Paediatric emergencies: Flashcards
In anaphalaxis, what is released in response to antigens
- Histamine
- Leukotrienes
- Prostaglandins
What systemic responses occur during anaphylaxis?
- Increased secretions from mucousmembranes
- Increased bronchial smooth muscle tone
- Decreased vascular smooth muscle tone
- Increased capillary permeability (oedema)
List 3 signs of anaphylaxis:
- Urticarial/erythematous/itchy rash
- Lip/face swelling
- Wheeze
- Stridor
Outline the management of anaphylaxis:
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
What should be given after resuscitation in anaphylaxis?
1) IV hydrocortisone (4mg/kg)
2) Antihistamine (e.g. chlorphenamine)
3) Observe for rebound symptoms
Give 4 features of meningitis:
- Neck stiffness
- Photophobia
- Kernigs sign (pain/resistance on passive knee extension with hips fully flexed)
- Bulging fontanelle in infants
What is Kernigs sign?
Pain/resistance on passive knee extension with hips fully flexed
Give 4 features of sepsis:
- Non-blanching rash
- Reduced level of consciousness
- Shock
- Multi-organ failure
What organism likely causes meningococcal sepsis?
Gram negative infection - Neisseria meningitidis
In meningococcal septicaemia, what Abx should be started for those >1 month?
Cefotaxime
In meningococcal septicaemia, what antibiotics should be started in neonates?
- Benzylpenicillin (staphs/streps)
- Gentamycin (gram -ve)
- Amoxicillin (?)
What are close contacts of those with Meningococcal septicaemia given?
Rifampicin
What is DKA defined by?
- Hyperglycaemia
- Ketonuria
- Metabolic acidosis (+/- respiratory compensation)
Outline of management of DKA:
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
What does Kussmauls breathing mean?
Deep sighing
What is a feared complication of DKA and what can be done to minimise its chances of occurring?
Cerebral oedema - minimise chances by slow rehydration/ slow correction of metabolic abnormalities
What 2 other complications can result during DKA?
- Hypokalaemia (preventable by careful monitoring and management
- Aspiration (Insert NGT in children with decreased consciousness)
What it the percentage dehydration based on in children?
On their weight
List 5 features in a history of someone with DKA:
- Polyuria
- Polydipsia
- Weight loss
- Vomiting
- Abdominal pain
- Tiredness
What would you see upon examination of someone with DKA?
- Dehydration
- Smell of ketones
- Kussmaul breathing
- Confusion
- Decreased level of consciousness
What investigations would you perform in someone with suspected DKA?
- BM
- ABG
- Urine dip/urinalysis
- HbA1C
- U+E
- FBC
- Blood culture
What investigation results would you see in someone with DKA?
- BM - >11mmol/L
- Metabolic acidosis: pH <7.3, HCO3 <15
For those in DKA, what would you want to observe on an ECG for changes?
T-waves
Outline the classifications of dehydration:
- Mild (<5%) - just clinically detectable
- Moderate (5-8%): dry mucus membranes, decreased skin turgor
- Severe (>8%): above + sunken eyes, poor capillary refill
What is the calculation used for fluid resuscitation in those with DKA? Which fluids should be used at what stage?
(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
What insulin therapy should be administered to those in DKA?
0.05-0.1U/kg/hr of rapid acting insulin.
DO NOT STOP insulin - required to stop ketone production.
What should one do if the glucose is falling too quickly in those with DKA with insulin therapy?
Reduce rate of infusion of insulin and add dextrose.
What should the rate of BM fall be during rehydration after DKA?
4-5mmol/hr
What should not be used to correct acidosis in those with DKA?
Bicarbonate should NOT be used.
Insulin and rehydration will suffice.
What could signs/symptoms could indicate cerebral oedema?
- Headache
- Irritability
- Slowing pulse with rising blood pressure
- Decreased conscious level ( decreased GCS)
- Papilloedema is a late sign
What is the management for cerebral oedema?
- PICU
- Hypertonic saline or mannitol
- Reduce rates of IV fluids
