Paediatric Emergencies Flashcards
State some common paediatric emergencies
- Cardiac arrest
- Croup
- Sepsis
- Meningitis
- Dehydration
- Febrile convulsions
- Anaphylaxis
- Overdose
- Hypothermia & hyperthermia
- Hypoglycaemia
- Respiratory arrest
- Poisoning of unknown origin
- Pneumothorax
- Peripheral nerve injuries/palsies
*NOTE: some emergencies covered here, some covered in other clases
The outcome following cardiac arrest in children is often poor; true or false?
True; problem is usually with respiratory system therefore even if get heart going again it doesn’t solve the problem
Management of paediatric emergencies is A-E approach as it is with adults; gauge the normal RR for children of different ages
*don’t need to know off by heart, just idea
Management of paediatric emergencies is A-E approach as it is with adults; what could the following clinical findings indicate in a child:
- Bubbling sound
- Harsh stridor & barking cough
- Soft stridor, drooling, fever, looks sick
- Sudden onset stridor with history of inhalation
- Stridor following allergen exposure
- Wheeze
- Bronchial breathing
Management of paediatric emergencies is A-E approach as it is with adults; gauge the normal HR for children of different ages
*don’t need to know off by heart, just idea
Management of paediatric emergencies is A-E approach as it is with adults; gauge the normal BP for children of different ages
*don’t need to know off by heart, just idea
During CPR, what position do you want the head of children:
- <1yr
- >1yr
- <1yr: neutral position
- >1yr: sniffing morning air
Describe the pattern of rescue breaths and compressions in child CPR
- Start with 5 rescue breaths
- 15 chest compressions
- 2 rescue breaths
… repeat
Describe the pattern of rescue breaths and compressions in child CPR
- Start with 5 rescue breaths
- 15 chest compressions
- 2 rescue breaths
… repeat
How should you position your hands for CPR in:
- Infants (<1yr)
- Toddlers/children
- Infants (<1yr): two fingers in centre of chest or two thumbs in centre with hand encircling chest
- Toddlers/children: heel of one hand
How should you assess a child who is choking?
A-E
How do you manage a choking child?
- Encourage to cough
- Infants:
- 5 back blows
- 5 chest thrusts
- Children:
- 5 back blows
- Heimlich manoeuvre
What is the most common overdose in paediatrics?
Paracetamol
State common clinical features of paracetamol overdose
- None
- Nausea/vomiting
- History of risk factors (self-harm, depression, regular pain relief medications, glutathione deficiency, long term treatment with CYP P450 inducers)
- Uncommon: abdo pain, jaundice, hepatomegaly,loin pain, altered conscious level
What investigations would you do in paracetamol overdose?
- Paracetamol level: treatment
- LFTs: monitor ALT for hepatotoxicity
- Clotting screen: functioning of liver
- U&Es: baseline, risk of AKI
- Glucose: hypoglycaemia common in liver necrosis
- Venous gas: acidosis in 10% acute liver failure
Discuss the management of paracetamol overdose
- If staggered overdose or timing unclear, start N-acetylcysteine straight away
- If not staggered, >150mg/kg, been <8hrs since ingestion and can get blood results back (and act on them) within 8hrs: do bloods and wait to see if need NAC
- If not staggered, >150mg/kg and been >8hrs since ingestion or cannot get blood results back (and act on them) within 8hrs start NAC
Use graph to determine if need treatment
State some potential causes of pneumothorax in:
- Infants
- Children
Infants
- Prematurity (fragile lungs)
- Meconium aspiration syndrome (idea that meconium is thick, when in airways allows air to pass through during inspiration but doesn’t allow air to flow out during expiration)
- RDS
Children
- Primary spontaneous (rupture subpleural blebs tall, thin, adolescent males)
- Secondary spontaneous: CF, asthma, Marfan’s syndrome
- Trauma
Discuss the management of pneumothorax in children
What is meant by:
- Biochemical hypoglycaemia in a neonate
- Biochemical hypoglycaemia for children older than neonate
- Clinical hypoglycaemia
- Biochemical neonate: 2.6mmol/L
- Biochemical older than neonate: 3mmol/L
- Clinical: glucose low enough to cause symptoms and/or signs of impaired brain function
(according to UHL guidelines gluocse <2.6mmol/L in infant <6months and <3mmol/L in children > 6 months)
Discuss the management of hypoglycaemia in children (not neonates)
Depends on if acidosis & hypoglycaemia present. Options include:
- Fast acting glucose (glucose tablets, glucose gel, fruit juice)
- IV glucose bolus
- IM glucagon
State some ways you could assess hydration status of infant or child
- CRT
- Heart rate
- Tachypnoea
- Fontanelle (depression)
