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Y5 Paediatrics > Paeds emergencies > Flashcards

Paeds emergencies Flashcards

1
Q

What do you give as fluid resus bolus

A

20ml/kg over 10 mins if in shock

10ml/kg over 10 mins if not in shock /DKA or circ overload of HF

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2
Q

what do you give as routine maintenance fluids?

A

0.9% NaCl/Plasmalyte + 5% dextrose

ALWAYS add dextrose other than in DKA as children become hypoglycaemic very quickly

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3
Q

how much maintenance fluid do you give to a child

A

o 100ml/kg/day for each first 10 kg
o 50ml/kg/day for next 10kg (10-20)
o 20ml/kg/day for every further kg

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4
Q

what is maintenance fluid requirement in neonates

A 
day 1: 50-60ml/kg/day
day 2: 70-80ml/kg/day
day 3: 80-100
day 4: 100-120
day 5-28: 120-150
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5
Q

why must you NOT replace fluid deficit too quicklyu

A

because it can cause a rapid reduction in plasma sodium > osmolality causes shift of water into cerebral cells > cerebral oedema > seizures

SO AIM TO REDUCE PLASMA SODIUM SLOWLY (i.e. over 48h)

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6
Q

what are the three types of fluid that you must give in dehydratyion

A

bolus
maintenance
rehydration

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7
Q

how do you calculate rehydration fluid requirement

A

10 x weight x % dehydration

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8
Q

What is AVPU

A

Measures cognitive state rapidly

Alert
responds to Voice
responds to Pain
Unresponsive

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9
Q

Explain what you are looking for in Airway and Breathing of A-E

A

Check for airway obstruction, respiratopry distressù

Look:

  • pallor/cyanotic
  • Work of breathing? (inspiratory effort - grunting, nasal flaring, head bobbing, tracheal tug, intercostal/subcostal recession)
  • Resp rate
  • O2 monitor

Listen:

  • stridor, wheeze
  • ascultate for air entry
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10
Q

Explain what you are looking for in Circulation

A

Central and peripheral perfusion
Cap refill
HR, pulse volume, BP

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11
Q

Explain what yoy are looking for in disability

A

Note level of consciousness, AVPU
Note posture (hypotonic, decorticate, decerebrate)
Pupil - size and reactivity

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12
Q

How do you perform CPR on child

A

15 chest compressions : 2 rescue breaths

  • infant: use two thumbs
  • small child: heel of one hand
  • large child: both hangs
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13
Q

What are the two shockable cardiac rhythms

A

VF

VT

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14
Q

What are the two non shockable rhythms

A

pulseless electical activity (PEA)

asystole

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15
Q

List the reversible causes of cardiac arresty

A

4Hs and 4Ts

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia

Tension pneumothorax
Tamponade
Thromboembolism
Toxins

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16
Q

What is T1 resp failure

A

Hypoxaemia with normo/hypocapnoea

oxygen is low but CO2 is normal

This is OXYGENATION failure due to V/Q mismatch

there is poor oxygenation of the lung, but the lung is still able to work and excrete CO2

17
Q

What kind of NIV can you give for T1RF

A

CPAP

18
Q

What is T2 Resp Failure

A

Hypoxaemia with Hypercapnoea

due to VENTILATION failure

19
Q

List causes for T2 RF in children

A

increased airway resistance
decreased breathing effort (very tired)
decreased lung area available (bronchiectasis)
neuromuscular problem (GBS)

20
Q

Why do children do head bobbing when struggling tro breathe

A

due to SCM involvement

21
Q

What is the function of grunting when struggling to.breathe

A

it is essentially physiological CPAP

as child tries to maintain alveoli open after exhalation

22
Q

Why should you weane children off steroids gradually

A

because they suppress the adrenal gland

so will have lowered endogenous cortisol production

23
Q

what are features of moderate/severe resp distress in infant=

A 
tachycardia 
RR >60 
nasal flaring 
head bobbing 
grunting 
tracheal tug 
use of accessory muscles (IC, SC recession)
reduced conscious levels 
saturation < 92
rising pCO2
24
Q

What are the three increasing steps to ventilation in an emergency

A

Oxygen (if O2<92)
Non invasive ventilation (CPAP/BiPAP)
Invasive ventilatory support (endotracheal intubation and mechanical ventilation)

25
Q

why are children so susceptible to fluid loss?

A

HIGHER REQ

EASIER DEHYDRATION

  • high surface area-volume ration
  • high basal metaboli rate
  • may become to take oral fluids
  • additional fluid loss if vomiting, diarrhoea, increased insensible losses
26
Q

What are early compensated features of dehydration

A 
tachypnoea, tachycardia (maintains BP)
decreased skin turgor 
sunken eyes, fontanelles 
mottled, pale, cold skin
delayed cap refill
core-peripheral temperature gap >4
decreased UO
27
Q

What are late decompensated features of dehydration

A

Kussmaul breathing
bradycardia, hypotension
blue peripheries
absent urine output

28
Q

What is shock?

A

The condition that arises when the body is unable to meet the metabolic demands of tissue

29
Q

what 2 key features occur with shock

A

10% decrease in body weight

Metabolic acidosis

30
Q

Explain the picture of a high risk sepsis child

A

Behaviour: no response to social cues, appears ill, does not wake, weak high pitched crying

HR: tachycardic / <60bpm

RR: tachypnoea, grunting, apnoea, SpO2<90% on air

Mottled/ashen appearance

Cyanosis of skin, lips, tongue

Non-blanching rash

Age <3m with >38 deg temp

Temp <36 degrees

31
Q

what lactate level makes you consider a child as high risk, and what is the immediate mx

A

> 2 mmol/L

give fluid bolus without delay

32
Q

What is SIDS

A

death with no identifiable cause even after autopsy after 1 month of age

33
Q

what is advice to prevent SIDS

A

sleep on back
avoid overheating (no headwrapping, blanket no higher than shoulders, no high room temp)
feet to foot position
no one should smoke near infant
have baby in parents bedroom for first 6m
avoid bringing the baby into their bed when they are tired /have had alcohool or drugs
avoid sleeping with baby on sofa
breastfeed if possible

Y5 Paediatrics (30 decks)

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