OSCE emergencies (Paediatrics) Flashcards
resuscitation fluids for children
10 mL/kg over <10 minutes
managment of hypoglycaemia
<4mmol
- Encourage drink of sweet drink e.g. lucozade
- IV dextrose 10%
- IM glucagon
investigations for overdose
Bedside
- BM
- 12 lead ECG
- Capillary blood gas
Laboratory
Bloods
- Full blood count
- Urea and electrolytes
- Liver function tests
- Clotting
- Blood conc of toxin
Urine
- Toxocology screen
examination for overdose
- A-E assessment
- AVPU
- Neuro examination
- Pupillary reflexes
- Height and weight
- specific signs
great resource for overdose
TOXBASE
management of paracteamol
- <1 hour give activated charcoal
- Serum conc (4h post ingestion)
- <8 hours: N-acetylcysteine infusion
aspirin overdose management
- acitvated charcoal
- fluid replacment
- urine alkalinisation with sodium bicarbonate
- benzos for seizures
- haemodialysis if severe
iron overdose management
- metabolic acidosis - sodium bicarbonate (large flush before and after due to irritation of vein)
- Desferrioxamine
benzodiazepine management
- fluids
- <1 hour activated charcoal
- Flumenzenil
maagement of button batteries
Surgical removal
- mucosal ulceration -> necrosis -> haemorrhage -> perforation
management of pneumothorax
if not breathlessness and <2cm
- no treatment
if breathless and/or >2cm rim of air on chest x-ray
- Aspiration - large bore cannula into 2nd intercost space midclavicular line
- When aspiration fails twice, a chest drain is required- triangle of safety - 5th intercostal spcae midaxillary line (above the rib)
pleural effusion management
Conservative management
- small effusions
- supportive
Pleural aspirtation
- 2nd intercostal space midclavicular line
- chest drain - 5th intercostal space mid axillary line
severity of asthma attach
management of mild asthma attack
Mild cases can be managed as an outpatient with regular salbutamol inhalers via a spacer (e.g. 4-6 puffs every 4 hours).
Moderate to severe asthma attack
cases require a stepwise approach working upwards until control is achieved
- Salbutamol inhalers via a spacer device: starting with 10 puffs every 2 hours
- Nebulisers with salbutamol / ipratropium bromide
- Oral prednisone (e.g. 1mg per kg of body weight once a day for 3 days)
- IV hydrocortisone
- IV magnesium sulphate
- IV salbutamol
- IV aminophylline
A typical step down regime of inhaled salbutamol is
- 10 puffs 2 hourly
- then 10 puffs 4 hourly
- then 6 puffs 4 hourly
- then 4 puffs 6 hourly.
asthma attack discharge
discharge can be considered when the child well on 6 puffs 4 hourly of salbutamol.
Presentation of DKA
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The patient will present with symptoms of the underlying hyperglycaemia, dehydration and acidosis:
- Polyuria
- Polydipsia
- Nausea and vomiting
- Weight loss
- Acetone smell to their breath
- Dehydration and subsequent hypotension
- Altered consciousness
- Symptoms of an underlying trigger (i.e. sepsis)
Diagnosing DKA
Check the local DKA diagnostic criteria for your hospital. To diagnose DKA you require:
- Hyperglycaemia (i.e. blood glucose > 11 mmol/l)
- Ketosis (i.e. blood ketones > 3 mmol/l)
- Acidosis (i.e. pH < 7.3)
management of DKA
- Correct dehydration evenly over 48 hours. This will correct the dehydration and dilute the hyperglycaemia and the ketones. Correcting it faster increases the risk of cerebral oedema.
- Give a fixed rate insulin infusion. This allows cells to start using glucose again. This in turn switches off the production of ketones.
Other important principles:
- Avoid fluid boluses to minimise the risk of cerebral oedema, unless required for resuscitation.
- Treat underlying triggers, for example with antibiotics for septic patients.
- Prevent hypoglycaemia with IV dextrose once blood glucose falls below 14mmol/l.
- Add potassium to IV fluids and monitor serum potassium closely.
- Monitor for signs of cerebral oedema.
- Monitor glucose, ketones and pH
clinical featues of kawasaki
A key feature that should make you consider Kawasaki disease is a persistent high fever (above 39ºC) for more than 5 days. Children will be unhappy and unwell. The key skin findings are a widespread erythematous maculopapular rash and desquamation (skin peeling) on the palms and soles.
Other features include:
- Strawberry tongue (red tongue with large papillae)
- Cracked lips
- Cervical lymphadenopathy
- Bilateral conjunctivitis
kawasaki investigations
- Full blood count can show anaemia, leukocytosis and thrombocytosis
- Liver function tests can show hypoalbuminemia and elevated liver enzymes
- Inflammatory markers (particularly ESR) are raised
- Urinalysis can show raised white blood cells without infection
- Echocardiogram can demonstrate coronary artery pathology
Management of kawasaki
There are two first line medical treatments given to patients with Kawasaki disease:
- High dose aspirin to reduce the risk of thrombosis (dont worry about Reyes syndrome)
- IV immunoglobulins to reduce the risk of coronary artery aneurysms
- Patients will need close follow up with echocardiograms to monitor for evidence of coronary artery aneurysms.
pyloric stenois
progressive hypertrophy of the smooth muscle fo the pyloric sphincter
presentation of pyloric stenosis
occurs in first few weeks of life
- failing to thrive
- projective vomiting (non- bilious)
- feels like a large olvie
- can often see peristalsis
blood gas for pyloric stenosis
hypochloremic hypokalaemic metabolic alkalosis
diagnosis of pyloric stenosis
US
principles of neonatal rescus
1) Warm the baby -> vigorous drying stimulates breathing
2) Calculate APGAR
3) Stimulate breathing - check for airway obstruction e.g. meconium
4) Inflation breaths: two cycles of five inflation breathes
5) If no response chest compression (<HR 60)
6) if risk of HIE therapeutic hypothermia