- Skin turgor
- Sunken eyes
- Urine output
- Dry mucous membranes
- Altered responsiveness
State some signs of clinical shock in a child
- Decreased level of consciousness
- Pale or mottled skin
- Cold extremities
- Pronounced tachycardia
- Pronounced tachypnoea
- Weak peripheral pulses
- Prolonged capillary refill time
- Hypotension
**Hypotension is sign of decompensated shock in children and is late sign!!!
If a child comes into A&E and there are minor concerns about hydration/fluid intake, what can you do?
Fluid challenge
What is the choice of fluids in children (and neonates who are not critically ill)
Sodium chloride 0.9% with 5% glucose
Discuss how you calculate paediatric maintenance fluids
Children (>28 days of age)
Routine maintenance fluids for children are calculated by weight using the Holliday-Segar formula:1,5
- 100 ml/kg/day for the first 10kg of weight
- 50 ml/kg/day for the next 10kg of weight
- 20 ml/kg/day for weight over 20kg
Discuss how you calculate neonatal fluids
Neonates (<28 days of age)
Maintenance for term neonates is calculated according to their age and weight:
- Birth to day 1: 50-60 ml/kg/day
- Day 2: 70-80 mL/kg/day
- Day 3: 80-100 mL/kg/day
- Day 4: 100-120 mL/kg/day
- Days 5-28: 120-150 mL/kg/day
How can you calculate percentage dehydration by weight?
What vol of fluid is used in resuscitation in paediatrics?
10-20ml/kg
Use smaller volume in situations such as cardiac failure, septic shock, diabetic ketoacidosis and major trauma.
**NICE CKS SAYS: 10ml/kg for children and young people over <10 minutes. 10-20ml/kg for term neonates over <10 minutes.
Describe how you calculate a fluid deficit in children?
- Fluid deficit (mL) = % dehydration x weight (kg) x 10
- *NOTE: the fluid deficit is corrected over 48hrs*
When correcting any hyper- or hyponatraemia you must ensure Na+ does not rise or fall more than ____ in 24hrs?
12mmol/L
What should children on IV fluids have checked everyday?
- Plasma glucose
- U&Es
What is the normal/acceptable urine output for the following ages:
- Neonate
- Infant
- Child
- Adolescent
- Neonate (<28 days): 2-3mL/kg/hr
- Infant (>28 days to <1yr): 2mL/kg/hr
- Child: 1-2mL/kg/hr
- Adolescent (10-18yrs): 0.5-1mL/kg/hr
Define hypothermia
Discuss management
- Temperature <35 degrees
- Management:
- Remove from sources of potential cooling e.g. remove wet clothes, bring inside
- Warmed IV fluids
- External warming e.g. Bair-Hugger
- Humidified oxygen at 40 degrees (decrease heat loss through respiration)
State some signs & symptoms of heat exhaustion
State some signs & symptoms of heat stroke
Heat Exhaustion
- Hx exposure to high heat or strenuous exercise
- Irritability
- Lethargy
- Headache
- Nausea
- Hyperthermia >38
Heat Stroke
- Seizures
- Anhidrosis
- Impaired consciousness
- Temp >40
Discuss the management of heat stroke
- ABCDE
- Remove excessive clothing
- Rapid acting cooling
- Cold or iced water immersion (exertional heat exhaustion)
- Wetting and fanning the skin
- Wet ice packs
- Supportive care (e.g. oxygen, IV fluids…)
For iron poisoning, discuss:
- Symptoms & signs
- Investigations
- Management
- Complications
- Nausea/vomiting, abdo pain, haematemesis, black bloody stools
- Investigations: Fe level, FBC, U&E’s, LFTs, CBG,?axr (can sometimes see pills)
- Management:
- First line= bowel irrigation
- If severe poisoning then IV chelation using deferoxamine
- Complications:
- Liver failure
- GI scarring (leading to early satiety and/or nausea)
