Paediatric emergency medicine Flashcards
when should a parent send in their child to ED to get their plaster cast checked?
the cast is cracked, soft, loose or tight, or has rough edges that hurt
you are worried that an object has been pushed inside the cast
there is an offensive smell or ooze coming from the cast
there is increasing pain–> signs of compartment syndrome
what are some general practice principles about plaster cast care?
- keep dry as much as possible
- do not stick things into the cast to scratch
- try not to bend it in the first 24hrs as it hardens
- do not remove the inside fluffy layer of the cast- exposing the skin directly to the plaster
what consists of a full septic work up for an unwell neonate?
FBE, blood culture, urine culture ± CXR (if respiratory symptoms or signs) ± LP
what should we do for a child with impaired conscious state, focal neurological signs or who is haemodynamically unstable?
working diagnosis= meningitis/encephalitis
so immediate management with IV or IM ceftriaxone or benzylpenicillin
+/- dexamethasone
what are some examination features of meningitis in a child?
In infants, the fontanelle may be full
Neck stiffness may or may not be present (not a reliable sign in young children)
A purpuric rash is suggestive of meningococcal septicaemia
Kernig’s sign: hip flexion with an extended knee causes pain in the back and legs
CSF shunts, spinal and cranial abnormalities (eg dermal sinuses) which may have predisposed a child to meningitis
Signs of encephalitis: altered conscious state, focal neurological signs
what are some follow up practice points for young children with diagnosed bacterial meningitis?
All children with bacterial meningitis should have a formal audiology assessment 6-8 weeks after discharge (earlier if there are concerns regarding hearing).
Neurodevelopmental progress should be monitored in outpatients.
acute management of open fracture?
• Fast the patient
• Morphine IV
• Tetanus status- ADT? Or Tetanus antibodies?
• IV antibiotics
• Immobilise fracture for pain management
Direct pressure on the bleeding vessel with blood loss apparent.
what is the significance of stridor/wheeze in a burns patient?
indicates where the injury is in the airway;
stridor= high (extrathoracic obstruction), wheeze = low (intrathoracic obstruction)
what management might we consider for a circumferential chest burn and why?
what about a circumferential burn for a limb like a leg or an arm?
an escharotomy; if its 3rd degree full thickness burn
this involves cutting the burned skin as it is restricting their ventilation
again consider escharotomy if you feel the burn is acting like a torniquet around the limb
how might we neutrally align the cervical spine of a child?
place 1-2 towels beneath buttock or back
this is because the child’s occiput is larger than the adult
what manoeuvre do we use to open a child’s airway?
jaw thrust (not chin lift or head tilt)
a child comes into ED and you suspect gastroenteritis. the child is unwell looking and dehydrated. you commence fluid resuscitation. 24 hrs later, the child is still unwell. what do you do?
immediate surgical referral to rule out appendicitis and intussusception
what is glue used for wound healing in ED?
glue= dermabond= cyanoacrylate= tissue adhesive that replaces sutures for small superficial lacerations
how is glue applied to a wound?
- LA if required
- Clean wound with n.saline
- bring wound edges together
- break vial and apply glue over (NOT INTO) the wound line
- Let dry for 2mins
- Apply second layer +/- steristrips if required
- let dry again for 2mins
- advise no picking at the glue adhesive, it will fall off itself. No scrubbing or applying lotions to the glue- pat dry if wet.
at what age are you seriously concerned about a child with a fever and what do you do?
less than 3 months old (but really now guidelines say less than 1 month) with a fever
bring them straight into the ED for a full septic work up