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Paediatrics cabinetchip > paediatric emergencies > Flashcards

paediatric emergencies Flashcards

1
Q

presenation of acute epiglottitis

A

syx of stridor/drooling

fever in 3-7yo becomes toxic within a few hours

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2
Q

cause of acute epiglottitis

A

haemophilus influenzae B
-found in throat and blood culutes

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3
Q

what not to do regarding mangement of acute epiglottits

A

DO NOT try and visualise epiglottis nor cause child distress (cannulation)

both can precipitate a respiratory arrest

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4
Q

management of acute epiglottits 4

A

move to nearest ITU

intubation of airway be experieinced anaethetis is likely needed

humified air/o2

cefotaxime IV

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5
Q

differentials for acute epiglottitis 3

A

foreign body
retropharyngeal abscess
diptheria

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6
Q

presenation of acute croup 4

A

inspiratory stridor usually preceded by a few days of coryzal syx
mild fever
contitutional upset
wheeze common

-can appear like epiglottitis

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7
Q

management of acute croup 2

A

humidy air/o2
no ABx
dexamethasone oral

rarely intubation

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8
Q

how can causes of acute respiratory failure be classified 4

A

central
airway
parenchymal
chest wall

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9
Q

regarding causes of acute respiratory failure
central causes 4

A

head injury

drugs

convulsion s

infection

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10
Q

regarding acute respiratory failure
airway causes 2

A

acute epiglottitis

foreign body

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11
Q

regarding acute respiratory failure
parenchymal causes 3

A

pneumonia

bronchiolitis

asthma

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12
Q

regarding acute respiratory failure
cehst wall acuses 3

A

polio

trauma

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13
Q

presenation of acute respiratory failure 4

A

restless
agitaed
cyanosis
silent chest no moving sufficeinct air

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14
Q

blood gasses in acute respiratory failure

A

low PaCO2 <8kPa
and/or rising CO2

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15
Q

basic management of acute respiratory failure 4

A

secure airway

bag and mask

intubate

assist ventilation

deal with primary causes

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16
Q

presentation of acute bronchiolitis 4

A

cold followed by (3-5days) later porgressive cough, wheeze, difficulty in feeding

signs as for asthma

fine inspiratory crepitation (in infants 6wks to 6 mnths) due to RSV

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16
Q

presentation of acute bronchiolitis 4

A

cold followed by (3-5days) later porgressive cough, wheeze, difficulty in feeding

signs as for asthma

fine inspiratory crepitation (in infants 6wks to 6 mnths) due to RSV

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17
Q

presentation of acute bronchiolitis 4

A

cold followed by (3-5days) later porgressive cough, wheeze, difficulty in feeding

signs as for asthma

fine inspiratory crepitation (in infants 6wks to 6 mnths) due to RSV

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18
Q

management of acute bronchiolitis 4

A

oxygen

suction of secretions

tube feeding or IV fluids if unable to feed orally

ABx given accoridng to age and severity of illness if bacterial infection suspected
\
*note 1/3 later develop asthma

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19
Q

presenation of acute asthma 7

A

from 1 year of age

expiratory wheeze
difficulty speaking
head extened
nostrils flared

chest increased AP diameter

accessory msucels working

rapid pulse

may have pulsus paradoxus

cyanosisin air

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20
Q

management of acute asthma 5

A

nebuliased salbutamol

oxygen if hypoxic/cyanosed or via nebuliser

theophylline IV

conisdr continous IV fluids, theophylline and hydrocort if inadequate response
-introduce oral pred and bronchodilators as sosn as practicle

ABx only if good evidence of infection
-monitor pulse, resp, CXR and blood gasses in severe or deteriroating episoders

