Paediatric emergency

Question 1

???

Answer 1

!!!

Question 2

Airway

• special consideration?
• management (4)

Answer 2

-if child below 1 then high floppy larynx so don’t over extend

-ensure the airway is patent
high flow O2
do they need air support/ ventilation
disease specific management

Question 3

Breathing

• how to determine the effort of breathing (5)
• hoe to determine the efficacy of breathing (4)

Answer 3

-rate
recession: subcostal/intercostal
accessory muscle use
grunting
nasal flaring

-expansion
additional noise: stridor/wheeze
pulse oximetry
effects on end organs

Question 4

Circulation

• how to asses (6)
• assesing dehydration: signs at 5-10% and signs at > 10%

Answer 4

-HR
rhythm
pulse volume
Cap refill (central and peripheral)
BP
effects on other organs (consciousness, skin perfusion- temp/colour, urine output 

-5-10%
mildly dry mucous membranes
slightly reduced skin turgor
mildly reduced urine output
normal conscious level
no shock

>10%
very dry mucous membranes
sunken fontanelle
reduced skin turgor
significantly reduced urine output
altered conscious level
shocked
\+cold hand and feet
prolonged CAP refill

Question 5

Disability

• asses using what (3)
• posture (2)

Answer 5

-AVPU
GCS
pupil response to light

-Decorticate: stiff, bent arms, clenched fists and arms held out straight
Decerebate: arms and legs held straight out, toes down, head and neck arched back

Question 6

Exposure

-asses by (3)

Answer 6

-temperature
bruising
RASH!!

Question 7

what is the paediatric sepsis 6?

Answer 7

1. give high flow O2
2. IV access & bloods: cultures, glucose & lactate
3. IV or IO broad spec antibiotics
4. fluid resuscitation: 20ml/kg salineover 5-10 mins
   revers shock and normalise HR, BP & peripheral perfusion
   asses for fluid overload
   do another bolus if still shocked
5. consider inotropic support wary (adrenaline)
6. involves senior clinicians/specialists early

Question 8

Sepsis

-presentation (5)

Answer 8

non-specific, generally unwell with tachycardia, fever and reap distress

Question 9

Bronchiolitis

• what is it
• presentation (4)
• treatment

Answer 9

• acute inflammatory injury of the bronchioles, usually viral
• cough, wheeze, off feeds, fever
• supportive: resp support & NG feeding

Question 10

Laryngotracheobronchitis

• also know as
• presentation
• treatment

Answer 10

-Croup, parainfluenzae virus

-upper airway obstruction
see hypopharynx distention and narrowing of the air column

-steroids reduce oedema and risk of admission

Question 11

Foreign bodies

-mangement

Answer 11

-x ray

Question 12

Meningitis

• presentation (7)
• investigations (8)
• management (2)
• rash characteristics

Answer 12

-non-specific: fever, headache, stiff neck, altered mental state, leg pain, cold peripheries and skin changes

-Lumbar puncture if no sign of raised ICP
+ FBC, CRP, coagulation screen, blood culture, PCR, blood glucose, blood gases

-supportive
+ bac= specific antibiotic after IV ceftriaxone if >3 months (benzylpenicillin if in community) ,
viral= steroids

-starts form a single point on the body so need to do whole body exam to look for rash
purpuric
tumbler test: non blanching

Question 13

NAI

• suspect when
• management

Answer 13

-when an injury is not matched by the history

-involve everyone
if you see pos rib fractures on X-ray then do full skeletal survey

Question 14

name the 4 causes of GI obstruction in children

Answer 14

congenital pyloric stenosis
volvulus
intussusception
malrotation

Question 15

most common arrhythmia in childhood?

Answer 15

SVT

Question 16

how does congenital heart disease present?

Answer 16

cyanosis & heart failure in the first aka/months