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1 Paediatrics > Paediatric emergencies > Flashcards

Paediatric emergencies Flashcards

1
Q

What is WET FLAG?

A

The purpose of WETFLAG is to work out (quickly) appropriate weight based drugs and equipment for the child you are looking after. Approach to managing sick child

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2
Q

What are the components of WET FLAG?

A

Weight
Energy
Tube
Fluid
Lorazepam
Adrenaline
Glucose

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3
Q

What is the dose and rate of bolus administration in neonate for resus?

A

10 ml/kg over 10 mins

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4
Q

Name three risk factors for neonatal sepsis

A

maternal pyrexia
prolonged ruptured membranes
preterm delivery
GBS in previous infant or GBS bacteremia during pregnancy
fetal distress

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5
Q

Why is it important to assess preductal and postductal oxygen saturations?

A

Oximeter probes can be placed on preductal (right hand) and postductal (feet) sites to assess for right-to-left shunting at the level of the foramen ovale and ductus arteriosus. A difference greater than 10% between preductal and postductal oxygen saturations correlates to right-to-left ductal shunting.

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6
Q

Name three differentials for collapsed baby

A

Cardiac disease
Sepsis
Non accidental disease
Metabolic

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7
Q

Name one cardiac cause of a collapsed baby

A

transposition of the great artery

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8
Q

How does baby initially survive with transposed great arteries

A

Patent ductus arteriosus accounts for initial compatibility. When this closes, compromises blood oxygenation.

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9
Q

Name three cyanotic conditions

A

tetralogy of fallot (boot-shaped heart)
univentricular heart
transposition of great arteries
tricuspid and pulmonary atresia

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10
Q

Which shunt exists in cyanotic conditions?

A

Right to left shunt

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11
Q

List three acyanotic conditions

A

No blueness
ventricular septal defect
atrial septal defect
patent ductus arteriosus
pulmonary valve stenosis
coarctation of the aorta
aortic valve stenosis

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12
Q

Name a longterm risk associated with a patent ductus ateriosus?

A

pulmonary HTN, therefore need to close ASAP

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13
Q

Is a murmur always bad?

A

No, innocent murmurs are fine. Also, a louder murmur does not equate to a more serious problem as a small murmur can be more serious

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14
Q

Name two metabolic causes of collapse

A

Raised ammonia
Glucose

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15
Q

After two attempts of IV access, what should you do?

A

Interosseous access

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16
Q

Why and when would you do LP?

A

To investigate for meningitis, wait for other investigations first

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17
Q

Two contraindications for LP?

A

If haemodynamically unstable
Coag disorder
Infection at site
Raised ICP

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18
Q

Name two common pathogens that cause meningitis in neonates

A

Group B strep
Listeria monocytogenes
E.coli

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19
Q

When would you perform an LP as an initial investigation in a neonate?

A

<3 months and presence of fever

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20
Q

Three investigations for septic screen in baby <3 months?

A

LP, bloods, blood cultures

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21
Q

For maintenance fluids, what should you prescribe alongside normal saline/plasmolyte/hartmann’s?

A

5% dextrose, always do this!

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22
Q

What is the most important aspect of managing croup?

A

do not agitate! DON’T TOUCH

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23
Q

List two causative agents of croup

A

parainfluenza virus, RSV, adenovirus, rhinovirus

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24
Q

List three symptoms in the presentation of croup

A

cough
coryza
mild fever
barking cough

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25
Q

List three causes of stridor

A

Foreign body
Anaphylaxis
Epiglottis
Infectious mononucleosis
Peritonsillar abscess
Bacterial tracheitis

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26
Q

State four immediate aspects of management in a seizure?

A

start timer
airway
oxygen
glucose

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27
Q

List two febrile causes of seizure?

A

febrile convulsion
meningitis
epilepsy

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28
Q

State three differentials for afebrile seizure?

A

hypoglycaemia
electrolyte imbalance
epilepsy
intracranial pathology
trauma
poisoning

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29
Q

How does sepsis 6 differ in children?

A
  1. High flow O2
  2. IV/IO access and take blood cultures, glucose, lactate
  3. Antibiotics
  4. Fluid resus
  5. Consider inotropic support early
  6. Involve senior support early
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30
Q

Name two differences in adult and child when assessing A

A

Large occiput- head falls forward
Large tongue
<6m obligate nasal breathers
Horse-shoe epiglottis
Short and soft trachea

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31
Q

What is the consequence of nasal breathing?

A

easily blocked due to narrow passages and secretions

32
Q

What is a complication of horse-shoe epiglottis?

A

difficult intubation- U shaped compared to flat in adults

33
Q

What is a complication of a short and soft trachea?

A

more easily compressed

34
Q

What does stridor suggest?

A

laryngeal or tracheal obstruction

35
Q

What does gurgling suggest?

A

secretions

36
Q

What does snoring suggest?

