Paediatric emergencies Flashcards by katie louise

What is WET FLAG?

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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What are the components of WET FLAG?

Weight
Energy
Tube
Fluid
Lorazepam
Adrenaline
Glucose

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

10 ml/kg over 10 mins

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Name three risk factors for neonatal sepsis

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

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

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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Name three differentials for collapsed baby

Cardiac disease
Sepsis
Non accidental disease
Metabolic

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Name one cardiac cause of a collapsed baby

transposition of the great artery

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How does baby initially survive with transposed great arteries

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

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Name three cyanotic conditions

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

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Which shunt exists in cyanotic conditions?

Right to left shunt

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List three acyanotic conditions

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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Name a longterm risk associated with a patent ductus ateriosus?

pulmonary HTN, therefore need to close ASAP

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Is a murmur always bad?

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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Name two metabolic causes of collapse

Raised ammonia
Glucose

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

Interosseous access

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Why and when would you do LP?

To investigate for meningitis, wait for other investigations first

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Two contraindications for LP?

If haemodynamically unstable
Coag disorder
Infection at site
Raised ICP

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Name two common pathogens that cause meningitis in neonates

Group B strep
Listeria monocytogenes
E.coli

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

<3 months and presence of fever

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Three investigations for septic screen in baby <3 months?

LP, bloods, blood cultures

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

5% dextrose, always do this!

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What is the most important aspect of managing croup?

do not agitate! DON’T TOUCH

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List two causative agents of croup

parainfluenza virus, RSV, adenovirus, rhinovirus

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List three symptoms in the presentation of croup

cough
coryza
mild fever
barking cough

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List three causes of stridor

Foreign body Anaphylaxis Epiglottis Infectious mononucleosis Peritonsillar abscess Bacterial tracheitis

State four immediate aspects of management in a seizure?

start timer airway oxygen glucose

List two febrile causes of seizure?

febrile convulsion meningitis epilepsy

State three differentials for afebrile seizure?

hypoglycaemia electrolyte imbalance epilepsy intracranial pathology trauma poisoning

How does sepsis 6 differ in children?

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

Name two differences in adult and child when assessing A

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

What is the consequence of nasal breathing?

easily blocked due to narrow passages and secretions

What is a complication of horse-shoe epiglottis?

difficult intubation- U shaped compared to flat in adults

What is a complication of a short and soft trachea?

more easily compressed

What does stridor suggest?

laryngeal or tracheal obstruction

What does gurgling suggest?

secretions

What does snoring suggest?

upper airway compression

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

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

Why do infants desaturate faster?

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

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

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

Name one early sign of shock

tachycardia

Name one late sign of shock

hypotension

What do you assess in B?

RR, noises, accessory muscle use, nostril flaring chest sounds O2 sats Colour

What do you assess in C?

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

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

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

What do you assess for in D in children?

GCS/AVPU Pupils Fontanelle Glucose Posture

What do you assess in E?

Temp, rashes, bruising

List three reasons to prescribe fluid in children

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

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

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

List three red flags of dehydration in children

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

How if fluid volume calculated in children?

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

How is the rate of fluid calculated in children?

4,2,1 rule

What is the bolus for a child?

10ml/kg 0.9% NaCl over <10 mins

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

DKA, haemorrhage, trauma

Name three paediatric emergencies affecting the airway

croup tracheitis epiglottitis

Which organisms causes acute epiglottitis?

h.influenzae

Three causes of acute respiratory failure?

head injury drugs central infection airway obstruction asthma pneumonia

What is the main organism responsible for bronchiolitis?

RSV= respiratory syncitial virus

Burns over what % body surface area should be referred?

>3%

List four types of burn

superficial superficial dermal deep dermal full thickness

List two clinical signs of mild dehydration (5%)

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

List two clinical signs of moderate dehydration (10%)

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

List two clinical signs of severe dehydration (15%)

shock, coma, hypotension

Contraindications for NG tube in dehydrated patient?

unconscious, absent bowel sounds

Three investigations for acute diarrhoea?

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

Meningococcal infection may present with which two conditions?

purpura and otitis media

Name one organism that likely causes meningitis in neonates

E.coli and group B haemolytic strep

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

h.influenzae, meningococcus, pneumococcus

List three complications of meningitis

Deafness Cerebral oedema Hyponatraemia Convulsions Long term disability

How does UTI present in a neonate?

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

How does UTI present in pre-school children?

diarrhoea, failure to thrive, crying, fever

How does UTI present in school age children?

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

Two differentials for dysuria?

UTI, vulvitis, balantitis

What is the antidote to paracetamol poisoning?

methionine/acetyl cysteine

What is the antidote to tricyclic poisoning?

activated charcoal

What is the antidote to alcohol poisoning?

glucose

What is the most common cause of seizure in children?

febrile convulsion