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Paeds > Paediatric emergencies: > Flashcards

Paediatric emergencies: Flashcards

1
Q

In anaphalaxis, what is released in response to antigens

A
  • Histamine
  • Leukotrienes
  • Prostaglandins
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2
Q

What systemic responses occur during anaphylaxis?

A
  • Increased secretions from mucousmembranes
  • Increased bronchial smooth muscle tone
  • Decreased vascular smooth muscle tone
  • Increased capillary permeability (oedema)
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3
Q

List 3 signs of anaphylaxis:

A
  • Urticarial/erythematous/itchy rash
  • Lip/face swelling
  • Wheeze
  • Stridor
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4
Q

Outline the management of anaphylaxis:

A

1) High flow oxygen
2) Remove allergen
3) IM adrenaline (0.01ml/kg, ‘1 in 1000’) can be repeated every 5 mins
OR
Nebulised adrenaline (5ml ‘1 in 1000’)
4) If reduced air entry give Nebulised/IV salbutamol
5) Rehydrate if circulation affected - 20ml/kg bolus

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5
Q

What should be given after resuscitation in anaphylaxis?

A

1) IV hydrocortisone (4mg/kg)
2) Antihistamine (e.g. chlorphenamine)
3) Observe for rebound symptoms

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6
Q

Give 4 features of meningitis:

A
  • Neck stiffness
  • Photophobia
  • Kernigs sign (pain/resistance on passive knee extension with hips fully flexed)
  • Bulging fontanelle in infants
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7
Q

What is Kernigs sign?

A

Pain/resistance on passive knee extension with hips fully flexed

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8
Q

Give 4 features of sepsis:

A
  • Non-blanching rash
  • Reduced level of consciousness
  • Shock
  • Multi-organ failure
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9
Q

What organism likely causes meningococcal sepsis?

A

Gram negative infection - Neisseria meningitidis

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10
Q

In meningococcal septicaemia, what Abx should be started for those >1 month?

A

Cefotaxime

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11
Q

In meningococcal septicaemia, what antibiotics should be started in neonates?

A
  • Benzylpenicillin (staphs/streps)
  • Gentamycin (gram -ve)
  • Amoxicillin (?)
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12
Q

What are close contacts of those with Meningococcal septicaemia given?

A

Rifampicin

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13
Q

What is DKA defined by?

A
  • Hyperglycaemia
  • Ketonuria
  • Metabolic acidosis (+/- respiratory compensation)
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14
Q

Outline of management of DKA:

A

1) A - Patent airway, insert NGT if vomiting/reduced consciousness
2) B - 100% oxygen
3) C - Correction of hypovolaemic shock (correctly SLOWLY for 48hrs)
4) DEFG - commence IV insulin, close monitoring of BM and Na/K, beware of cerebral oedema

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15
Q

What does Kussmauls breathing mean?

A

Deep sighing

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16
Q

What is a feared complication of DKA and what can be done to minimise its chances of occurring?

A

Cerebral oedema - minimise chances by slow rehydration/ slow correction of metabolic abnormalities

17
Q

What 2 other complications can result during DKA?

A
  • Hypokalaemia (preventable by careful monitoring and management
  • Aspiration (Insert NGT in children with decreased consciousness)
18
Q

What it the percentage dehydration based on in children?

A

On their weight

19
Q

List 5 features in a history of someone with DKA:

A
  • Polyuria
  • Polydipsia
  • Weight loss
  • Vomiting
  • Abdominal pain
  • Tiredness
20
Q

What would you see upon examination of someone with DKA?

A
  • Dehydration
  • Smell of ketones
  • Kussmaul breathing
  • Confusion
  • Decreased level of consciousness
21
Q

What investigations would you perform in someone with suspected DKA?

A
  • BM
  • ABG
  • Urine dip/urinalysis
  • HbA1C
  • U+E
  • FBC
  • Blood culture
22
Q

What investigation results would you see in someone with DKA?

A
  • BM - >11mmol/L

- Metabolic acidosis: pH <7.3, HCO3 <15

23
Q

For those in DKA, what would you want to observe on an ECG for changes?

A

T-waves

24
Q

Outline the classifications of dehydration:

A
  • Mild (<5%) - just clinically detectable
  • Moderate (5-8%): dry mucus membranes, decreased skin turgor
  • Severe (>8%): above + sunken eyes, poor capillary refill
25
Q

What is the calculation used for fluid resuscitation in those with DKA? Which fluids should be used at what stage?

A

(resuscitation with 10ml/kg bolus - max. 30ml/kg)

%dehydration * 10 * weight (kg) = mls of fluid replace over 48hours (added to maintenance)

1) Start with 0.9% saline
2) Once BM <14 add 5% dextrose
3) If passing urine add KCL to fluids

26
Q

What insulin therapy should be administered to those in DKA?

A

0.05-0.1U/kg/hr of rapid acting insulin.

DO NOT STOP insulin - required to stop ketone production.

27
Q

What should one do if the glucose is falling too quickly in those with DKA with insulin therapy?

A

Reduce rate of infusion of insulin and add dextrose.

28
Q

What should the rate of BM fall be during rehydration after DKA?

A

4-5mmol/hr

29
Q

What should not be used to correct acidosis in those with DKA?

A

Bicarbonate should NOT be used.

Insulin and rehydration will suffice.

30
Q

What could signs/symptoms could indicate cerebral oedema?

A
  • Headache
  • Irritability
  • Slowing pulse with rising blood pressure
  • Decreased conscious level ( decreased GCS)
  • Papilloedema is a late sign
31
Q

What is the management for cerebral oedema?

A
  • PICU
  • Hypertonic saline or mannitol
  • Reduce rates of IV fluids

Paeds (13 decks)

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