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ENT > Paediatric Emergency > Flashcards

Paediatric Emergency Flashcards

1
Q

How to manage foreign body ear canal

A

-Otoscopy
-Child Restraint
-Removal with
=Jobson Horne
=Syringing
=Crocodile Foreceps
-Theatre – next available list

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2
Q

Management of acute otitis media in children

A

-Otoscopy + Swab if discharging (not if empyema)
-Antibiotics – Oral + Topical if discharging
-Analgesia

-Admit + IV Abx
=Unwell Child
=Neurological Symptoms
=Suspecting Mastoiditis

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3
Q

Presentation and management of acute mastoiditis

A

-Necrosis breakdown= swelling, ear proptose and falls forward
-Facial nerve, sigmoid sinus thrombosis, meningitis, septic emboli or sepsis

-Admit
-IV Abx + Analgesics
-Swabs if discharging ear
-CT Scan
-Observe for neurological symptoms

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4
Q

How to manage foreign body nose

A

-Ant. Rhinoscopy
-Parental Kiss
-Restraining the Child
-Removing the FB
=Jobson Horne
=Wax Hook
=Croc. Forceps
-Theatre Emer List – Risk of Aspiration

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5
Q

Symptoms and signs suggestive of OME (with effusion)

A

-Hearing difficulty
-Indistinct speech or delayed language development
-Repeated ear infections or earache
-Poor educational progress
-Recurrent upper respiratory tract infections or frequent nasal obstruction
-Behavioural problems
-Less frequently- balance, difficulties, tinnitus, intolerance of loud sounds

=Eustachian tube URTI- shorter, thinner, horizontal in children so mucous build up

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6
Q

Formal assessment of OME

A

-Clinical history (focus on poor listening skills, indistinct speech or delayed language development, inattention and behaviour problems, hearing fluctuation, recurrent ear infections or URTI, balance problems and clumsiness, educational progress)
-Clinical examination (focus on otoscopy, general upper respiratory health, development)
-Hearing testing (use tests appropriate for child’s developmental stage)
-Tympanometry

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7
Q

Initial management of OME

A

-Active observation 3 months (confirm presence bilateral OME and hearing loss, advise educational and behavioural strategies to minimise impact of hearing loss, offer autoinflation to cooperative children, reassess)
-Resolves vs persistent bilateral OME

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8
Q

Surgical intervention for OME

A

-Give info on benefit/ risk
-Insert ventilation tubes (grommits)= allows fluid to drain, rejected by ear after 1yr
-Do not use adjuvant adenoidectomy in absence of persistent and/or frequent upper respiratory tract symptoms

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9
Q

Non-surgical interventions for OME

A

-Offer hearing aids
-Do not offer: antibiotics, antihistamines, decongestants, steroids, homeopathy, cranial osteopathy, acupuncture, dietary modification, immunostimulants, massage

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10
Q

Describe neonatal hearing loss

A

-National screening program
=All children OEA / ABR
=Pass / Refer
-Refer retested & if still failing investigated
-Appropriate aiding allows speech and language development
-Cochlea implantation early permits mainstream schooling
-Beware delayed congenital causes

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11
Q

Assessment and presentation of orbital cellulitis

A

-Ophthalmic: VA, colour, pupil reactions, ocular mobility, skin sensation
-IV access, FBC, blood culture
-Decision to make for axial CT brain and orbits

=Sinusitis
=Oedema on conjunctiva (bubble wrap)
=RAPD if optic nerve strain
=Pain on movement
=Cavernous sinus thrombosis
=Eye bulging forward

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12
Q

Management of orbital cellulitis

A

-Baseline vision assessment
-Nasal decongestant, steroids, washes to flush sinuses
-IV antibiotics (24hr)
=Cefotaxime and flucloxacillin
=Otrivine nasal drops qds
=4 hourly neuro obs
=If swinging pyrexia or no improvement after 24-36 hours consider adding metronidazole and repeat CT (venous phase)

-CT shows intracranial infections= neurosurgical referral
-Orbital subperiosteal abscess= external drainage (endoscopic not preferred)

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13
Q

Presentation and management of acute tonsillitis

A

-Pharyngitis, malaise, lymphadenopathy, odynophagia, fever
-Strep pyogenes= oedematous, yellow/ white pustules

-Admit
-IV Abx (penicillin delayed)
-Analgesia
-IV fluids
-Monospot/ throat swabs/ rapid antigen test
-Advice
=Tonsillectomy (3x3, 5x2, 7x1)

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14
Q

Features of quinsy

A

-Hot potato voice
-Severe throat pain lateralises to one side
-Trismus
-Fever
-Neck swelling and reduced neck mobility
-Deviate uvula (to unaffected side)

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15
Q

Management of quinsy

A

-Admit, IV Abx, Analgesics
-IV fluids
-Reassess in 24 hrs
-Consider Parapharyngeal & Retropharyngeal Abscesses
-Theatre if not improving – Hot Tonsillectomy
-IJV thrombosis?

