Paediatrics in Emergency Medicine Flashcards
How to measure temperature in young children? (4 weeks to 5 years)
FOR 4 WEEKS TO 5 YEARS:
- Electronic thermometer in axilla
- Chemical dot thermometer in axilla
- Infra-red tympanic thermometer
What signs should you assess for in children immediately?
VITAL SIGNS:
- Temperature
- HR
- RR
- CRT
[NB: BP isn’t often measured in children because it tends to compensate and drop only at the last minute; RR is the most important parameter; HR isn’t as useful as it tends to increase with many things]
ASSESS FOR SIGNS OF DEHYDRATION:
- Prolonged CRT
- Skin turgor (elastin is intact in children so this is a good sign)
- Abnormal respiratory pattern
- Weak pulses
- Cool extremities
What is the NICE Traffic Light system?
hx:
- 5 week old
- Parents reported high temperature at home
- Generally unwell
- Not feeding well
- Cough
- Stopped breathing
o/e:
- Increased work of breathing
- HR 170
- RR 60
- Chest wheezy
- Abdomen SNT, no liver edge
ddx?
inv?
management plan?
DDX:
- Bronchiolitis (correct answer)
- Viral wheeze
- Asthma
BRONCHIOLITIS:
- Acute inflammation and infection of bronchioles causing wheezing and airway obstruction in children < 2 years old
- Takes 7 days to peak and about 10 days to resolve, tends to be seasonal
- Caused by viruses, namely RSV (most common), parainfluenza, influenza, rhinoviruses, coronaviruses
MANAGEMENT:
- Oxygen
- Encourage feeding and consider NG top-ups
- Screen for RSV and isolate
hx:
- 8 year old
- Complaining of feeling unwell
- Cough
- Not sleeping
- pmh of asthma
o/e:
- Temperature 37.5
- Sat still
- Increased work of breathing
- RR 45
- Quiet chest
- Abdomen SNT
ddx?
inv?
management plan?
DDX:
- Acute asthma (correct answer)
- Viral wheeze
- Inhaled foreign body
INVESTIGATIONS:
- Capillary blood gas (for children!!)
hx:
- 5 week old
- Parents reported high temperature while at home
- Generally unwell
- Not feeding well and fussy
o/e:
- Temperature 36.2
- No rash
- Chest clear
- Abdomen SNT
- Cries while being handled and settles at rest
ddx?
inv?
management plan?
DDX:
- Meningitis
- Non-accidental injury
MENINGOCOCAL DISEASE:
- Ill-looking
- Non-blanching rash
- Lesions > 2mm in diameter (purpura)
- CRT > 3 seconds
- Neck stiffness (not in babies)
MENINGITIS:
- Bulging fontanelle
- Decreased LOC
hx:
- 5 year old
- Feeling unwell
- Headache
- Ear pain
- Anorexia
- Abdominal pain
- Sore throat
- Coughing
o/e:
- Temperature 38.5
- Lying still
- Chest clear
- Abdomen mild tenderness, non-specific
- No rash
- Mild throat inflammation
- Ear wax
ddx?
inv?
management plan?
DDX:
- Influenza (correct answer)
MANAGEMENT:
- Conservative and symptomatic
- Consider tamiflu
hx:
- 3 year old
- Cough and cold
- Suddenly hot
- Jerking movements, generalised
- Tonic-clonic fit lasting 5 minutes
- Now back to normal
o/e:
- Temperature 40
- HR 110
- CRT < 2 seconds
- No rashes
- No signs of meningism
- Mild suprapubic tenderness
FEBRILE CONVULSIONS:
- Onset 6-60 months
- Temperature high (> 38 degrees) and sudden increase
- Not due to CNS infection/insult or due to any metabolic disturbances
- Only 2-7% of children who experience febrile seizures proceed to develop epilepsy later in life
SUBTYPES OF FEBRILE CONVULSIONS:
a) Simple
- Primary, generalised, usually tonic-clonic
- a/w fever
- Lasts a maximum of 15 minutes
- Not recurrent within 24 hours
b) Complex
- More prolonged (> 15 minutes)
- Focal
- Recurs within 24 hours
c) Febrile status epilepticus
- Lasts > 30 minutes
hx:
- 3 year old
- Feeling unwell
- Vomiting
- Diarrhoea
- Unable to keep anything down
- Sleepy and drowsy
o/e:
- Temperature 37.5
- Dry lips
- Sunken eyes
- Chest clear
- Abdomen soft, mild tenderness
DDX:
- Gastroenteritis (correct answer)
- DKA
INVESTIGATIONS:
- BM
MANAGEMENT:
- Oral fluid challenge (5 ml every 5 minutes) and reassess for dehydration
- Use dioralyte (tastes bad though)
