Paediatric Emergency Medicine

Question 1

What does the height of fever tell us about aetiology, bacterial Vs viral?

Answer 1

There is no correlation between fever height and whether infection is bacterial or viral

Question 2

Does using an antipyrexial to lower a fever reduce the body’s immune response?

Answer 2

No

Question 3

When would we not give a child antibiotics?

Answer 3

If they are well and not distressed

Question 4

Do antipyrexials help to prevent febrile seizures?

Answer 4

Not really

Question 5

What temperatures of fever are high indicators of serious bacterial infection?

Answer 5

> 38 degrees in under 3 months
39 degrees in 3-6 months

Question 6

What are some signs of severe croup?

Answer 6

Stridor and intercostal recessions at rest, agitation/lethargy, reduced oral intake <50%

Question 7

A child with severe croup is appearing sleepy, they had intercostal recessions which seem to not look as bad as before. Are you worried?

Answer 7

Yes, the diminishing recessions are a sign of impending respiratory failure

Question 8

What is the diagnostic criteria for DKA?

Answer 8

Hyperglycaemia >11
Ketones >3 (serum), 3+ (urine)
Acidosis pH<7.3 or bicarbonate <15

Question 9

How would you initiate DKA treatment and why?

Answer 9

Give fluids first, then after an hour give insulin 0.1unit/kg/hr- as according to local guideline
Why? Because the main problem is hypovolaemia, giving insulin will drive glucose and water out of blood into the cells further depleting intravascular compartment

Question 10

What are the indications to do an urgent CT head on a child?

Answer 10

One of: GCS<14, ?NAI, basal skull fracture, focal neurology, large laceration
Two of: LOC>5 mins, 3 or more discrete episodes of vomiting, amnesia >5mins, dangerous mechanism of injury

Question 11

What are signs of basilar skull fracture?

Answer 11

CSF rhinorrhoea, otorrhoea, bilateral peri-orbital ecchymoses, battles signs, blood behind the tympanic membrane