Paediatric ED Flashcards
A healthy child with a limp should be assumed to have
until proven otherwise (based on age <4, 4-9, >9):
- Hip dysplasia if younger than 4 years old
- Perthes disease if 4-9 years old
- Slipped upper femoral epiphysis if older than 9 years
What is the antidote for sodium nitrite?
Methylene blue
What is the antidote for propranolol poisoning?
Glucagon
What is the antidote for tricyclic poisoning?
NaHCO3
What are the diagnostic criteria for Kawasaki?
Temp >39 with 4/5 of
- eye signs (conjunctival hyperemia, limbal sparing, non exudative)
- oral changes (cheilitis, lipstick sign/strawberry tongue)
- peripheral skin changes
- rash (perineal important, can have nearly anything)
- lympadenopathy (sentinel node)
With SSRI toxicity, what symptom do you NOT get?
Coma
What is the most likely ingestion in a teenager with
confusion, sweating and blurred vision, hyperthermic with T 40°C and CK is 40000U/L?
MDMA/ecstasy; supportive therapy only
What is the antidote for organophosphate poisoning?
Atropine
What ingestion might you suspect in a 4-year-old with constricted pupils, sweating and increased salivation?
- This is a CHOLINERGIC toxidrome from mushrooms, organophosphate, carbamate insecticides
- DUMBBELLS - Diarrhoea, Urination, Miosis [ pinpoint pupils], Bradycardia, (Bronchorrhoea/spasm kill you particularly with organophoshates) Emesis, Lacrimation, Lethargy and Salivation
- so it could be organophosphates
What happens at different carboxyhaemoglobin levels?
- 0 – 1%: Normal (smokers often 5 – 10%)
- 10 – 30%: Headache, SOBOE, confusion
- 30 – 50%: Severe headache, N+V, tachycardia/tachypnoea, visual disturbances, memory loss, ataxia
- 50 – 70%: Convulsions, coma, severe cardiorespiratory compromise
- 70%: dead
What is the next resus step for haemodynamically stable VT?
Adenosine
What do you do for PEA?
- 0.01mg/kg adrenaline
- DO NOT SHOCK
What do you do for shocked SVT?
If IV access, adenosine 100mcg/kg; if not shock 1J/kg synchronized
What is the cut off for investigation following repeated supratherapeutic ingestion of paracetamol?
- 24hrs >200mg/kg
- 48hrs >150mg/kg/24hrs
- 72hrs >100mg/kg/24hrs
What do you give for digoxin overdose?
Digoxin FAb/Digibind if >4mg ingested or arrest/life threatening arrhythmia
What are contraindications to use of continuous NO for sedation?
- Fractured ribs
- Acute asthma
- B12 deficiency
How do you calculate positive and negative likelihood ratios?
Positive LR = sensitivity/(100% - specificity)
Negative LR = (100% - sensitivity)/specificity
What is a type one error?
- rejecting a null hypothesis when it is actually correct (you see a result when there is actually no difference)
- chance of this is known as alpha
What is a type 2 error?
- failing to reject a null hypothesis when the null hypothesis is wrong (i.e. you get no difference but there should be)
- chance of this is known as beta
What is the definition of power?
Power = probability test will reject false null Ho
• Power = 1- β = sensitivity target 0.8 or 0.9
Determined by:
• Population size
• Size of effect
• Variance within populations – Test used
How do you calculate serum osmolality?
2 x (Na + K) + Glucose
What are the GCS parameters?
Best Motor Response 1 = none 2 = extensor response to pain 3 = abnormal flexion to pain 4 = withdraws from pain 5 = localises pain 6 = responds to commands
Eye Opening 1 = none 2 = to pain 3 = to speech 4 = spontaneous
Best Verbal Response 1 = none 2 = incomprehensible sounds 3 = inappropriate words 4 = appropriate words but confused 5 = fully orientated
How do you calculate clearance of a drug?
Clearance = (0.693 x Volume of distribution) / half life
What is the classical presentation of digoxin toxicity?
- GI problems
- Hyperkalemia and life-threatening dysryhthmias
- CVS: enhanced automaticity (atrial tachycardias (e.g. flutter, AF) with AV block, VF, VT, ventricular ectopic beats), bradyarrhythmias (Conduction delays / blocks, slow or regularised AF), hypotension, shock
- Confusion/lethargy
