Paediatric emergencies 2 Flashcards

1
Q

A 3yo boy is brought to ED with abdo. pain + vomiting. Parents report that he has been drinking + weeing a lot over the last few weeks and note a 3kg weight loss.

Describe key features you must assess for on examination given the likely diagnosis.

A
  1. Breathing: ?Kussmaul breathing, ?ketotic breath
  2. Fluid balance: ?dry mucous membranes, ?sunken eyes
  3. Shock: HR, BP, CRT
  4. Level of consciousness: ?drowsy, ?confused
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2
Q

A 3yo boy is brought to ED with abdo. pain + vomiting. Parents report that he has been drinking + weeing a lot over the last few weeks and note a 3kg weight loss.

Which investigations would you perform given the likely diagnosis and what results would you expect?

A

Bedside tests:

  1. capillary blood glucose: >11 mmol/L
  2. near-patient ketone testing: >3 mmol/L
  3. venous or capillary blood glucose: pH <7.3 or bicarb <15

Bloods:

  1. glucose
  2. U+Es
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3
Q

A 3yo boy is brought to ED with suspected DKA. He is drowsy and clinically dehydrated but is not in shock.

How would you initially manage him?

A
  1. 10ml/kg NaCl bolus IV over 60 mins
  2. calculate fluid requirements and correct over 48hrs: (fluid deficit - bolus) + maintenance fluids. Use 0.9% NaCl with 40mmol K+/L
  3. after fluids have been running 1-2 hrs: insulin infusion at 0.05-0.1 units/kg/hr
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4
Q

How do you calculate fluid deficit in children presenting with DKA?

A

Fluid deficit = % dehydration x kg x 10

% dehydration:

  • pH 7.2-7.29: 5% deficit
  • pH 7.1-7.19: 7% deficit
  • pH <7.1: 10% deficit
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5
Q

What is the most common cause of death in children presenting with DKA? Which features should you look out for? How would you treat?

A

Cerebral oedema due to over rapid correction of fluid imbalance causing fluid shift back from ECF into ICF.

Early features: headache, irritability/agitation, unexpected decreased HR, increasing BP
Late features: deteriorating LoC, breathing pattern abnormalities, respiratory pauses, decreased SpO2. occulomotor n. palsies, abnormal posturing, pupillary inequalities/dilation

Treat with:

  • hypertonic saline (2.7% NaCl) over 10-15 mins OR
  • mannitol over 10-15 mins
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6
Q

A 12yo boy is brought to ED by his parents after collapsing at home. On assessment he appears distressed with swelling of the lips, dyspnoea and a widespread urticarial rash. A wheeze is heard on auscultation. His BP is 90/65.

What would your initial Mx be?

A

Alert senior.

  1. Adrenaline IM 0.01ml/kg of 1:1000 into mid lateral thigh
  2. Nebulised salbutamol 5mg
  3. Hydrocortisone IV 100mg
  4. 0.9% NaCl IV bolus 20ml/kg

Regularly reassess. Repeat adrenaline IM up to twice 5-10 mins apart as required.

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7
Q

A 6 yo girl (20kg) with a known history of epilepsy is brought into ED. She has been fitting for 5 mins and has not yet received any treatment. How should she be managed?

A
  1. A-E assessment + establish IV access
  2. high-flow O2
  3. check BG
  4. 2 mg lorazepam (0.1mg/kg) IV
  5. after 10mins: repeat lorazepam 0.1mg/kg
  6. after 10mins: 400mg phenytoin IV infusion (20mg/kg) or phenobarbitol IV
  7. alert CICU for possible RSI (thipental sodium)
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8
Q

A 12yo known diabetic is taken to ED. He is confused and has been vomiting. His BG is 2.6. How would you manage him?

A
  1. If IV access: 10% dextrose (2mls/kg) IV
    If no IV access: IM glucagon 1mg (0.5mg in <8yo)
  2. Recheck BG in 15mins
  3. If required: 10% dextros3/0.9% Nal (5mg/kg/min)
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