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21
Q

what type of pneumonia is more common in children

A

bronchopneumonia commoner than lobar pneumonia
-espically in pre-school child

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22
Q

hwo can causes of pneumonia be split

A

primary -bacterial or viral

or

secondary

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23
Q

secondary causes of pneumonia 3

A

post measles

whooping cough

milk inhalation

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24
Q

how do babies with pneumonia present 5

A

v ill

grey

cyanosed

resp rate and effort increased

can have febrile convulsions

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25
Q

what can lobar pneumonia in older children mimic

A

acute appendicitis

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26
Q

investgiations for pneumonia 5

A

CXR

Hb and WBC

throat swab

blood cultures

mantoux

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27
Q

what investigations can be indicated in recurrent pneumonia 3

A

sweat test

look for foreign body

immune deficeincy

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28
Q

management of pneuonai 5

A

suck out secretions from airway

give physio

O2

NG or IV feed

ABx

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29
Q

abx used for paeds pneumonia 3

*-what if staph pneumonia suspected 11

A

<5 - (highly likely strep pneumoniae)
- amoxicillin

≥5 or likely mycoplasma or chlamydia
= azithromycin

pneumonia compication influenxa - co-amox

*-fluclox

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30
Q

important syx of cardiac failure in children 3

A

feeding prblems

breathlessness on feeding

sweating

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31
Q

other syx of cardiac failure in children 4

A

lethargy

failure to thirve

recent excessive weight gain or oedema

blue attacks

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32
Q

what can often precipitate or exacerbate cardiac failure in children

A

intercurrent illness eg pneumonia

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33
Q

signs of cardiac failure in children 2

A

rapid pulse and respiration

HSM

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34
Q

investigations for cardiac failure in children 6

A

CXR

ECG

Hb

WBC

UnEs

bacteriology

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35
Q

management of cardiac failure in children 6

A

diuretic- furosemide

digoxin

oxygen

morphine for agitation

position

treat preciptiting event (ie infection, anaemia)

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36
Q

what needs to be considered with diuretic use in cardiac failure in children

A

chekc UnEs
-conisder potassium supplements
-unless spiro added

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37
Q

point about dignoxin use in cardiac failure in children 3

A

can be omitted or relatively CI eg fallots tetrology

oral admision
-maintenance is 1/4 of loading dose

CHECK pulse rate before each dose
-if slow or irregular -OMIT

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38
Q

position of cardiac failure in children

A

sitting or on an incline , head up

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39
Q

what needs to be monitored in cardiac failure in children 4

A

weight

pulse

resp rate

liver size

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40
Q

rate of compression in a child

A

1 breath to 5 compressions at 80-100 compressions per minute

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41
Q

drugs for cardiac arrest

A

ABCDE
adrenaline/atropine/antidote (eg naloxone in newborn)
bicarb
calcium salts
dextrose
ECG

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42
Q

immediate action of burns and scalds at home 3

A

strip off afffected clothing
-as retains hot liqiud

if small immerse in cold running water
or ad ice to basin of cold water until cool

cover area in clean dry sheet, towel or dressing

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43
Q

hospital assement of burns and scalds

A

airway -respiratroy tract burn likely if soot in nostils or wheezy

IV access

appropriate analgesia IV morphine

plasma expanders if >10% of surface area affected

weigh patient

Hb check for early haemoconcentration

monitor urine output, bood and urine bioche

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44
Q

what plasma expanders are used in burns and scalds 3
*why use pplasma expanders

A

ONLY IF >10% SA AFFECTED

colloid (plasma/plasma portein fraction)

ringers solution

if full thicknesss burn/scald-blood

*-prevent shock , renal failure

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45
Q

classificying surface area of burns and scalds in children

A

cant use ruleof 9s

charts available in ED or size of childs palm is roughly 1%

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46
Q

classification of burn depth 4

A

superficial

superficil dermal

deep dermal

full thickness

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47
Q

appearnace of superficial burns

A

essentially like sunburn
no blisters

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48
Q

appearance of superficial dermal burns

A

good blood supply
pink
blistered

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49
Q

presentation of deep dermal burns

A

altered sensation but not painless

blisters may be present

ofteb well demarcated w a speckled appearance

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50
Q

presenation of full thickness burns

A

painless
white/brown
dry

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51
Q

when shoudl burns be refered 3

A

all burns over 3% TBSA

all full thickness burns over 1% TBSA

> 30%- PICU

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52
Q

when do children need IV fluids with burns and scalds

A

over 10% TBSA affected

-how much to give depneds on local guidance
-ask senior

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53
Q

what should always be considered when a child presents with burns and scalds

A

NAI

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54
Q

when should burns be referred 4

A

all burns over 3% TBSA

all full thickness burns over 1% TBSA

> 30%- PICU

burns in special areas- hands, feet, genitals and around joints

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55
Q

clinical signs of isotonic dehydration as a percentage of body weight
5% (milkd=50ml/kg) 4

