Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBBS IV - Junior Clerkship WCS > JC115 (Paediatrics) - Childhood Medical Emergencies > Flashcards

JC115 (Paediatrics) - Childhood Medical Emergencies Flashcards

1
Q

3 anatomical differences in a child’s respiratory system + implications on resuscitation

A

CNS receptors/ effectors in neonates has Biphasic response (tachypnea, bradypnea) to hypoxia
- Always give high levels of supplemental oxygen

Cartilaginous thorax, more horizontal ribs: chest stability and strength relies on diaphragm

  • Less respiratory reserve
  • Allow position of comfort/ sniffing position

Low number of alveoli, high airway resistance
- Common airway obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Physiological differences in cardiovascular system between adults and children

A

Children:

  • Small absolute blood volume: Low stroke volume and cardiac out depends on HR
  • CVS response to fluid is similar to adults after 2 months old (CVP measurement in baby under 2 months is inaccurate)
  • Pulmonary vasculature more reactive: easily go into pulmonary hypertension and hypoxia
  • Variable catecholamine response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ddx non-hypovolemic shock in children

Initial treatment

A

 Pneumothorax
 Pericardial effusion, myocardial dysfunction
 Adrenal insufficiency
 Intestinal ischemia, sepsis
 Pulmonary artery hypertension, coarctation of aorta

Tx:
titrated fluid to 40 mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Physiological differences in metabolic function between children and adults

A

Children:

  • Lower urine output
  • Greater insensible water loss and heat loss (larger surface area to weight)
  • Hypoglycemia more common, need higher glucose infusion
  • Sodium control is not as refined: Hypo-, hypernatremia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define the normal urine output for children

A

 Neonate 2ml/kg/hr

 Child 1ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Outline P/E for paediatric medical emergencies

  • What to examine in General, Neurological, Respiratory, CVS P/E
A

General examination:
 Skin perfusion: color, warmth, capillary refill (normally <3s)
 Hydration (skin turgor, mucosa; dehydrated if depressed anterior fontanelle)
 Fever

Neurological:
 Alertness, response to stimuli
 Irritability, restlessness
 Seizures and abnormal muscle activity

Respiratory:
 Tachypnea, bradypnea
 Expiratory grunting (significant respiratory distress)
 Obligate nose breathing (<6mo), nasal flaring)

Compensated shock:
 Tachycardia, BP may be normal,
 Skin vasoconstriction/ mottling (marked with spots/ smears of color)
 Long capillary refill (>4s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical grading system for paediatric medical emergencies

A

Paediatric Early Warning Score (PEWS):

Grades Behavior, Cardiovascular and Respiratory metrics
Cumulative score dictates management

Score reference (may vary between institutions):
 0-4: (stable) continue 4hrly assessment
 5-6: more frequent assessment; notify doctor
 >7: critical frequent assessment q30min; immediately notify doctor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Features of critical paediatric emergency on PEWS

A

Behavior:
 Lethargic/ confused
 Reduced response to pain

Respiratory:
 Respiratory rate 5 /min below normal parameters
 Sternal recession/ tracheal tug/ grunting
 50% FiO2
 >8L/min respiration

Cardiovascular
 Grey and mottled/ Capillary refill >5s
 Tachycardia (30bpm above normal rate) or Bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Differentiate IHCA and OHCA Chains of survival

A

IHCA (In-Hospital Cardiac Arrest):
surveillance and prevention&raquo_space; recognition and activation of emergency response system&raquo_space; immediate high-quality CPR&raquo_space; rapid defibrillation&raquo_space; advanced life support

OHCA (Out-Hospital Cardiac Arrest):
Out-Hospital Cardiac Arrest: recognition and activation of emergency response system&raquo_space; immediate high-quality CPR&raquo_space; rapid defibrillation&raquo_space; ambulance**&raquo_space; advanced life support

Ambulance is the only difference between IHCA and OHCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Resuscitation procedures for Unwitnessed collapse in children/ infants

A

International Liaison Committee on Resuscitation (ILCOR):

Unwitnessed collapse in children/ infants:
1. Give 2 minutes of CPR (vs. adults: get AED first)

  1. Leave the victim to activate the emergency response system and get the AED
  2. Return to the child/ infant and resume CPR
  3. Use the AED as soon as it is available
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Phases of Cardiac pulmonary resuscitation (CPR)

A

Phase 1 – basic CPR for maintaining oxygenation and circulation:
 Airway
 Breathing
 Circulation

Phase 2 – advance life support for restoration of spontaneous circulation
 Fibrillation
 Drugs
 ECG

Phase 3 – prolonged life support for managing multiple organ failure
 brain resuscitation
 Gauging: cause of arrest; assess condition
 Intensive care support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe bystander CPR resuscitation techniques for adults

e.g compression frequency, depth…

A

Circulation = most important, Recommend Compression Only for untrained lay rescuer

  1. Compression frequency recommended at 100-120/min
  2. Compression depth: 5-6cm for adult
  3. Chest recoils:
    Avoid leaning on the chest between compression for better recoils
    Provide a relatively negative intrathoracic pressure for better venous return
  4. Avoid compression interruption for >10s
  5. first ventilation after 30 compressions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe resuscitation for unwitnessed collapse, witnessed cardiac arrest

A

Unwitnessed collapse:

  • 2 mins CPR, search for AED, then resume CPR (cf AED first in adults)
  • Ventilation with advanced airway: 1 breath every 6 seconds (cf 1 ventilation every 30 compressions)
  • Ventilation with bag-mask ventilation if possible

