Obs & Paeds Flashcards

Question

bronchiolotis

Answer 1

respiratory infection, children under 2 (3-6mo) clinical diagnosis coryza, fever, wheeze, cough, crepitations varying respiratory failure DDx pneumonia, croup, asthma, viral wheeze Severe disease - FiO2 > 0.5 to maintain 95% - severe recessions - tachypnoea, tachycardia, apnoeas Life threatening - Sats < 88% despite HF / CPAP - respiratory acidosis - apnoeas requiring FMV, exhaustion, grunting

Answer 2

- chronic lung disease - prematurity - cardiac comorbidity - < 6 weeks of age

Answer 3

- clear nasal secretions - respiratory support - humidified O2, CPAP, BIPAP - hydration / NG feed - gastric decompression - invasive ventilation - deteriorating severe disease - respiratory acidosis, hypoxia on NIV ICU complciations - secondary bacterial infection - mucous plugging - bronchospasm - bradycardia - hyponatraemia

Answer 4

- cardiac arrest - respiratory failure - shock - failure to thrive - cyanosis

Answer 5

single functional ventricle e.g. pulmonary atresia, hypo plastic left heart 4-12 mo cavopulmonary connection 5 year completion - IVC connection to PA

Answer 6

- severe cyanosis - TGA, pulmonary atresia, obstructed TAPVD - cardiac failure - left outflow obstruction.- severe AS, coarctation, hypo plastic left heart. may present when DA closes. cold pale weak pulses, hepatomegaly

Answer 7

- reduce O2 demand - IPPV - correct acidosis, hypoxia, hypercarbia - prostaglandins for duct patency - inotropes - dw cardiac centre patients surviving to adulthood and may present to adult critical care.

Answer 8

Likely if PaO2 doesn't rise 20kPa after 10 mins 100% O2 obstruction to pulmonary flow - ToF, pulmonary stenosis Pulmonary and systemic circulations in parallel - TGA Complete mixing of systemic and pulmonary blood - single ventricle, truncus arteriosis pulmonary venous abnormalities - TAPR intubation and early prostaglandin

Answer 9

- septal defects - left --> right shunt - left sided obstruction - coarctation, AS lead to pulmonary oedema. systemic circulation from RV through DA.

Answer 10

Duct dependent pulmonary circulation - pulmonary atresia - pulmonary stenosis - tricuspid atresia - Severe ToF Duct dependent systemic circulation - Severe AS - Coarctation - Hypoplastic left heart Duct dependent pulmonary and systemic - Transposition of great arteries

Answer 11

cyanosis hypoxia despite O2 tachypnoea without lung pathology Pulmonary oedema, pathological murur, absent femoral pulse, hepatomegaly, cardiogmegaly, lactic acidosis 100% O2 may result in excess flow through the lungs - pulmonary overcirculation. aim for pre and post ductal saturations 75-85%. pink and shocked. balanced circulation - increase PVR or decrease SVR. avoid high O2, modest PEEP

Answer 12

apnoea ypertherthermia hypotension 5-100ng/kg/min. greater SE with high dose

Answer 13

HCO3 < 15 / pH < 7.30 Ketones > 3 Differences - first presentation of diabetes - susceptible to cerebral oedema - glucose falls rapidly with rehydration - withhold insulin 1-2 hrs start 0.05units/kg/hr - abdo pain common

Answer 14

shock - bolus 10ml/kg as needed if not shocked consider 10ml/kg over 60 mins replacement of deficit over 48hrs 0.9% + 20mmol KCL - severe DKA = 10% dehydration - mild-moderate = 5% Add deficit to maintenance maintenance fluid 10 / 50 / 20

Answer 15

early - headache, agitation, bradycardia, hypertension late - reduced GCS, abnormal breathing pattern, palsies, posturing 3ml/kg 3% saline 0.5g/kg mannitol reduce fluid

Answer 16

risks fetal - < 37/40, congenital abnormalitiy maternal - infection, PET, high BMI intrapartum - em CS, GA, bleeding, breech vaginal delivery meconium, fetal compromise

Answer 17

First 60s - delay cord clamping if possible - assess colour, tone, breathing, HR - open airway - 5 inflation breaths (30cmH20) if gasping / not breathing Ongoing - reassess - if no HR improvement look for chest movement - if no chest movement use 2 person airway control - repeat 5 breaths - ventilate for 30s if HR < 60 - chest compressions 3:1 if HR < 60. fiO2 1.0 - reassess every 30s 32/40 + air 28-31/40 0.21 - 0.3 < 28/40 - 0.3 preductal sats (right hand) 65 - 85 -90 2-5-10mins Bradycardia despite AB and CPR adrenaline IV 20mc/kg review at 10mins usually discontinue at 20mins

Answer 18

clinica, biochemical evidence of risk of hypoxic ischaemic encephalopathy - consider inducing hypothermia 33-34 degrees

Answer 19

5 rescue breaths 15:2 non-shockable - 10mcg/kg adrenaline shockable 4J/kg

Answer 20

decompensation - reduced LOC, tachypnoea, BP < 5 gentile, CRT > 2 bradycardia - oxygenate. if vagal 20mcg/kg atropine. if not 10mcg/kg adrenaline narrow complex tachycardia - sinus tachycardia infant 180-220, child 160-180. treat precipitant (sepsis, hypovolaemia, pain) - SVT infant > 220 child > 180 - adenosine 100-150mcg/kg, DCCV 1j/kg broad complex tachycardia - if conscious - sedate and DCCV - unconscious - DCCV - 2--> 4 j/k. amiodarone 5mg/kg before 3rd

