Paediatric Emergencies Flashcards by Annie Evans

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.

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What are the main causes of hypovolaemic shock in children?

Dehydration - gastroenteritis
DKA
Blood loss - trauma

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What are the main causes of shock caused by maldistribution of fluid?

Septicaemia

Anaphylaxis

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What are the main causes of cardiogenic shock in children?

Arrhythmias

Heart failure

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What are the main causes of respiratory distress due to upper airway obstruction (stridor) in children?

Croup/epiglottitis
Foreign body
Congenital malformations
Trauma

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What are the main causes of respiratory distress due to lower airway obstruction in children?

Asthma
Bronchiolitis
Pneumonia
Pneumothorax

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What are the main causes of infection in the drowsy or unconscious or seizing child?

Meningitis/encephalitis

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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

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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

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What are the main acute abdominal surgical emergencies in children?

Appendicitis

Peritonitis

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What are the main intestinal obstruction surgical emergencies in children?

Intussusception
Malrotation
Bowel atresia/stenosis

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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

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What are the late (decompensated) signs of shock?

Acidotic (Kussmal) breathing
Bradycardia
Confusion/depressed cerebral state
Blue peripheries
Absent urine output
Hypotension

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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

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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

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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 ```