A

lethargic
loss of skin turgor
dry mouth
fontanelle slack

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56
Q

clinical signs of isotonic dehydration as a percentage of body weight
10% (moderrate = 100ml/kg) 5

A

+
tachycardic
tachypneoa
fontaelle and eyes sunken
mottled skin
oliguria

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57
Q

clinical signs of isotonic dehydration as a percentage of body weight
15% severe >150ml/kg 3

A

+
shock
common
hypotension

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58
Q

investigations of acute diarrhoea 5

A

Hb
WBC
UnEs
bacteriology of stools x3
throat urine and blood cultures

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59
Q

when should IV feeds be considered in acute diarrhoea 4

A

unconcious
absent bowel sounds
10% or more dehyardated
shocked

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60
Q

fluid resus if shocked in acute diarrhoea

A

give plasma or 0.9% saline Iv 20ml/kg over 20 mins

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61
Q

IV fluids over 24hrs for acute diarrhoea

A

4% dextrose and 0.18% saline for 24hrs

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62
Q

when can bicarb be considered in acute diarrhoea

A

if acidosis is severe but care is needed

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63
Q

maintance fluid in infants and children

A

infant 150ml/kg

children 50-100 ml/kg inchildren

64
Q

what do oral rehydration solutions contain

A

sodium potassium bicarb clorid glucose

65
Q

when should ORS be used in acute diarrhoea

A

little and often to replace defiict

offere extra after each vomit or diarrhoea

breastfeeding should continue

66
Q

how should food stuffs be reintroduced after acute diarrhoea

A

diluted whole/powered cows milk over 1-3days

starches within 1-2 days

*soy milk may be preferred for few days to avoid post enteritis lactose and cows milk intolerance

67
Q

how does hypernatraemic dehydration fluid replacement compare to hyponatraemia

A

correcetd more slowly , over 24-72hrs to avoid convulsions

68
Q

what should be monitoreed in acute diarrhoea 3

A

for signs of renal failure

weigh regularly

investigate blood biochem and gases

69
Q

important complications of bacterial meningitis 7

A
  1. Reportable infection –protect other children in family, nursery and school by
    reporting to public health.
  2. Convulsions
    145
  3. Cerebral oedema, subdural effusion, hydrocephalus
  4. Hyponatraemia from inappropriate antidiuretic hormone release
  5. Deafness: always screen hearing immediately on recovery
  6. Drug fever: rise of fever after initial fall
  7. Long term: mental handicap, cerebral palsy, epilepsy, deaf
70
Q

empirical ABx for <6wk olds with bacterial meningitis 3

A

cefotaxime

amox

gent

71
Q

empirical Rx for children over 3 months old with bacterial mengitis 2

A

cefotaxime

dexamthasone (4 weeks)
-ONLY IF NO PURPURA

72
Q

common presentation of osteomyelitis 3

A

relctuance to use limb

local swelling

tenderness

*-this can porgress to a toxic looking specticaemic infant or child

73
Q

which bone in paritcular is affected by osteomyeltits in infants

A

the femur

-early diagnosis and treatment are vital in preveenting damgage to the femoral head

74
Q

investigations for osteomyeltis/ septic arthitis 4

A

blood cultures

Hb

WBC

X-rays

75
Q

treatment of osteomyeltits/ septic arthirits (ABx regime):
- ≤5yo (1)
- ≥6yo(1)

A

≤5yo - cefuroxime

≥6yo Fluclox

THEN SWITCH BOTH TO ORAL CO-AMOX

immbolise the limb and watch

76
Q

when is surgery indicated in osteomyelitits/septic arthirits:
-for infants
-for older children

