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FRCEM ‘23 > Paediatircs > Flashcards

Paediatircs Flashcards

1
Q

What are concerning HR’s for children? (Amber flag)

A

<1yr - >160bpm
1-2yrs - >150bpm
2-5yrs - >140

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2
Q

What are concerning RR for kids? (Amber)

A

6-12 months - >50bpm
>1yr - >40bpm

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3
Q

What are the reassuring features in Brief Resolved Unexplained Events?

A

> 60 days old
Born >32 weeks
No CPR
1st event
<1min duration

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4
Q

What are the red flags for paediatric dehydration? (6)

A
  • appears unwell/deteriorating
  • Reduced level of consciousness (irritable, lethargy)
  • sunken eyes
  • tachycardia
  • tachypnoea
  • reduced skin turgor
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5
Q

What are the three levels of dehydration?

A
  • mild <5% loss of body weight
  • moderate 5-10% loss of body weight
  • severe >10% loss
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6
Q

Consider hypernatraemic dehydration if: (4)

A
  • child <6 months old
  • doughy skin
  • tachypnoea
  • jitteriness

Other neuro signs include increased muscle tone, hyperreflexia, convulsions, coma

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7
Q

Stool culture should not be routine but consider if: (6)

A
  • Recent travel to at-risk area
  • Diarrhoea not improved for 7 days
  • uncertainty re: Dx
  • septic
  • blood/mucus in stool
  • immunocompromised
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8
Q

Weight from Age calculations for 0-1, 1-5, 6-12.

A
  1. (0.5 x age(months)) + 4
  2. (2x age) + 8
  3. (3 x age) + 7
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9
Q

Febrile seizures are simple if:

A

Febrile seizures are considered “simple” providing they last less than 15 mins, don’t recur within 24 hours or within the same illness, have a complete recovery within an hour, and if they are generalised (as opposed to focal). They are most common up to the age of 2 years, but can range from 6 months to 6 years. Tell the parents that 1 in 3 children will have another febrile seizure, they reduce with age and are not harmful.

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10
Q

What are the ventilatory rates in children in arrest once ETT in situ?

A

Infant (<1yr) - 25 breaths/min
1-8 - 20bpm
8-12 - 15bpm
12-18 - 10-12bpm

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11
Q

What is the adrenaline dose for children in cardio-respiratory arrest?

A

10mcg/kg or 0.1ml/kg of 1 in 10,000

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12
Q

Other than the femoral a, where should you feel for a pulse in a child in arrest?

A

If infant (<1yr) then brachial
If child (1-18) carotid

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13
Q

What is the dose of Amiodarone in paediatric arrest?

A

5mg/kg - give after 3rd shock and again after 5th shock or if re-enters shockable rhythm after cardio version if second dose not already given.
Give over 3 mins in neonates, and over 5 mins in other ages.

N.b it is mildly negatively inotropic

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14
Q

What is the alternative to amiodarone in paediatric arrest? And what is the dose?

A

Lidocaine, 1mg/kg.

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15
Q

What is the initial fluid bolus in paediatric arrest? What is the maximum total you can give?

A

10ml/kg
40-60ml/kg

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16
Q

When should you initiate oxygen therapy in an unwell child?

A

<94% sats or 3% drop from usually level in children with known chronic resp ds.

17
Q

What are the first line vasopressors in paediatrics?

A

Adrenaline and noradrenaline.
Dopamine is only used if these are unavailable

18
Q

What are the doses of adenosine in paediatric SVT?

A

Neonate (<1m) 150mcg/kg - increase by 50-100mcg with each attempt (max 300)
Infant 150mcg/kg - max 500mcg
1-11yrs 100mcg/kg - max 12mg
12-17 - 6mg, then 12mg.

19
Q

What is the paediatric dose of Mg for torsades de pointes?

A

25-50mg/kg - max 2g - over 10-15mins

20
Q

What is the weight calculation for Paeds?
Age 1-10yrs

A

(Age + 4) x 2

21
Q

What is the paediatric dose of atropine?

A

20mcg/kg if 1-11yrs
300-600mcg if 12-18

22
Q

What is the dose of calcium gluconate in paediatric hyperkalaemia?

A

0.11mmol/kg over 5-10mins

Max doses:
Neonates - 2ml
Child - 20ml

23
Q

What are the 5th centiles for SBP in Paeds?

A

1m - 50
1yr - 70
5yr - 75
10yr - 80

24
Q

What are the signs of acute severe asthma in Paeds?

A

PEFR 33-50%
O2<92%
Mod to marked accessory muscle use
Can’t complete sentences
Agitated, distressed

25
Q

What is the management of status epilepticus in Paeds?

A

Confirm clinically
ABC, O2 & monitoring
Check BM and Rx if <3

Consider pre-hospital Rx (max two doses benzodiazepines)
1st line at 5mins
- midazolam (buccal/IN) 0.3mg/kg
- lorazepam IV/IO 0.1mg/kg (max 4)
- midazolam IV/IO 0.15mg/kg (max 10)

At 10-15 mins
- repeat IO/IV options

2nd line - all IV - at 15-35 mins
- Keppra 40mg/kg IV over 5 mins, max 3g
- Phenytoin 20mg/kg over 20 mins with ECG monitoring
- Phenobarbital 20mg/kg over 5mins

Call anaesthetics/PICU

26
Q

How do you calculate level of dehydration in Paeds DKA?

A

It is based on pH or bicarbonate
7.2-7.29 or <15 = mild (5%)
7.1-7.19 or <10 = mod (5%)
<7.1 or <5 = severe (10%)

Give 10ml/kg of NaCl to all.
Over 30mins if no shock
Over 5-10mins if shock and re-assess (up to 40ml/kg)

27
Q

What is the treatment protocol for Paeds DKA?

A

Aim to correct fluid balance over 48hrs (remove 10ml/kg initial bolus from fluids if pt was not shocked initially).

Start insulin 1-2 hours after fluids commenced at a rate of 0.05-0.1 units/kg/hr (0.05 if <5y/o).

28
Q

How do you calculate the fluid deficit in Paeds?

A

% dehydration x wt x 10

29
Q

What is maintenance fluids in Paeds?

A

4ml/kg/hr for first 10kg
2ml/kg/hr for 10-20kg
1ml/kg/hr for the rest up to 75kg

30
Q

Meningitis in children. When should you give IV ceftriaxone immediately?

A

Petechiae start to spread
Rash becomes purpuric
Signs of bac meningitis
Sings of meningococcal septicaemia
Child appears ill to HCP
Or
If unexplained petechial rash and fever if CRP/WCC raised.

31
Q

Pyloric stenosis usually begins in the first 2-6 weeks of life. What are the features associate with it?

A

First born male children are most affected
Projectile vomiting, always hungry
Hypochloraemic alkalosis
Palpable olive

US to confirm Dx

Sx to divide pyloric muscle

32
Q

What are the treatment options for the various degrees of croup?

A

Mild - dexamethasone 0.15mg/kg PO

Moderate - 0.15-0.3mg/kg Dex PO
- if worsens during observation period then 5ml adrenaline neb 1:1000

Severe - Adrenaline neb 0.5ml/kg 1:1000
- oxygen
- oral/IM dex 0.3-0.6mg/kg
- monitor for >4hrs following adrenaline

Admit if:
Severe
Mod with deterioration or rpt adrenaline
Toxic child
O2 requirement
Unable to tolerate PO fluids

FRCEM ‘23 (12 decks)

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