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Year 4 - Paeds > Paeds Emergencies > Flashcards

Paeds Emergencies Flashcards

1
Q

Paeds Seizure
- Ix

A

Paeds Seizure Ix

  1. CBG
  2. ECG
  3. Bloods
    - VBG
    - FBC
    - U&E
    - Ca/Mg
    - LFT
  4. US Cranial
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2
Q

Paeds Epilepsy
- Hx taking

A

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
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3
Q

Paeds Seizures
- Aetiologies

A

Paeds Seizure Aetiologies

  1. Structural
  2. Infectious
  3. Metabolic
  4. Immune
  5. Unknown
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4
Q

Generalized Seizure
- Mx >1mo

A

> 1mo Seizure

  1. Benzo
    IV Lorazepam
    0.05 to 0.1 mg/kg

Midazolam
0.2 mg/kg intranasally

  1. IV Phenytoin
    15-20 mg/kg
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5
Q

Paeds Cardiac Arrest
- Presentation and prognosis

A

Paeds Cardiac Arrest

  1. Long period of compensating
  2. Hypoxia
  3. Poor prognosis
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6
Q

Paeds Cardiac Arrest
- Routes to arrest

A

Routes to paeds cardiac arrest

  1. Airway
  2. Respiratory depression
  3. Chest wall problem
  4. Fluid loss
  5. Fluid distribution
  6. Heart failure
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7
Q

Paeds emergencies
- Neuropathology sx progression

A

Paeds neuropathology sx

  1. Agitated
  2. Combative
  3. Coma
  4. Death
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8
Q

Paeds Emergencies
- Four Basic Red Flags

A

Paeds red flags

  1. Hypoxia
  2. Hypotension
  3. Silent chest
  4. Unresponsive pupils
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9
Q

Paeds Emergencies
- Neonatal seizure Mx

A

Neonatal seizure

  1. ABC
    - Blood gas
    - Glucose
    - Calcium
  2. IV access
    - ?ABX
  3. > 3 minutes/3/hour
    - Phenobarbitone (20mg/kg IV - 40mg/kg)
    - Phenytoin (20mg/kg IV)
    - Levetiracetam/Keppra (20mg/kg)
    - Midazolam (150 mcg/kg IV)
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10
Q

Paeds A-E
- Hypoglycaemia Mx

A

Paeds Hypoglycaemia Mx
1. Glucose (2ml/kg)
- 40% Glucogel
- 10% IV
2. Recheck CBG

  1. IM Glucagon
    - Unconscious/unable to swallow
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11
Q

Bronchiolitis
- S&S
- Mx

A

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
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12
Q

Paeds Abdo Pain
- DDx

A

Paeds abdo pain
1. Constipation
2. Mesenteric lymphadenitis
3. Appendicitis
4. Intussusception

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13
Q

Intussusception
1. Epidemiology
2. S&S
3. Mx

A

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
  1. Fever and V
  2. Tucking legs
  • Mx
    1. Fluid resus
    2. Contrast enema
  • No shock, no perf, no peritonitis
    3. Surgery
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14
Q

Toxic ingestions

  1. Immobile children
  2. Toddlers
  3. Older Children
A

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
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15
Q

Child poisoning
- Common intentional agents

A

Child poisoning agents

  • Commonly prescribed
    1. Anticonvulsants
    2. Antidepressants
    3. Salt/iron
    4. Laxatives/emetics
    5. Insulin
  • Recreational drugs
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16
Q

Child poisoning
- Common plants

A

Child poisoning plants

  1. Crocus (Colchicine)
  2. Mayapple (podophyllotoxin)
  3. Water/poison hemlock (cicutoxin/coniine)
  4. Monkshood/wolfsbane (aconitine)
  5. Foxglove (digitalis)
17
Q

Poisons S&S

  1. Sympathomimetic
  2. Antimuscarinic
  3. Opioid
  4. Sedative-hypnotic
  5. Cholinergic
A

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
18
Q

Toxidrome causes

  1. Hypotension with bradycardia
  2. HTN + hyperthermia
  3. Hypoventilation
  4. Hyperventilation
A

Toxidrome causes

  1. Hypotension with bradycardia
    - Beta blockers/CCBs/Digoxin
    - Alpha-2 agonists
  2. HTN + hyperthermia
    - Sympathomimetics
    - Antimuscarinics
  3. Hypoventilation
    - Opioids
    - Alpha-2 agonists
  4. Hyperventilation
    - Salicylates
    - Cyanide/iron
    - Toxic alcohols
19
Q

Toxidrome causes

  1. Reduced vision/blindness
  2. Reduced hearing/tinnitus
  3. Reddened skin discolouration
  4. Jaundice
  5. Seizures
  6. Hypoglycaemia
A

Toxidrome causes

  1. Reduced vision/blindness
    - Methanol
    - Quinine/chloroquine/hydroxychloroquine
  2. Reduced hearing/tinnitus
    - Salicylates
    - Loop diuretics
    - Aminoglycosides
  3. Reddened skin discolouration
    - Cyanide
  4. Jaundice
    - Late paracetamol
  5. Seizures
    - Many causes (mimetics, anti-musc, anti-dep, cholinergics)
    - Propranolol
    - Theophylline
    - Opioids
  6. Hypoglycaemic
    - Sulfonylureas
20
Q

Toxidrome causes

  1. Hyperreflexia and myoclonus
  2. Muscle rigidity
  3. Nystagmus
  4. Ataxia
A

Toxidrome causes

  1. Hyperreflexia and myoclonus
    - Serotonin syndrome
    - SSRIs, lithium
    - Opioids
    - MAOIs
    - Amphetamines
    - Tryptophan
  2. Muscle rigidity
    - Phenothiazines (chlorpromazine/promethazine)
    - Atypical antipsychotics
    - Anti-emetics
    - Parkinson’s meds
  3. Nystagmus
    - Dextromethorphan
    - Ethanol
    - MAOIs/SSRIs
  4. Ataxia
    - Sedative hypnotics
    - Neuroleptics
    - Anti-convulsants
21
Q

Paeds cardiac arrest
- Mx

A

Paeds Cardiac Arrest

  1. Help
  2. Airway
    - Neutral in infant
    - ‘Sniffing morning air’ in child
  3. 5 rescue breaths
  4. Signs of life
  5. 15 chest compressions
  6. 2 rescue breaths
22
Q

Paediatric hypothermia

  • S&S
  • Physiological defences
  • Complications
A

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
23
Q

Hyperthermia emergencies (paeds)

  1. DDx
  2. Mx
A

Hyperthermia emergencies (paeds)

  • DDx
    1. Suspected sepsis
  • Shock
  • Sepsis 6
  1. Leukaemia
    - Hydration
    - Induction therapy
    - Electrolyte correction
    - Transfusion
  2. Thyroid storm
    - Beta blocker
    - Anti-thyroid medication
    - Glucocorticoid
  3. Serotonin syndrome
    - Supportive care
  4. Imposed factitious disorder
    - Removal of carer
24
Q

Seriously unwell child

  1. Airway mx
  2. Breathing mx
  3. Circulation mx
A

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
25
Q

Paediatric breathing
- Rates

A

Paediatric breathing rates

<1 30-40

1-2 25-35
2-5 25-30

5-12 15-25
>12 12-20

Year 4 - Paeds (11 decks)

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