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16
Q

Management of neck swellings

A

-History and examination
-USS
-IV Abx
-Theatre?
-Observe for
=Torticollis
=Drooling / Dysphagia
=Trismus

17
Q

Overview of parapharyngeal abscess

A

-Unwell, torticollis, trismus
-CT
-Theatre= hot tonsillectomy, drainage of abscess? Intraorally

18
Q

Overview of retropharyngeal abscess

A

+/- Drooling & Dysphagia
-CT
-Theatre
=Skilled Anaesthetist
=Intraorally Drainage
-Complications

19
Q

Management of foreign body oesophagus

A

-Admit
-CXR / Confirmation of Position with Metal Detector
-Above lower oesophageal sphincter, theatre for rigid oesophagoscopy and removal of foreign body
-Below diaphragm, consult surgeons
-A&E Protocol

20
Q

Management of foreign body airway

A

-History: cough, stridor, sudden onset dyspnoea, no fever unless secondary infection, no prodrome of viral illness
-Theatre Immediately
-Bronchoscopy and removal of FB (more likely right main bronchus)
-Consider FB airways for children with short live history of recurrent croup / chest infections
-Fill audit form

21
Q

Management of child with stridor

A

-History and examination
-Adrenaline Nebs (1ml of 1:1000 in 4mls of saline)
-Dexamethasone ( 0.25 mg /kg bolus; 0.1mg /kg qds)
-Oxygen
-Anaesthetist Review ?intubation

22
Q

Presentation and management of epiglottitis

A

-Differential for croup (bacterial infection of epi and Supraglottitis- Haem infl type B)
=Tripoding, drooling (too sore to swallow), inspiratory stridor, high temp
=Spasm= loss of airway

-Admit, oxygen wafting
-Adrenaline nebs (dilate airway)
-No intervention! Prevent airway spasm
-Gas induction, laryngoscope to confirm diagnosis, endotracheal intubation
=Diagnosis with X-ray: lateral view thumb sign, posterior-anterior steeple sign
=Ceftriaxone, steroids, trial extubation

23
Q

Management of croup

A

-IV steroids
-Adrenaline nebs
-Oxygen

24
Q

Symptoms and signs of laryngomalacia

A

-Prominent after few weeks of birth and start to settles after 18 months of life
-Reflux

-Oxygen Saturation
-Inspiratory Stridor
-Tracheal Tug
-Coastal Recession
-Pectus Cavum
-Thriving ???

25
Q

Management of post tonsillectomy bleed

A

-Initial Resuscitation including IV Access + Bloods
-Stabilize Haemodynamically
-Assess for bleeding
-If bleeding = Theatre
-If no active bleeding = Admit for IV Abx, NBM, Reassess

26
Q

Anatomical differences and susceptibility in children

A

-High anterior larynx
-Epiglottis has folded over shape
-Tall, tight supraglottic
-Short trachea
=Greater resistance to flow so sensitive to small changes in airway diameter
=airway flow improved with adrenaline in saline nebulised in oedematous airway
-More elastic ribs/ compliant chest wall and diaphragmatic breathers= chest wall recessions
-Subglottic stenosis in long-term intubation
-Strawberry birth marks= possible subglottic haemangioma
-More susceptible to HPV infection
-Obligate nasal breathers
-Large tonsils and adenoids
-Large occiput

27
Q

Legal aspects of paediatrics

A

-Child until 16
-Can give consent aged 12 if judged to have adequate understanding
-Parents/guardian have legal responsibility
-Person over 16 with care and control over the child unless they know parents would refuse

28
Q

Red flags for decompensating tonsillitis in children

A

-Fever
-Increased HR
-Decreased BP
-Reduced oral intake

29
Q

Indications for tonsillectomy

A

-Tonsillitis (3x3, 5x2, 7x1)
-Airway obstruction (sleep apnoea)
-Quinsy x2
-Tumour
-Parapharyngeal abscess

30
Q

Presentation of sleep apnoea in children

A

-Hyperactivity during day
-Poor concentration
-Poor development
-Faltering growth
-Pulmonary hypertension

ENT (14 decks)

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