A

upper airway compression

37
Q

What are the differences between adults and children when assessing breathing?

A

upper and lower airways smaller
infants diaphragmatic breathers
infants desaturate faster
younger children have a more compliant chest wall

38
Q

Why do infants desaturate faster?

A

greater metabolic rate, more O2 consumption, lower lung volumes, less respiratory reserve

39
Q

Why are children’s heart rates higher than in adults?

A

children have a lower stroke volume therefore heart beats faster to accommodate cardiac output

40
Q

Name one early sign of shock

A

tachycardia

41
Q

Name one late sign of shock

A

hypotension

42
Q

What do you assess in B?

A

RR, noises, accessory muscle use, nostril flaring

chest sounds

O2 sats

Colour

43
Q

What do you assess in C?

A

HR
Pulse volume- peripheral and central
Perfusion- CRT, urine output, temp
BP

44
Q

Name three ways to differentiate cardiac and respiratory cause in children?

A

tachy but no other chest signs, cyanosis with low sats despite O2
Additional heart sounds
Raised JVP
Hepatomegaly
Absent femoral pulses
Radiofemoral delay

45
Q

What do you assess for in D in children?

A

GCS/AVPU
Pupils
Fontanelle
Glucose
Posture

46
Q

What do you assess in E?

A

Temp, rashes, bruising

47
Q

List three reasons to prescribe fluid in children

A
  1. Dehydration
  2. Sepsis
  3. Bleeding
  4. Increases losses (D/V)
  5. NBM
48
Q

List three differences in physiology between children and adults in relation to water regulation

A

Higher body water content
Increased surface area
Increased RR
Increased metabolic rate
Immature renal function
May not understand/act on need for hydration

49
Q

List three red flags of dehydration in children

A
  1. Sunken fontanelle
  2. Reduced GCS
  3. Dry mucous membranes
  4. Sunken eyes and tearless
  5. Reduced CRT
  6. Tachy, hypo
  7. Sudden weight loss
50
Q

How if fluid volume calculated in children?

A

Over 24 hours
First 10kg- 100ml/kg
Second 10kg- 50 ml/kg
Subsequent- 20ml/kg

51
Q

How is the rate of fluid calculated in children?

A

4,2,1 rule

52
Q

What is the bolus for a child?

A

10ml/kg 0.9% NaCl over <10 mins

53
Q

In which circumstances do the fluid prescription rules differ in children?

A

DKA, haemorrhage, trauma

54
Q

Name three paediatric emergencies affecting the airway

A

croup
tracheitis
epiglottitis

55
Q

Which organisms causes acute epiglottitis?

A

h.influenzae

56
Q

Three causes of acute respiratory failure?

A

head injury
drugs
central infection
airway obstruction
asthma
pneumonia

57
Q

What is the main organism responsible for bronchiolitis?

A

RSV= respiratory syncitial virus

58
Q

Burns over what % body surface area should be referred?

A

> 3%

59
Q

List four types of burn

A

superficial
superficial dermal
deep dermal
full thickness

60
Q

List two clinical signs of mild dehydration (5%)

A

letheragic, loss of skin turgor, dry mouth, fontanelle slack

61
Q

List two clinical signs of moderate dehydration (10%)

A

tachy, tachyopnoea, fontanelle and eyes sunken, mottled skin, oligouria

62
Q

List two clinical signs of severe dehydration (15%)

A

shock, coma, hypotension

63
Q

Contraindications for NG tube in dehydrated patient?

A

unconscious, absent bowel sounds

64
Q

Three investigations for acute diarrhoea?

A

Hb
WBC
U+E
cultures: stool, throat, urine, blood

65
Q

Meningococcal infection may present with which two conditions?

A

purpura and otitis media

66
Q

Name one organism that likely causes meningitis in neonates

A

E.coli and group B haemolytic strep

67
Q

Name one organisms that like to causes meningitis in >3 month old

A

h.influenzae, meningococcus, pneumococcus

68
Q

List three complications of meningitis

A

Deafness
Cerebral oedema
Hyponatraemia
Convulsions
Long term disability

69
Q

How does UTI present in a neonate?

A

poor feeding, vomiting, fever, weight loss, conjugated jaundice

70
Q

How does UTI present in pre-school children?

A

diarrhoea, failure to thrive, crying, fever

71
Q

How does UTI present in school age children?

A

pain localised to suprapubic/loin area, fever, polydipsia, polyuria, dysuria

72
Q

Two differentials for dysuria?

A

UTI, vulvitis, balantitis

73
Q

What is the antidote to paracetamol poisoning?

A

methionine/acetyl cysteine

74
Q

What is the antidote to tricyclic poisoning?

A

activated charcoal

75
Q

What is the antidote to alcohol poisoning?

A

glucose

76
Q

What is the most common cause of seizure in children?

A

febrile convulsion

1 Paediatrics (19 decks)

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