Paediatric emergencies 2 Flashcards
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.
- Breathing: ?Kussmaul breathing, ?ketotic breath
- Fluid balance: ?dry mucous membranes, ?sunken eyes
- Shock: HR, BP, CRT
- Level of consciousness: ?drowsy, ?confused
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?
Bedside tests:
- capillary blood glucose: >11 mmol/L
- near-patient ketone testing: >3 mmol/L
- venous or capillary blood glucose: pH <7.3 or bicarb <15
Bloods:
- glucose
- U+Es
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?
- 10ml/kg NaCl bolus IV over 60 mins
- calculate fluid requirements and correct over 48hrs: (fluid deficit - bolus) + maintenance fluids. Use 0.9% NaCl with 40mmol K+/L
- after fluids have been running 1-2 hrs: insulin infusion at 0.05-0.1 units/kg/hr
How do you calculate fluid deficit in children presenting with DKA?
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
What is the most common cause of death in children presenting with DKA? Which features should you look out for? How would you treat?
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
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?
Alert senior.
- Adrenaline IM 0.01ml/kg of 1:1000 into mid lateral thigh
- Nebulised salbutamol 5mg
- Hydrocortisone IV 100mg
- 0.9% NaCl IV bolus 20ml/kg
Regularly reassess. Repeat adrenaline IM up to twice 5-10 mins apart as required.
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-E assessment + establish IV access
- high-flow O2
- check BG
- 2 mg lorazepam (0.1mg/kg) IV
- after 10mins: repeat lorazepam 0.1mg/kg
- after 10mins: 400mg phenytoin IV infusion (20mg/kg) or phenobarbitol IV
- alert CICU for possible RSI (thipental sodium)
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?
- If IV access: 10% dextrose (2mls/kg) IV
If no IV access: IM glucagon 1mg (0.5mg in <8yo) - Recheck BG in 15mins
- If required: 10% dextros3/0.9% Nal (5mg/kg/min)