Witnessed cardiac arrest:
- Energy for SVT cardioversion revised to 1 J/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hypothermia therapy for paediatrics use

  • Indication
  • Function
  • Specific temperatures
A

Indication:

  • both in-hospital and out-of-hospital cardiac arrest
  • children who remain comatose after cardiac arrest

Function:
keep core temperatures within a certain range to reduce tissue metabolic rate and ischemic damage

Temps:
 Option 1: maintain 32-34oC, followed by 36-37.5oC
 Option 2: maintain 36-37.5oC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment options for paediatric in-hospital cardiac arrest

A
  1. Conventional paediatric CPR
  2. Extracorporeal CPR: Cardiopulmonary bypass to maintain organ perfusion during cardiac arrest
    - Indication: witness cardiac arrest or post-operative cardiac arrest in hospita;
    - Improve response to cardiac arrest
    - May increase risk of CNS complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Differences in CPR for children compared to adults

A

Phase 2 and 3 CPR:

  • Avoid compression interruptions >10s
  • More monitoring support than adults (continuous end-tidal CO2, pulse oximetry…etc)
  • Cautious use of hypothermia therapy for post-cardiac arrest
  • Cautious use of fluid replacement in sepsis
  • Use epinephrine for failed CPR (same as adults, no longer recommend vasopressin)
17
Q

Neonatal resuscitation

Anatomical differences in upper respiratory tract and implication on respiratory resuscitation

A

Anatomical difference:
 Airway smaller, shorter than adult - prone to airway obstruction
 Larynx funnel-shaped, narrowest at cricoid cartilage, more superior and anterior (cf adult: more cylindrical, narrowest at vocal cord) - less functional lung capacity
 Tongue and epiglottis relatively large - central airway obstruction

Resuscitation:

  • Commonly use non-cuffed*** endotracheal tube
  • Laryngeal mask is acceptable alternative
18
Q

Neonatal resuscitation

  • Procedures to avoid/ not recommended
  • Time limit for start ventilation
  • Monitoring methods
A

Procedures to avoid:

  • Do not suction non-vigorous infants with meconium-stained liquor
  • No recommended to do cord milking for preterm babies
  • Do not delay ventilation

Time limit: 60s to start ventilation

Monitoring: SpO2, ECG, exhaled CO2 to confirm endotracheal tube placement

19
Q

Neonatal resuscitation

Route of administration of drugs

A

Intraosseous route:

  • Useful for volume bolus and effective delivery of medication
  • Site: usually anterior tibial
  • Technique: same as bone marrow puncture
20
Q

Equipment required for resuscitation of acute epiglottitis in paediatrics

A 
Prepare equipment:
 Bag and mask
 Laryngoscope
 ET tubes just 1 size smaller than recommended
 Percutaneous tracheostomy set
21
Q

Resuscitation steps for acute epiglottitis in paediatric

A

General:
 Monitor vital sign
 No throat examination (stimulate laryngeal spasm and respiratory arrest)
 Transport patient in sitting position (not horizontal) for intubation

Treatment:

  1. Oxygen supplement
  2. Antibiotics
  3. Supportive: fluid, hydration, humidify air, sedation and ET tube care
  4. Treat post-obstructive pulmonary oedema, ET tube care
  5. Extubation (18-24 hours later): fever subsiding and condition improve, or ET tube is leaking air
22
Q

Status epilepticus (SE)

  • Clinical definition
  • Timing to start intervention
A

Definition:
 3 seizures without awakening; or
 Continuous motor seizure activity for >30 minutes

Timing:
Start treatment in Prolonged seizures of >5 minutes:

23
Q

Systemic complications a/w Status epilepticus

A 
Hypotension 
Hypoxia
Acidosis
High fever
Arrhythmia 
Atelectasis 
Cerebral hemorrhage and ischemia
24
Q

Pre-hospital treatment of Early convulsive Status Epilepticus

A

Emergency management and seizure control

0-5 min:
 Supportive (semi-prone position, O2 suppl etc)
 Prepare anti-epileptic medications

6-30min – first line anti-epileptic medications, Repeat bolus after 5-10min if necessary
 Diazepam – rectal ****
Alternatives: 
 Lorazepam
 Midazolam – buccal/ intranasal
25
Q

Management of convulsive status epilepticus (after 30 mins to 1 hour)

A

Additional anti- epileptic drugs to Diazepam
Investigations for underlying causes, e.g. brain malformation, infections, poisoning, overdose etc.

Second line treatment if not responsive:

  1. IV Phenytoin (1st choice)
  2. IV Phenobarbital
  3. Buccal Midazolam
  4. Levetiracetam (Keppra)
  5. Thiopentone/ pentobarbitone infusion
  6. Propofol / other anaesthetic agents
  7. Sodium valproate
26
Q

Management of refractory status epilepticus

A

Refractory SE (unresponsive to 2 anti- epileptic drugs), ongoing >60 mins

ICU admission

aggressive drug therapy control,

ventilatory / haemodynamic support

27
Q

Side effects of second line anti-epileptic drugs for Status epilepticus

A
  1. Phenytoin (1 st choice): hypotension,strong alkaline, arrhythmia
  2. Phenobarbital: hypotension, respiratory suppression
  3. Thiopentone/ pentobarbitone infusion: Need ventilator support and more haemodynamic disturbance

MBBS IV - Junior Clerkship WCS (131 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions