Paeds Emergencies Flashcards
Paeds Seizure
- Ix
Paeds Seizure Ix
- CBG
- ECG
- Bloods
- VBG
- FBC
- U&E
- Ca/Mg
- LFT - US Cranial
Paeds Epilepsy
- Hx taking
Paeds Epilepsy Hx
- Before
1. Aura
2. Stops activity
3. Pallor
4. Pre-syncope
- During
1. Onset and duration
2. Progression
3. Eyes
(Open/closed/flickering/rolling)
4. Limb movements
5. Responsiveness
6. Automatisms
7. Incontinence/tongue biting - After
1. Confusion
2. Post-ictal paralysis
Paeds Seizures
- Aetiologies
Paeds Seizure Aetiologies
- Structural
- Infectious
- Metabolic
- Immune
- Unknown
Generalized Seizure
- Mx >1mo
> 1mo Seizure
- Benzo
IV Lorazepam
0.05 to 0.1 mg/kg
Midazolam
0.2 mg/kg intranasally
- IV Phenytoin
15-20 mg/kg
Paeds Cardiac Arrest
- Presentation and prognosis
Paeds Cardiac Arrest
- Long period of compensating
- Hypoxia
- Poor prognosis
Paeds Cardiac Arrest
- Routes to arrest
Routes to paeds cardiac arrest
- Airway
- Respiratory depression
- Chest wall problem
- Fluid loss
- Fluid distribution
- Heart failure
Paeds emergencies
- Neuropathology sx progression
Paeds neuropathology sx
- Agitated
- Combative
- Coma
- Death
Paeds Emergencies
- Four Basic Red Flags
Paeds red flags
- Hypoxia
- Hypotension
- Silent chest
- Unresponsive pupils
Paeds Emergencies
- Neonatal seizure Mx
Neonatal seizure
- ABC
- Blood gas
- Glucose
- Calcium - IV access
- ?ABX - > 3 minutes/3/hour
- Phenobarbitone (20mg/kg IV - 40mg/kg)
- Phenytoin (20mg/kg IV)
- Levetiracetam/Keppra (20mg/kg)
- Midazolam (150 mcg/kg IV)
Paeds A-E
- Hypoglycaemia Mx
Paeds Hypoglycaemia Mx
1. Glucose (2ml/kg)
- 40% Glucogel
- 10% IV
2. Recheck CBG
- IM Glucagon
- Unconscious/unable to swallow
Bronchiolitis
- S&S
- Mx
Bronchiolitis (RSV)
- S&S
0-3yo
1. Several days of rhinitis and cough
2. Low-grade fever
3. Wet/croupy cough
3. LRTI - Retractions
- Wheezing
- Crackles
- Apnoea/hypoxaemia
- Mx
1. Oxygen
2. High flow (HFNC/nCPAP)
3. NG/IV fluids
4. No evidence for steroids
Paeds Abdo Pain
- DDx
Paeds abdo pain
1. Constipation
2. Mesenteric lymphadenitis
3. Appendicitis
4. Intussusception
Intussusception
1. Epidemiology
2. S&S
3. Mx
Intussusception
- Epidemiology (74/100,000)
1. 3-12 months (peak 5-9mo)
2. 2M:1F - S&S
Triad
1. Collickly pain
2. Redcurrant stool
3. Mass
- Fever and V
- Tucking legs
- Mx
1. Fluid resus
2. Contrast enema - No shock, no perf, no peritonitis
3. Surgery
Toxic ingestions
- Immobile children
- Toddlers
- Older Children
Toxic ingestions
- Immobile children
1. Accidental medication error
2. Carer aware - Toddlers
1. Sweet-like objects
2. Found objects eg. handbag, sofa, floor
3. Presents - Witnessed
- Crying
- Later changes
- Older children
1. Deliberate
2. Tell friend or adult
3. Easy to identify
4. Self-harm if covert
Child poisoning
- Common intentional agents
Child poisoning agents
- Commonly prescribed
1. Anticonvulsants
2. Antidepressants
3. Salt/iron
4. Laxatives/emetics
5. Insulin - Recreational drugs
Child poisoning
- Common plants
Child poisoning plants
- Crocus (Colchicine)
- Mayapple (podophyllotoxin)
- Water/poison hemlock (cicutoxin/coniine)
- Monkshood/wolfsbane (aconitine)
- Foxglove (digitalis)
Poisons S&S
- Sympathomimetic
- Antimuscarinic
- Opioid
- Sedative-hypnotic
- Cholinergic
Poisons S&S
- Sympathomimetic (alpha/betas, amphetamines/tricyclics/MAOIs)
1. Mydriasis
2. Metabolic overdrive
3. HTN, TC, TP, hyperthermia
4. Agitation/seizures - Antimuscarinic (Diphenhydramine)
1. HTN
2. Tachy
3 Hyperthermia
4. Mydriasis (dilated)
5. Flushed skin - Opioid (codeine, heroin, morphine, tramadol, oxycodone, methadone)
1. Miosis (pin-point)
2. Bradypnoea
3. Absent bowel sounds
4. Coma - Sedative-hypnotic (benzodiazepine/barbiturate)
1. Coma
2. Depressed mental status
3. Poikilothermic - Cholinergic (organophosphate)
1. Secretions
2. Bradycardia + Hypotension
3. Mental status change
Toxidrome causes
- Hypotension with bradycardia
- HTN + hyperthermia
- Hypoventilation
- Hyperventilation
Toxidrome causes
- Hypotension with bradycardia
- Beta blockers/CCBs/Digoxin
- Alpha-2 agonists - HTN + hyperthermia
- Sympathomimetics
- Antimuscarinics - Hypoventilation
- Opioids
- Alpha-2 agonists - Hyperventilation
- Salicylates
- Cyanide/iron
- Toxic alcohols
Toxidrome causes
- Reduced vision/blindness
- Reduced hearing/tinnitus
- Reddened skin discolouration
- Jaundice
- Seizures
- Hypoglycaemia
Toxidrome causes
- Reduced vision/blindness
- Methanol
- Quinine/chloroquine/hydroxychloroquine - Reduced hearing/tinnitus
- Salicylates
- Loop diuretics
- Aminoglycosides - Reddened skin discolouration
- Cyanide - Jaundice
- Late paracetamol - Seizures
- Many causes (mimetics, anti-musc, anti-dep, cholinergics)
- Propranolol
- Theophylline
- Opioids - Hypoglycaemic
- Sulfonylureas
Toxidrome causes
- Hyperreflexia and myoclonus
- Muscle rigidity
- Nystagmus
- Ataxia
Toxidrome causes
- Hyperreflexia and myoclonus
- Serotonin syndrome
- SSRIs, lithium
- Opioids
- MAOIs
- Amphetamines
- Tryptophan - Muscle rigidity
- Phenothiazines (chlorpromazine/promethazine)
- Atypical antipsychotics
- Anti-emetics
- Parkinson’s meds - Nystagmus
- Dextromethorphan
- Ethanol
- MAOIs/SSRIs - Ataxia
- Sedative hypnotics
- Neuroleptics
- Anti-convulsants
Paeds cardiac arrest
- Mx
Paeds Cardiac Arrest
- Help
- Airway
- Neutral in infant
- ‘Sniffing morning air’ in child - 5 rescue breaths
- Signs of life
- 15 chest compressions
- 2 rescue breaths
Paediatric hypothermia
- S&S
- Physiological defences
- Complications
Paediatric hypothermia
- S&S
1. Anti-coagulated - Physiological defences
1. Diving reflex - apnoea, bradycardia, vasoconstriction
2. High BMR - Complications
1. Re-warming shock - Peripheral vasodilatation
2. HypERthermia - Metabolic increase
Hyperthermia emergencies (paeds)
- DDx
- Mx
Hyperthermia emergencies (paeds)
- DDx
1. Suspected sepsis - Shock
- Sepsis 6
- Leukaemia
- Hydration
- Induction therapy
- Electrolyte correction
- Transfusion - Thyroid storm
- Beta blocker
- Anti-thyroid medication
- Glucocorticoid - Serotonin syndrome
- Supportive care - Imposed factitious disorder
- Removal of carer
Seriously unwell child
- Airway mx
- Breathing mx
- Circulation mx
Seriously unwell child
- Airway management
1. Neutral neonate
2. Morning air infant
3. Adjuncts
4. Anaesthetic help - Breathing
1. High flow oxygen - Non-rebreath
2. Bag-valve mask - Inadequate respiratory effort
3. Ventilation - Circulation
1. 20ml/kg bolus
2. DKA - 10ml/kg
- Cerebral oedema
3. Consider IO early
Paediatric breathing
- Rates
Paediatric breathing rates
<1 30-40
1-2 25-35
2-5 25-30
5-12 15-25
>12 12-20