Answer 21

life threatening organ dysfunction caused by dysregulated host response to infection - severe sepsis 2 + SIRS criteria, confirmed or suspected invasive infection, cvs dysfunction, ARDS or 2+ other organ system dysfunction - septic shock - severe infection leading to cvs hypotension, vasoactive medication, impaired perfusion

Answer 22

2 or more 1 must be abnormal temp or abnormal WCC - temp > 38.5 or < 36 - WCC > 34 ---> 11 1w ---> 17 - HR > 2SD above normal (180 up to 1yr, 140 2-5, 130 6-12, 11 13-17 - RR > 2SD above normal

Answer 23

resp - P/F < 300 - need for invasive or non-invasive ventilation CVS - despite 40ml/kg isotonic crystalloid - hypotension BP < 2SD below normal - vasoactive support - acidosis, lactataemia, oliguria, CRT > 5s, core to peripheral temperature differential 3 degrees Neuro - GCS < 11 renal - creatininee > 2x ULN Hepatic - bili > 4mg/dl (68) haem - platelets < 80, INR > 2

Answer 24

- cardiac - trauma (NAI) - metabolic - surgical

Answer 25

- source control - 40-60ml/kg fluid in 1st hour if shock or organ dysfunction - adrenaline, NA first line vasoactive - IV hydrocortisone in refractory instability Extracorporeal support - RRT - fluid overload - VV-ECMO severe pARDS - VA-ECMO - refractory shock

Answer 26

- RTC - fall from height - drowning - burns - poisoning

Answer 27

Primary - speed limits, cycle lanes, child resistant medication containers Secondary - seat belts, bike helmets Tertiary - pressure to laceration, cold water to burns

Answer 28

Chest - elastic tissues - high degree of force to fracture rib. - contusions common Abdomen - liver, spleen, bladder all more exposed - less protection Neuro - single biggest cause of trauma death - fontanelles / sutures may mitigate ICP rise - prone to cerebral oedema Limbs / spine - extremity injury common but less likely to be life threatening - pelvic fractures uncommon - spinal cord injury in absence of fracture

Answer 29

- head injuries - long bone fractures, multiple - ruptured viscus - glove and stocking burns - suffocation - bruising in non-mobile infant, non-exposed areas

Answer 30

- blood - 5ml/kg - TXA - 15mg/kg - crystalloid 10ml/kg - 20ml/kg blood --> 10ml/kg platelets - 0.1ml/kg 10% calcium chloride transfusion targets - platelets 50 - fibrinogen 1 - ica 1 - hb 80-120

Answer 31

< 4 - children's GCS E / M same as adult V 5 - babbles, coos, alert to normal level 4 - less than usual words, irritable cry 3 - cries only to pain 2 - moans to pain 1 - nil to pain preverbal - grimace response

Answer 32

- GCS < 14 initial (< 15 if under 1) - GCS < 15 at 2hrs - suspected NAI - seizure in absence of epilepsy - suspected BOS fracture - focal neurology - suspected open / depressed fracture - < 1 with > 5cm bruise, swelling, laceration

Answer 33

- sepsis - toxic-shock - HLH - MAS - Kawasaki disease - PIMS-TS (paediatric multisystem inflammatory syndrome temporally associated with Sars Cov-2

Answer 34

fever, oxygen requirement, hypotension others - mucous membrane changes - lymphednopathy - syncope - confusion - gi upset High fibrinogen, CRP, d-dimer, ferritin low albumin, lymphocytes CXR - patchy infiltrates Echo - myocarditis, valvulitis Management - treat as covid-19 - evaluate cardiac dysfunction - empirical abx - immunomodulation on discussion with MDT - IVIG if Kawasaki disease criteria fulfilled

Answer 35

acute inflammatory multi system condition associated with exotoxin production from gram positive infections. early shock, rash, desquamation, fever

Answer 36

Group A strep - strep progenies (burns, new fas) (TSLS) Staph aureus - menstrual products, nasal packs, IUD, pneumonia

Answer 37

fever, malaise, rash circulatory compromise myocarditis abdo pain

Answer 38

Blood cultures MC/S any fluid usual bloods urine - haemoglobinuria cxr - ards staphylococcal antibody, streptococcal exotoxin

Answer 39

Probable: clinical case definition + isolation of GAS from non sterile site confirmed : GAS from sterile site clinical case definition - hypotension - 2+ organ involvement - renal, haem, liver, ards, generalised rash, soft tissue necrosis Non-strep - clinical + lab criteria - lab includes negative cultures (apart from SA) negative serology for rocky mountain fever, lepto, measles

Answer 40

source control - debridement - antimicrobials + antitoxin - ivig in streptococcal - supportive care

Answer 41

Diagnosis same as adults severity pH < 7.1 - severe (10% dehydration) pH < 7.2 - moderate (5% dehydration) pH < 7.3 - mild (5% dehydration) deaths - cerebral oedema - hypokalaemia - inadequate fluid replacement - aspiration pneumonia

Answer 42

Shocked - 10ml/kg bolus, repeat as needed not shocked 10ml/kg over 30 mins requirement = deficit + maintenance maintenance = 100 / 50 / 20 deficit = according to severity 5 / 5/ 10%. replaced over 48 hours n/saline + 40mmol KcL switch to 5% dextrose when BM < 14

Answer 43

- start 1-2 hours after fluid - 0.05 - 0.1 units/kg/hr - reduce rate when BM < 14

Answer 44

headache / agitation / fall in HR / rise in BP deterioration in consciousness, posturing, pupillary changes, breathing abnormalities - 2.5ml/kg 3% saline or 0.5g/kg mannitol 20% - fluid 1/2 maintenance