A

infants- immediatley

older children- if poor response to treatment after 24hrs

77
Q

syx of UTI in an infant 7

A

dysuria

frequency

haematuria

smelly urine

bed wetting (new/recurrence)

pyrexia of unknown origin

general malaise/non specific illness/not feeding

78
Q

syx of UTI by age
-neonate 5

A

poor feeding

vomiting

fever

weight loss

conjugated jaundice

Boys>girls

79
Q

syx of UTI by age
-preschool 5

A

vomiting

diarrhoea

failure to thrive

irritability and crying

fever

girl>boys

80
Q

syx of UTI by age
-school age 4

A

localisation of pain to suprapubic/loin area

fever

polydipsia

polyuria

dysuria

81
Q

common differentials for dysuria in older child 3
*-why is it still important to investigate for UTI

A

UTI
vulvitis
balinitis

*-untreated UTI may lead to renal scarring

82
Q

investigations of UTIs 6

A

always check BP

Hb

WBC

UnEs

serum creatinine

urine and blood cultures

83
Q

imaging for UTIs 1

-what abnormalities can be visualised 5

A

USS -cayceal radio isotope studies

look for:
-scarring
-pelvi-ureteric obstruction
-ureteral reflux
-duplex collecting systems
-bladder diverticuli/obstruction

84
Q

common organism in UTIs for <1yo 1

A

E coli

85
Q

common organisms in UTI 3

A

1/3 each
E Coli
Proteus
others

86
Q

diagnostic values for a UTI dependent on sample collected

A

Clean catch urine or MSU
- two separate samples
>10(x5)/ml

catheters
>10(x4)/ml

any growth on suprapubic urine obtained by bladder puncture

87
Q

diagnostic values for a UTI dependent on sample collected

A

Clean catch urine or MSU
- two separate samples
>10(x5)/ml

catheters
>10(x4)/ml

any growth on suprapubic urine obtained by bladder puncture

88
Q

management of hypoglycaemia 2

A

oral gluocse if available
otherwise Iv glucose 0.5 g/Kg body weight as 50% solution

89
Q

immediate action at home after poisoning 1

-when is this not appropriate 3

A

induce vomiting with fingers
-NOT SALT WATER

EXCEPT for
-volatile hydrocarbons
-caustics (irritating chemicals, oven cleaner,drain cleaner
-child unconcious

90
Q

inital hospital assessment for poisoning

A

establish poisin
-its name
-amount
-when
-how

*consider non-accidental ingestion

91
Q

how is vomiting induced in poisoning in the hospital and in what timeframe

*-when is this contraindicated

A

syrup of ipeacac 15ml + glass of water
-within 6 hrs of ingestion
-up to 24hrs for salicylates

-repeat after 20mins if no result

*CI in caustics, petrol or white spirit ingestion

92
Q

inital poisoning management of unconcoisu 1

A

gastric lavage with protected airway

93
Q

specific antidotes for poisoning
paracetamol

A

acetyl cysteine

94
Q

antidotes for poisoning
tricylcis, opiates or slow realsing theophylline WITHIN ONE HOUR

A

actiavted charcoal

95
Q

specific antidotes for poisoning
salicylate or phenobarbitone

A

alkali diuresis

96
Q

specific antidotes for poisoning
iron

A

desferrioxamine

97
Q

specific antidotes for poisoning
alcohol

A

glucose -hypoglycaemia may be severe

98
Q

specific antidotes for poisoning
opiates, lomotil

A

naloxone

99
Q

general management for poisoning 5

A

observation

monitor:
-airway
-circulation
-temp
-fluid balance
-blood glucose

100
Q

signs of paracetomol overdose 5

A

assess for hepatotoxicity
-jaundice
-encephalopahty

N+V

abdo discomfort

hypoglycaemic

101
Q

signs of opiate overdose 2

A

pinpoint pupils
respiratory depression

102
Q

investgtions for paracetomol overdoses 4

A

LFTs

UnEs

coag

paracetomol level

103
Q

management of paraccetomol overdose if presenting in first hour and then after

A

within 1hr since ingestion- activated charcoal

main treatment - N-aceytlcysteine

104
Q

generally what level of paracetomol would indicate the need for N-acetyl cysteine

