Paediatric emergencies Flashcards
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
What are the components of WET FLAG?
Weight
Energy
Tube
Fluid
Lorazepam
Adrenaline
Glucose
What is the dose and rate of bolus administration in neonate for resus?
10 ml/kg over 10 mins
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
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.
Name three differentials for collapsed baby
Cardiac disease
Sepsis
Non accidental disease
Metabolic
Name one cardiac cause of a collapsed baby
transposition of the great artery
How does baby initially survive with transposed great arteries
Patent ductus arteriosus accounts for initial compatibility. When this closes, compromises blood oxygenation.
Name three cyanotic conditions
tetralogy of fallot (boot-shaped heart)
univentricular heart
transposition of great arteries
tricuspid and pulmonary atresia
Which shunt exists in cyanotic conditions?
Right to left shunt
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
Name a longterm risk associated with a patent ductus ateriosus?
pulmonary HTN, therefore need to close ASAP
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
Name two metabolic causes of collapse
Raised ammonia
Glucose
After two attempts of IV access, what should you do?
Interosseous access
Why and when would you do LP?
To investigate for meningitis, wait for other investigations first
Two contraindications for LP?
If haemodynamically unstable
Coag disorder
Infection at site
Raised ICP
Name two common pathogens that cause meningitis in neonates
Group B strep
Listeria monocytogenes
E.coli
When would you perform an LP as an initial investigation in a neonate?
<3 months and presence of fever
Three investigations for septic screen in baby <3 months?
LP, bloods, blood cultures
For maintenance fluids, what should you prescribe alongside normal saline/plasmolyte/hartmann’s?
5% dextrose, always do this!
What is the most important aspect of managing croup?
do not agitate! DON’T TOUCH
List two causative agents of croup
parainfluenza virus, RSV, adenovirus, rhinovirus
List three symptoms in the presentation of croup
cough
coryza
mild fever
barking cough
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?
- High flow O2
- IV/IO access and take blood cultures, glucose, lactate
- Antibiotics
- Fluid resus
- Consider inotropic support early
- 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
- Dehydration
- Sepsis
- Bleeding
- Increases losses (D/V)
- 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
- Sunken fontanelle
- Reduced GCS
- Dry mucous membranes
- Sunken eyes and tearless
- Reduced CRT
- Tachy, hypo
- 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
