Paediatric Emergencies - Encephalitis, Sepsis, Collapse and Burns Flashcards
What is encephalitis?
Inflammation of the brain parenchyma due to a virus
What are the main causes of encephalitis?
Direct viral infection of the brain - mostly herpes simplex
Post infectious - autoimmune process following virus elsewhere in the body
Bacterial, fungal, parasitic
What is the main trio of symptoms seen in encephalitis?
Altered Mental State
Fever
Headache
What other symptoms would you see in encephalitis?
Meningitis symptoms Seizures Flu-like symptoms RICP symptoms Focal neurological signs
How is encephalitis diagnosed?
Lab diagnosis based on CSF
Lymphocytosis
Normal glucose ratio
Normal/high protein
Virology PCR
What other scans can you do for encephalitis and under what circumstances?
CT - Raised ICP MRI - show demyelination and oedematous change HIV test Swabs or stool/urine sample EEG - behavioural changes
What is needed to diagnose sepsis?
Suspected Infection
2/3 Temp >38.5 <36 WCC high or low Tachypnoea Tachycardia
When would you screen for sepsis?
Child score PEWS >3
Parental/clinical suspicion
What are the red flags for sepsis in children?
Change in mental state/behaviour Doesn't wake if roused/stay awake Looks very ill SpO2 < 90% / new need for O2 Tachycardia (5y >130, 5-7y >120, 8-11y >115) Tachypnoea (5y >28, 6-7y >26, 8-11y >24) Anuria for 18h Mottled, ashen or blue skin Non blanching rash
What is sepsis 6?
1 Give high flow O2 until sats >94%
2 Gain IV access - blood cultures, blood gas, FBC, U&E, CRP, crag
3 Give Antibiotics
4 Give fluids - 20ml/kg (max 500ml) over 5-10 mins
5 Review by ST4 or above. If Lactate >4 review by consultant
6 If normal physiological parameters aren’t restored after 2 hours, consider adrenaline infusion
What are the main categories of causes for collapse?
Postural Cardiac Neurological Neurally mediated Other
What postural causes can lead to collapse?
Drugs
Hypovolaemia - blood loss or dehydration
What are some cardiac causes that lead to collapse?
Arrhythmia
HOCM - hypertrophic cardiomyopathy
Aortic Stenosis
What neurological causes could lead to collapse?
Seizure
Head Injury
What neurally mediated causes lead to collapse?
Vasovagal syncope
Situational syncope - micturition
Carotid Sinus hypersensitivity
What other things can cause a child to collapse?
Breath holding spells
Anaemia
Hypoglycaemia
What is the most common cause of burns in children?
Scalding from hot liquids
What other causes are there for burns?
Fire Chemical Electrical Cold Inhalation
How deep do electrical burns tend to be?
Full thickness
How deep do scalds tend to be?
Deep but partial thickness
What should be estimated when assessing burns?
Extent
Depth
Distribution
How would a superficial burn appear?
Red
No blistering
Affect only epithelial layer
How would a partial thickness burn appear?
Pink or mottled
Blisters
Some dermal damage
How would a full thickness burn appear?
Painless
White or charred
Full dermal and nerve damage
Roughly what percentage of surface area does each part of the body make up in a child?
9% = head (reduce with age - 18% when <1y) 18% each torso and back 18% each leg 9% each arm 1% gonads
What investigations should be carried out for burns?
ABG Carboxyhaemoglobin Blood count U&E - inc. creatinine Group and save Serum albumin
How deep must a burn penetrate to affect cap refill time?
Prolonged if deeper dermis
No cap refill if full thickness
What first aid is recommended for burns?
Run under cold water for 5 minutes
When would you admit a child to the burns centre?
Over 5% full thickness Over 10% partial thickness Difficult area involved - face, hands, feet, perineum or genitalia Inhalational injury Chemical or circumferential burn
How are burns managed?
Analgesia
IV Fluids
Wound care
When do you give IV Fluids for a burn?
> 10% in infants
>15% in children
How much fluid should be given for burns?
20ml/kg (shock)
Normal fluid req plus parklands formula
What is parklands formula?
% burn x weight x 4
Half amount given within 8 hours
What should you aim to keep urine output above in a burns patient?
1ml/kg/hr
What other things can you consider giving a burns patient?
Humidified 100% O2
Tetanus jab
CONSIDER SAFEGUARDING
What is important to consider with facial burns?
Airway involvement
Scarring
What is important to consider with hand burns?
Contractures
Functional loss
What is important to consider with genitalia burns?
Difficult to nurse
Risk of infection
What would make you worry a burn is non accidental?
Glove and sock distribution - immersion injury
Delay in presentation
Buttocks or perineum burns
Other social concerns with family
