Paeds Emergency Flashcards
what is the paediatric sepsis 6 bundle?
- O2 (aiming for >94%)
- obtain IV access and take bloods (blood culture, blood gas, FBC/CRP/coag/U+E)
- give IV abx
- consider IV fluid resus
- escalation - senior
- consider early inotropic support
definition: anaphylaxis
severe, life threatening allergic reaction that is acute onset and can cause death
immediate tx whe pt in anaphylaxis?
- Call for help!!
- remove allergen if present
- high flow o2 via mask
- do not wait for iv access
- IM adrenaline (mid lateral thigh)
- lie flat on back with knees up
then ABC
clincial features of urticaria?
intensely pruritic erythematous plaque (+/- angioedema)
difference between acute and chronic urticaria
acute: <6wks, triggers allergy, URTI, idiopathic
chronic: >6wks, spontaneous or physical triggers
Tx for urticaria
high dose non sedating antihistamines (e.g. chlorphenamine)
+/- oral glucocorticosteroids
immediate tx for intentional paracetamol ingestion
if ingestion <1hr ago and >150mg/kg:
oral charcoal and IV antiemetic
+ everyone NEEDS:
N acetylcysteine infusion
features differentiating viral and bacterial community acquired pneumonia
bacterial:
age >2yrs
temp >38.5
absence of wheeze
absence of rhinorrhea
chest pain
viral:
age> 2hrs
temp<38.5
wheeze
rhinorrhea
no chest pain
acute clinical manifestations of sickle cell disease?
- anaemia
- acute anaemic
- infection
- painful crisis (vaso occlusive crisis to organs = pain)
- priapism
Mx of pt who presents to GP with suspected meningitis
IM benzylpenicilin
high flow o2
blue light ambulance
hospital Mx of a pt with meningitis
notify ICU and anaesthesia pre arrival
A-E
high flow o2
IV/IO access: blood tests IV ceftriaxone, fluid bolus
early inotrope support
early airway support
seizure mx
- A-C
- Lorazepam IV
- wait 10 mins - another dose of lorazepam IV
- wait 10 mins - phenytoin IV
- if status epilepticus > 30mins: thiopentone
common cuases of seizures?
- febrile convulsions
- known epilepsy
- meningitis/encephalitis
- hypoglycaemia/hypocalcaemia
- metabolic/poisoning
- trauma - accidental or non-accidental
features of febriles convulsions
generalised in nature
6months to 5yo - no previous neurology
<15 mins
no interstitial cystitis infection/metabolic disturbance
recurrence risk 30-40%
age of onset of absence seizures?
4-12 yrs
girls>boys
features of absence seizure
sudden onset
last few secondds
flcikering of eyes
purposelss movements of eyes/mouth
generalised convulsions therefore LOC
what is included in the PEWS score?
- nurse/family concern
- resp rate
- resp distress
- O2 administration
- heart rate
- conscious level
clinical features of testicular torsion?
acute rapid onset of unilateral testicular pain
w/ abdo pain and vomiting
- firm swollen testicle
- elevated (retracted) testicle
- absent cremasteric reflex
- abnormal testicular lie (horizontal)
- rotation
what is bell clapper deformity?
no fixation between testicle and tunica vaginalis therefore testicle hangs in horizontal position, it is also able to rotate within tunica vaginalis, twisting at the spermatic cord
**can cause testicular torsion
Ix to confirm testicular torsion?
scrotal US
however if this delays pt going to theatre then do not perform GO STRAIGHT to theatre
Mx of testicular torsion?
- NBM in prep for surg
- analgesia
- urgent senior urology assessment
- surgical exploration of scrotum
- orchiopexy (correcting position of testicles + fixing them)
- orchidectomy (removing testicle) if necrosis
what is epididymoorchitis?
inflammation of the epididymis and testicle
usually as a result of infection
main bacterial causes of epididymoorchitis?
E.coli
chlamydia trachomatic
Neisseria gonorrhea
mumps
clinical features of a child with epididymoorchitis?
presents with gradual onset, over mins to hours, unilateral:
- testicular pain
- dragging or heavy sensation
- swelling of testicle and epididymis
- tenderness on palpation, particualry over epididymis
- urethral discharge (chlamydia or gonorrhea)
- fever and potential sepsis
key differential diagnosis for epididymoorchitis that needs to be excluded?
testicular torsion
what is a key feature that points towards epididymoorchitis being from a sexually transmitted organism rather than E Coli?
discharge from urethra (+ increased number of sexual aprtners in last 12 months)
Ix to establish diagnosis of epididymoorchitis?
- urine microscopy, culture and sensitivity (MC&S)
- chlamydia and gonorrhoea: NAAT testing on first pass urine + charcoal swab of urethral discharge
- mumps: saliva swab (PCR) + serum antibodies
- assess torsion of tumours: USS
Mx of epididymoorchitis?
septic: IV abx + admission
sexually transmitted: GUM referral fro assess + tx (IM ceftriaxone or doxy)
if e.coli most likely: ofloxacin for 14 days
additionally:
- analgesia
- supportive underwear
- reduce physical activity
- abstain from intercourse
complications of epididymoorchitis?
- chronic pain
- chronic epididymitis
- testicular atrophy
- subfertility or infertility
- scrotal abscess
what can undescended testes (cryptorchidism) put you at higher risk of in the future?
testicular torsion
infertility
testicular cancer
risk factors for
undescended testes?
- FHx of undescended testes
- low birth weight
- small for gestational age
- prematurity
- maternal smoking during pregnancy
Mx of undescended testes?
watching and waiting in newborns - shld testes within 3-6months
if not descended by 6 months then see a paeds urologist for orchidopexy within 6 and 12 months of age
