Paediatric Emergencies Flashcards
What are the main causes of cardiopulmonary arrest in children?
Children usually have healthy hearts but experience hypoxia from respiratory or neurological failure or shock.
What are the main causes of hypovolaemic shock in children?
Dehydration - gastroenteritis
DKA
Blood loss - trauma
What are the main causes of shock caused by maldistribution of fluid?
Septicaemia
Anaphylaxis
What are the main causes of cardiogenic shock in children?
Arrhythmias
Heart failure
What are the main causes of respiratory distress due to upper airway obstruction (stridor) in children?
Croup/epiglottitis
Foreign body
Congenital malformations
Trauma
What are the main causes of respiratory distress due to lower airway obstruction in children?
Asthma
Bronchiolitis
Pneumonia
Pneumothorax
What are the main causes of infection in the drowsy or unconscious or seizing child?
Meningitis/encephalitis
What are the main metabolic causes in a drowsy or unconscious or seizing child?
DKA, hypoglycaemia, electrolyte disturbances (calcium, magnesium, sodium), inborn error of metabolism
What are the main causes of a drowsy or unconscious or seizing child?
Post-ictal status epilepticus Infection Metabolic Head Injury Drug/poison ingestion Intracranial haemorrhage
What are the main acute abdominal surgical emergencies in children?
Appendicitis
Peritonitis
What are the main intestinal obstruction surgical emergencies in children?
Intussusception
Malrotation
Bowel atresia/stenosis
What are the early (compensated) signs of shock?
Tachypnoea Tachycardia Decreased skin turgor Sunken eyes and fontanelle Delayed cap refil (>2 secs) Mottled, pale, cold skin Core-peripheral temperature gap (>4 degrees) Decreased urinary output
What are the late (decompensated) signs of shock?
Acidotic (Kussmal) breathing Bradycardia Confusion/depressed cerebral state Blue peripheries Absent urine output Hypotension
How would you manage a child in shock?
Fluid resuscitation
Tracheal intubation and mechanical ventilation
Invasive monitoring of blood pressure
Inotropic support
Correction of haematological, biochemical and metabolic derangements
Support for renal or liver failure
What is the most common bacteria that causes septicaemia and septic shock in children?
Pneumococcus is the commonest organism causing bacteraemia, but the commonest organism causing septic shock is meningococcal infection
What are bacteria are the commonest causes of septicaemia in neonates?
Group B Strep or gram negative organisms acquired from the birth canal
What are the clinical features of septicaemia?
Fever
Poor feeding
Miserable, irritable, lethargy
History of focal infection (meningitis, osteomyelitis, gastroenteritis, cellulitis)
Predisposing conditions (sickle cell, immunodeficiency)
What would you find on examination in septicaemia?
Fever Tachycardia Tachypnoea, low blood pressure Purpuric rash (meningococcal septicaemia) Shock Multi-organ failure
How would you manage septicaemia?
Antibiotics, fluids, circulatory support, watch out for DIC
What is a coma?
Disturbance of the functioning of the cerebral hemispheres and/or the reticular activating system of the brainstem. The level of awareness may range from excessive drowsiness to unconsciousness.
What are the measurements of eyes in the children’s Glasgow coma scale?
Open spontaneously
React to speech
React to pain
No response
What are the measurements for motor response in the children’s Glasgow coma scale?
Spontaneous or obeys verbal command Localises pain Withdraws Abnormal flexors Abnormal extension No response
What are measurements for best verbal response in the children’s Glasgow coma scale?
Smiles, orientated to sounds, follows objects, interacts
Fewer than usual words, spontaneous irritable cry
Cried only to pain
Moans to pain
No response to pain
How do you treat raised intracranial pressure in children?
The head positioned midline
The head end of the bed tilted by 20-30
Isotonic fluids at 60% maintenance
Intubation and ventilation if Glasgow coma score <9
Mannitol or 3% saline as osmotic diuretics
Maintaining normothermia and high normal blood pressure
What is status epilepticus?
A seizure lasting 30 minutes or longer, or when successive seizures occur so frequently that the patient does not recover consciousness between them.
What are main causes of anaphylaxis in children?
Food allergy, most are IgE-mediated reactions with significant respiratory or cardiovascular compromise.
How do you manage anaphylaxis in children?
Short term: adrenaline
Long term: detailed strategies and training for allergen avoidance, the provision of adrenaline auto-injectors
What are apparent life-threatening events?
A combination of apnoea, colour change, alteration in muscle tone, choking or gagging
What are the main causes of coma in children?
Infection (meningitis) Status epilepticus or post-ictal Trauma (AI or NAI) Intracranial tumour or haemorrhage/infarct/abscess Metabolic (DM, hypo, hepatic failure, acute renal failure) Poisoning Shock Hypertension Respiratory failure
What is sudden infant death syndrome?
The sudden or unexpected death of an infant or young child for which no adequate cause is found after a thorough post-mortem examination.
At what age is sudden infant death syndrome most common?
2-4 months old
What does the ‘back to sleep’ campaign advocate?
Infants should be put to sleep on their back
Overheating by heavy wrapping and high room temp should be avoided
Infants should be placed in the ‘feet to foot’ position
Do not smoke near child
Sleep in same room as baby for first 6 months
What are the infant risk factors for SIDS?
Age 1-6 months, peak at 12 weeks
Low birthweight and preterm
Sex (boys - 60%)
Multiple births
What are the parental risk factors for SIDS?
Low income Poor or overcrowded housing Maternal age (mother aged <20 years) Single unsupported mother High maternal parity Maternal smoking during pregnancy Parental smoking