A

over 150mg/kg

105
Q

J

A

J

106
Q

when should N=acetyl cysteine be strated in a paracetomol overdose 3

A

blood paracetomol level above treatment line

staggered overdose/unclear time of ingestion

late presenation (after 24hrs)

107
Q

indications for liver trasnplant after paracetomol overdose 3

A

arterial pH<7.3 24hrs after ingestion

or
-PT >100secs
creatinie >300 micromol/l
grade III or IV encephalopathy

108
Q

clinical features of opiate toxiciity 6

A

reducece GCS

respiratory depression

pinpoint pupils

seizures\

muscle spasms

hypotension

109
Q

managemtn of opitate toxicity

A

manage airway

naloxone
-usually 400micrograms
-can be repeated if required
-if requiring multiple doses consider infusion

110
Q

causes of neuromalignant syndrome 4

A

haloperidol
droperidol
promethazine
etc
-dopamine blockers

111
Q

MOA of neuromalignant syndrome

A

decreaed levels of dopamine

112
Q

clinical features of neuromalignant syndrome 5

A

muscle cramps
tremors
pyrexia
sweating
rgidity

113
Q

treatment for neuromalignant syndrome 2

A

cooling

dantrolene

114
Q

cause of serotonin syndrome 4

A

SSRIs
SNRIs
MAOIs
MDMA

115
Q

traid of features in serotonin syndrome

A

CNS effects -agitation, coma, altered mental state

autonomic instabbility - hyperthermia

neuromsulceu instabliity - clonus, elevated CK, hyperreflexia, rgiditiy

116
Q

treatment of serotonin syndrome 4

A

cooling

supportive- eg IV fluids

benzos

more severe cases - cyproheptadine

117
Q

antidote for benzo overdose
-caution with this drug

A

flumazenil
-hazardous- reduces seizure threshold particulrry in mixed overdoses involivng tricyclic antidepressants or benzo-dependet patients

118
Q

clinical featueres of benzo overdose 6

A

drowsiness
bradycardia
hypotension
respiratory depression
coma
ataxia
dysarthia
nystagmus

119
Q

what is included in an infection screen for a child with pyrezia 6

A

blood culutes

urine cultures ± LP

Hb

WBC

ESR

CXR

120
Q

msot comomn cause sof seizures in a child

A

febrile convulsions

-in the absecne of fever- epilepsy must be considered

121
Q

how is status epilepticus IN PAEDS defined

A

fit lasting more than 30 minutes
or
several fits with failure to regain consciousness between them

122
Q

initial management of seizing child 3

A

move child from danger

place prone to avoid inhalationof vomit or saliva

losen clothing around neck
-do not attempt toprise open mouth

123
Q

drugs given initaly for seizing child 2

A

give diazepam IV 1mg + 1mg for each year of life
-can be given as rectal prepartion

if no response after 10 mins
-paraldehyde 1ml for each year of life
-divided doses if morer than 2ml into each buttock
(phenytoin is an alteritive)

124
Q

when should general anaestghesia be consdered for a sezing child

A

if no respone to both drugs and duration longer than 30 minutes

125
Q

what important complication must be considered in a seizing child (1) and how is this combated (3)

A

cerebral oedema

-restrict fluid and consider mannitol and dexamethasone

126
Q

important investigation in a prlonged sezing child

A

blood glucose

127
Q

when should LP be considered in a seizing child 4

A

if first febrile convulsions under 2 years old

prolonged

focal

if meningism is present

128
Q

specific treatment for infantile spasms 2

A

ACTH injections or coritocosteroids
+
benzo, eg nitrazepam

129
Q

specific treatement for petit mal seizures 2

A

ethosuximide

valporate

130
Q

specific treatment for temporal or focal epilepy 2

A

carbamazepine

phenytoin

131
Q

definition of sudden infant death syndrome

A

sudden and unexpceted death after which an autopsy fials to reveal a major cause of death

predominantly 1month to 1 year old

132
Q

risk factors for sudden infant death syndrome4

A

boy

LBW

winter

adversre social and domestic conditiosn

133
Q

managemtn of sudden infant death syndrome 6

A

resus may be appropriate

if hsitory and exam do not sugegst prior illess or injury
and no suspcicion of parents
-should be told cot death (SIDS) is likely

coroner- inform police, get autopsy , take statements

inform family doc, health visotrs an d social sevrvices

suppress lactation if breast feeding

134
Q

define non-accidental injury

A

abuse is/was infliced or knowinlgy not prevented by person caring for child
and
signs are present

