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Y4 medicine > Paeds Emergency > Flashcards

Paeds Emergency Flashcards

1
Q

what is the paediatric sepsis 6 bundle?

A
  1. O2 (aiming for >94%)
  2. obtain IV access and take bloods (blood culture, blood gas, FBC/CRP/coag/U+E)
  3. give IV abx
  4. consider IV fluid resus
  5. escalation - senior
  6. consider early inotropic support
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2
Q

definition: anaphylaxis

A

severe, life threatening allergic reaction that is acute onset and can cause death

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3
Q

immediate tx whe pt in anaphylaxis?

A
  • 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

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4
Q

clincial features of urticaria?

A

intensely pruritic erythematous plaque (+/- angioedema)

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5
Q

difference between acute and chronic urticaria

A

acute: <6wks, triggers allergy, URTI, idiopathic

chronic: >6wks, spontaneous or physical triggers

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6
Q

Tx for urticaria

A

high dose non sedating antihistamines (e.g. chlorphenamine)
+/- oral glucocorticosteroids

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7
Q

immediate tx for intentional paracetamol ingestion

A

if ingestion <1hr ago and >150mg/kg:
oral charcoal and IV antiemetic

+ everyone NEEDS:
N acetylcysteine infusion

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8
Q

features differentiating viral and bacterial community acquired pneumonia

A

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

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9
Q

acute clinical manifestations of sickle cell disease?

A
  • anaemia
  • acute anaemic
  • infection
  • painful crisis (vaso occlusive crisis to organs = pain)
  • priapism
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10
Q

Mx of pt who presents to GP with suspected meningitis

A

IM benzylpenicilin
high flow o2
blue light ambulance

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11
Q

hospital Mx of a pt with meningitis

A

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

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12
Q

seizure mx

A
  1. A-C
  2. Lorazepam IV
  3. wait 10 mins - another dose of lorazepam IV
  4. wait 10 mins - phenytoin IV
  5. if status epilepticus > 30mins: thiopentone
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13
Q

common cuases of seizures?

A
  • febrile convulsions
  • known epilepsy
  • meningitis/encephalitis
  • hypoglycaemia/hypocalcaemia
  • metabolic/poisoning
  • trauma - accidental or non-accidental
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14
Q

features of febriles convulsions

A

generalised in nature
6months to 5yo - no previous neurology
<15 mins
no interstitial cystitis infection/metabolic disturbance
recurrence risk 30-40%

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15
Q

age of onset of absence seizures?

A

4-12 yrs

girls>boys

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16
Q

features of absence seizure

A

sudden onset
last few secondds
flcikering of eyes
purposelss movements of eyes/mouth
generalised convulsions therefore LOC

17
Q

what is included in the PEWS score?

A
  • nurse/family concern
  • resp rate
  • resp distress
  • O2 administration
  • heart rate
  • conscious level
18
Q

clinical features of testicular torsion?

A

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
19
Q

what is bell clapper deformity?

A

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

20
Q

Ix to confirm testicular torsion?

A

scrotal US
however if this delays pt going to theatre then do not perform GO STRAIGHT to theatre

21
Q

Mx of testicular torsion?

A
  • NBM in prep for surg
  • analgesia
  • urgent senior urology assessment
  • surgical exploration of scrotum
  1. orchiopexy (correcting position of testicles + fixing them)
  2. orchidectomy (removing testicle) if necrosis
22
Q

what is epididymoorchitis?

A

inflammation of the epididymis and testicle
usually as a result of infection

23
Q

main bacterial causes of epididymoorchitis?

A

E.coli
chlamydia trachomatic
Neisseria gonorrhea
mumps

24
Q

clinical features of a child with epididymoorchitis?

A

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
25
Q

key differential diagnosis for epididymoorchitis that needs to be excluded?

A

testicular torsion

26
Q

what is a key feature that points towards epididymoorchitis being from a sexually transmitted organism rather than E Coli?

A

discharge from urethra (+ increased number of sexual aprtners in last 12 months)

27
Q

Ix to establish diagnosis of epididymoorchitis?

A
  • 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
28
Q

Mx of epididymoorchitis?

A

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

29
Q

complications of epididymoorchitis?

A
  • chronic pain
  • chronic epididymitis
  • testicular atrophy
  • subfertility or infertility
  • scrotal abscess
30
Q

what can undescended testes (cryptorchidism) put you at higher risk of in the future?

A

testicular torsion
infertility
testicular cancer

31
Q

risk factors for
undescended testes?

A
  • FHx of undescended testes
  • low birth weight
  • small for gestational age
  • prematurity
  • maternal smoking during pregnancy
32
Q

Mx of undescended testes?

A

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

Y4 medicine (17 decks)

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