Emergency paeds

Question 1

What is the paediatric sepsis six?

Answer 1

In this order:
1. Admin supplementary oO2
2. IV/IO access and take bloods - culture, gas, FBC, CRP, coag, U+E, LP unless contraindication,
3. IV/IO abx
4. Fluids
5. Escalation - senior
6. Early inotropic support

Question 2

What are the criteria of anaphylaxis?

Question 3

What is the emergency treatment of anaphylaxis?

Answer 3

1. Call for help
2. Remove allergen
3. High flow O2
4. Do not wait for IV access
5. IM adrenaline
6. Lie flat on back w knees up

Question 4

What is the further management of anaphylaxis?

Question 5

What is urticaria?

Answer 5

Intensely itchy erythematous plaque, can be associated w angioedema.
- <6 w = acute = allergy, URTI and other viral illnesses
- >6 weeks = chronic - spont or physical triggers

Question 6

What is the management of urticaria?

Answer 6

High dose non sedation antihistamines +/- oral steroids, more for acute intense itch

Question 7

Give an example of a 1st gen antihistamines? Why is it so problematic?

Answer 7

Chlorphenamine, needs high doses and is v sedating

Question 8

What are the 2nd gen antihistamines?

Answer 8

• Certirizine
• Loratadine
• Fexofenadine - gold standard
  Non sedating

Question 9

What is the management of paracetamol overdose?

Answer 9

<1 hour - activated charcoal and IV anti emetic
>4 hours - N acetylcysteine, paracetamol level, U+E, LFT, glucose, clotting screen, VBG

Question 10

Pre septal vs orbital cellulitis

Answer 10

Pre septal - inflam of orbit limited to tissues ant to orbital septum
Orbital - superficial and deep structures affected - is painful, red eye

Question 11

What are the causes of pre septal and orbital celluitits?

Answer 11

URTI and sinusitis - S.pneumoniae, H.infleunzae

Question 12

What is the definition of a BRUE?

Answer 12

Brief resolved unexplained event
- Cyanosis or pallor
- Absent, decreased or irreg breathing
- Marked changes in tone
- Alt levels conc
No other explanation after assessment.
<1 min, now resolved w 1+ criteria.

Question 13

Stridor vs stertor vs wheeze

Answer 13

Stridor - high pitch, high energy inspiratory, narrowing of upper airway
Stertor - low pitched snoring, nasal tonsil adenoid obstruction
Wheeze - expiratory sounds, narrowing of lower airways

Question 14

What is the main cause of epiglottitis?

Answer 14

H.influenzae

Question 15

WHat re the contraindications of a LP?

Answer 15

Cardio resp
Raised ICP
Coag abnorm
After seizure
Signs of infection
Focal neuro signs

Question 16

What are the LP parameters?

Answer 16

Normal - clear, <5 lymphocytes, 0.14-0.4gL >50%BG
Bacterial - cloudy, raised neutrophils, high protein, low glucose
Viral - clear, raised lymphocytes >1000,

Question 17

What is the difference between meningococcal septicaemia?

Answer 17

Meningitis can occur w or w/o septicaemia
Septicaemia can occur w or w/o meningitis
Meningococcal septicaemia is much more devastating than just meningitis.

Question 18

What are febrile convulsions?

Answer 18

6m - 5 years w no prev neurology
Generalised seizure, <15min duration
No infection or metabolic disturbance
Recurrence rate ~1/3

Question 19

What are the paeds fluid prescribing principles?

Answer 19

10 ml/kg = resus/bolus
Maintenance:
100 ml/kg/day for 1st 10 kg
50 ml/kg/day for 2nd 10kg
20 ml/kg/day for any weight >20kg

Question 20

How do you calculate rehydration fluid amount/

Answer 20

Replacement = %weight loss x kg x 10
Normal Na dehydration = rehydration over 24 hours
Hypernatraemic dehydration = rehydration over 48 hours = maintenance x2 + replacements

Question 21

What are the different fluid options in paeds?

Answer 21

0.9% NaCl
0.9% NaCl + 5% dextrose
0.45% NaCl + 5% dextrose