bodies
Delayed wound closure
Raise and immobilise limb
Regular wound review
Tetanus booster
Prophylactic antibiotics - co-amoxiclav
23
Q

What is the management of airway obstruction from a foreign body?

A

Assess severity
If effective cough - encourage to cough, continue to check for deterioration

Ineffective cough
Unconscious - open airway, 5 breaths, start CPR
Conscious - 5 back blows, 5 thrusts or chest for infant

24
Q

What is the assessment of the seriously ill child?

A 
Airway and breathing
Look for obstruction, distress
Work of breathing, rate
Stridor or wheeze
Auscultation for air entry
Cyanosis

Circulation - HR, CRT, BP

Disability
LOC, posture, pupil size and reactivity

25
Q

What are causes of hypovolaemia?

A

Dehydration - gastroenteritis
DKA
Blood loss -trauma

26
Q

What can cause maldistribution of fluid?

A

Septicaemia

Anaphylaxis

27
Q

What can cause cardiogenic shock?

A

Arrhythmias

Heart failure

28
Q

What can cause respiratory distress?

A 
Upper airway obstruction:
causes stridor
Croup/epiglottitis
Foreign body
Congenital malformations
Trauma

Lower airway disorders e.g. asthma, bronchiolitis, pneumonia, pneumothorax

29
Q

What are surgical emergencies?

A

Acute abdomen - appendicitis, peritonitis

Intestinal obstruction - intussusception, malrotation, bowel atresia/stenosis

30
Q

What are the chest compressions for a child?

A

15 compressions, 2 breaths

100-120 compression/min

31
Q

What are examples of shockable rhythms?

A

Ventricular fibrillation VF

Pulseless ventricular tachycardia

32
Q

When can adrenaline be administered in cardiac arrest?

A

Give adrenaline every 3-5 mins after 3 shock and then at alternate cycles if shockable rhythm

If unshockable rhythm, CPR and adrenaline every 3-5 mins ie every other cycle

33
Q

What are reversible causes of cardiac arrest?

A

4Hs and 4Ts

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia

Tension pneumothorax
Toxins
Tamponade
Thromboembolism

34
Q

What are the clinical signs of shock?

A 
Tachypnoea, tachycardia
Decreased skin turgor 
Sunken eyes and fontanelle
Delayed CRT
Mottled pale cold skin
Core peripheral temp gap
Decreased urinary output

Late - acidotic, bradycardia
Confused, blue peripheries Hypotensive
Absent urine output

35
Q

What are the clinical features of sepsis?

A 
Fever, poor feeding, misery
Lethargy
History of focal infection
Predisposing conditions
Tachycardia, tachypnoea
Purpuric rash
Shock, multi-organ failure
36
Q

What are causes of pinpoint fixed pupils?

A

Opiates, barbiturates

Pontine lesion

37
Q

What are causes of fixed, dilated pupils?

A

Severe hypoxia
During/post seizures
Anticholinergic drugs
Hypothermia

38
Q

What are causes of a unilateral dilated pupil?

A

Expanding ipsilateral lesion
Tentorial herniation
Third nerve lesion
Seizures

39
Q

What are apparent life threatening events? ALTE

A

Combination of apnoea, colour change, alteration in muscle tone, choking or gagging

Most common in infants less than 10 weeks old
May occur on multiple occasions

Can be presentation of deadly serious disorder, or no cause identified

40
Q

What are some causes of a coma and appropriate investigations?

A

Infection - fever, rash, seizures, neck stiffness
Do FBC, cultures, CSF, PCR

Status epilepticus or post-ictal - hx of seizures, neurocutaneous lesions on skin, developmental delay, ongoing seizure activity
Do blood glucose, electrolytes, drug levels, EEG, CT

Trauma - RTA, bruising, haemorrhage, fractures
Do x-rays, CT, MRI

Diabetes - DKA, diabetes
Blood glucose, plasma electrolytes, urine, blood gas

Hypoglycaemia
Inborn errors of metabolism
Hepatic failure - do LFTs, PT
Acute renal failure - creatinine

Poisoning - toxicology, FBC
Shock - FBC, cultures, urea, blood gases

HTN - left ventricular hypertrophy on ECG or echo

Resp failure - chest x ray, arterial blood gas - hypoxia, hypercarbia

41
Q

What is the management protocol for status epilepticus?

A

A-E, check blood glucose
If <3, give glucose IV
If no vascular access - diazepam or midazolam buccal

If IV access lorazepam
Repeat if no response in 5-10 mins
Paraldehyde PR
Phenytoin if no response
Rapid sequence induction and mechanical ventilation if still no response
42
Q

What are some causes to be considered in apparent life threatening events?

A 
Infections - RSV, pertussis
Seizures
GORD
Upper airways obstruction
No cause identified
Uncommon - 
Arrhythmias
Breath holding
Anaemia
Heavy wrapping/heat stress
Central hypoventilation syndrome
Cyanotic spells from intrapulmonary shunting
43
Q

What are red flags in a history of acutely swollen joint?

A 
Fever
Refusal to weight bear or use affected joint
Constant severe pain
Night pain
Weight loss
Unexplained bruising
44
Q

What are common differentials for an acutely swollen joint?

A

Infection - septic arthritis, osteomyelitis
Viral arthritis

Trauma - fracture, dislocation, soft tissue injury, child abuse, NAI

Reactive arthritis

Haemophilia - family history, unexplained bruising

Juvenile idiopathic arthritis
Kawasaki disease
Acute rheumatic fever
Henoch-Schonlein purpura
Serum sickness

Leukaemia
Soft tissue malignancy
IBD
Ehlers-Danlos

45
Q

What is croup?

A

URTI
Toddlers and infants
Stridor due to laryngeal oedema and secretions
Parainfluenza virus cause

46
Q

What are the features of croup?

A

Stridor
Barking cough - worse at night
Fever
Coryzal symptoms

47
Q

What features of croup may prompt admission?

A

<6 months of age
Known upper airway abnormalities e.g. laryngomalacia, Down’s
Uncertainty about diagnosis
Moderate or severe croup

48
Q

What are the investigations of croup?

A

Clinical diagnosis

CXR - PA view subglottic narrowing - steeple sign

49
Q

What is the management of croup?

A

Single dose oral dexamethasone regardless of severity
Or prednisolone

High flow oxygen
Nebulised adrenaline

50
Q

When is the heel prick test completed and what does it test for?

A 
Day 5-9
Hypothyroidism
PKU
Metabolic diseases
CF
MCADD

Paediatrics (17 decks)

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