135
Q

what are potential signs of non accidental injury 5

A

physical injruy

neglect

drug administriation

failure to thrive

emotional or sexual abuse

136
Q

commonn presentation of non accidental injury 3

A

injuries inconisitente with explination

delay in seeking help

medical advice sought for repeated minor injuries

137
Q

risk facgtors for parents to inflict non accidnetal injury 5

A

young

single

mentally ill

known to social services

low IQ

138
Q

which conditions can cause adrenal insufficiency in a child 4

A

any child on daily replacement hydrocortisone treatment
for example:
-congenital adrenal hyperplasia
-congenital adrenal hypoplasia
-adrenal insuffiency
-multiple pituitary hormone defiency

139
Q

management of child on hydrocortisone replacement with an incurrent illness
-is stilll well, feeding playing and tolerating normal meds

A

no need to increase steroids

140
Q

management of child on hydrocortisone replacement with an incurrent illness
-is unwell with fever and reduced acitivty

A

if tolerateing oral meds:
-double largest daily hydrocoritsone dose and administer three times per day for 48hrs

eg, if normally on 10mg morniing and 5 mg eveing-> give 20mg three times/day for 48hrs

141
Q

management of child on hydrocortisone replacement with an incurrent illness
-severely unwell /unresponsive/vomitting 6

A

check BM, UnEs and FBC

if BM <3mmol/l give 2ml/kg of 10% dextrose

fluid bolus if inidcated

give IV hydrocort bolus and start IV infusion

start IV maintenance fluids

consider double dose hydrocor therapy once tolerating oral meds

142
Q

who is at risk of diabetes insipidus

A

children with suprasellar tumours
-particularly craniopharyngiomas

143
Q

what is a diagnosis of diabetes insipidus based on 2

A

elevated plasma osmolality due to hypernatraemia
AND
inapporpriately dilute urine

144
Q

sx and syx of diabetes insipidus 3

A

polydipsia
polyuria
dehydration/weight loss

145
Q

urine output to consider diabetes insipidus

A

5ml/kg/hr for 2 consecutive hours

146
Q

plasma sodium value to consider diabetes insipidus

A

> 145mmol/l

147
Q

serum and urine osmolatitly to consider diabetes insipidus

A

plasma >295 mOsmol/kg

urine <450 mOsmol/kg

148
Q

dipstick results in diabetes insipidus

A

specific gravity <1.005

149
Q

observatiosn for diabetes insipidus

A

strict fludi input and output - 4 hourly balances

daily weights 8am and 8pm

regulary UnEs

150
Q

prinicples of management for diabetes insipidus

A

monitor Na+ and urine output

make fluid replaceemnts

DDAVP administration

DO NOT OVER CORRECT- hypernatraemia is better than hyponatraemia

151
Q

management of diabetes insipidus if pateitn hypernatraemia (>150mmol/l

A

increase IV fluids ± further dose of DDAVP

152
Q

management of diabetes insipidus if sodium in normal range 135-145mmol/l

A

do not give further DDAVP
-monitor Na 4-6hrly and fluid balance

153
Q

indications for hypothyroidism in infants

A

guthrie heel spot test
-TSH high-> suggests hypothyroidism

154
Q

confirmatory tests of hypothyroidisim 2

A

pre-treatment thyroid function tests
-TSH and T4

quantitative thyrodglobulin

155
Q

optional confirmatiory tests for hypothyroidism

A

thyroid imaging - US ± radioisotop scans of neck

thyroid antibodies

maternal TFTs

156
Q

thyroid antibodies to test for in hypothyroidism 2

A

thyroid peroxidates

TSH receptor antibodies

157
Q

treatment of hypothyroidism in childrne

A

replacement therapy with lebothyroxine

Paediatrics cabinetchip (80 decks)

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