Pediatric emergencies

Question 1

What is the normal respiratory rate for infants, young children and older children in that order?

Answer 1

30-40 Infants
25-35 Young children
20-25 Older children

Question 2

What is normal heart rate of Infants, young children and older children in that order?

Answer 2

Infants 110-160
young children 95-150
Older chidren 80-120

Question 3

What is the normal systolic BP for infants, young children and older children in that order?

Answer 3

Infants 80-90
young children 85-100
older children 90-110

Question 4

What does AVPU stand for and what does it asses?

Answer 4

Alert, Respond to voice, Responds to pain, Unresponsive

it asses level of consciousness but less detailed than glascow coma scale.

Question 5

If child present with shock, what can be the cause and give examples of diseases?

Answer 5

• Hypovolemia (sepsis, dehydration-gastroenteritis, diabetic ketoacidosis, blood loss).
• Maldistribution of fluid ( sepsis and anaphylaxis)
• Cardiogenic (arrhythmias and heart failure)
• Neurogenic (spinal cord injury)

Question 6

If child present with respiratory distress, what can be the cause and give examples of disease?

Answer 6

• Upper airway obstruction- stridor (croup/epiglottitis, foreign body, congenital malformations, trauma)
• Lower airway obstruction (asthma, bronchiolitis, pneumonia, pneumothorax)

Question 7

If child present drowsy or unconscious or seizing, what can be the cause and give examples of disease?

Answer 7

• Post-ictal, status epilepticus or infection (Meningitis/enchephalitis)
• Metabolic (diabetic ketoacidosis, hypoglycemia, electrolyte imbalances, congenital error of metabolism
• Head injury (trauma/non-accidenta injury)
• Drug/poison ingestion
• Inctracranial hemorrhage

Question 8

Give examples of surgical emergencies?

Answer 8

• Acute abdomen (appendicitis, peritonitis)

- Intestinal obstruction (Intussusception, Malrotation, Bowel atresia/stenosis)

Question 9

What is the pathophysiology of respiratory failure?

Answer 9

Alveolar hypoventilation, diffusion impairment, intrapulmonary shunting or ventilation-perfusion mismatch.

Question 10

Complication of respiratory failure?

Answer 10

hypoxemia leading to tissue hypoxia or hypercabia which can cause carbon dioxide narcosis, or both.
Also respiratory arrest

Question 11

What is the maximum fractional concentration of oxygen delivered via facemask?

Answer 11

0.60 unless a reservoir bad is added.

Question 12

What is inlcuded in noninvasive ventilation?

Answer 12

continous positive airway pressure (CPAP) or biphasic positive airways pressure via face mask or nasal mask.
Also high-flow humidified gas.

Question 13

When should you use endotracheal intubation or mechanical ventilation?

Answer 13

• severe respiratory distress
• tiring due to excessive work of breathing
• progerssive hypoxemia
• reduced conscious level
• progressive neuromuscular weakness (Guillain-Barre syndrome)

Question 14

why are children so susceptible to fluid loss?

Answer 14

• Higher surface area-to-volume ratio and higher basal metabolic rate.

Question 15

What are the features of early compensated shock?

Answer 15

• Maintained blood pressure by increased HR and RR.
• Redistribution from periphery to vital organs–> pale skin and cold.
• 10% loss of bodyweight and acidosis, if its due to dehydration.
• delayed capilarry refil >2s
• sunken eyes and fontanelle

Question 16

What are the features of late compensated shock?

Answer 16

• Low blood pressure (compensatory is failing)
• Lactic acidosis increases
• Bradycardia
• Confusion
• Kussmaul breathing
• blue peripheries
• Absent urine output

Question 17

What is the main management of shock following fluid loss?

Answer 17

0.9% saline, or blood if following trauma

Question 18

If fluid and blood fails to get the child out of shock, what to do?

Answer 18

• Intubation
• Invasive monitoring of Bp
• Inotropic support
• Correction of hematologic, biochemical and metabolic derangements
• Support for renal failure

Question 19

Whats the most common cause of anaphylaxis in children?

Answer 19

85% is food allergy; IgE mediated

Question 20

What the emergency treatment of anaphylaxis?

Answer 20

adrenaline IV

Question 21

What is status epilepticus?

Answer 21

continues seizure lasting more than 30 minutes or seizure intermittently lasting more than 30 minutes without recovery of consciousness between seizures.

Question 22

What is the priority in status epilepticus?

Answer 22

to stop the seizure by treating any reversible causes such as hypoglycemia or electrolte disturbance.

Question 23

Management protocol for status epilepticus

Answer 23

0 min: airway (high-flow oxygen, dont forgen glucose).

5 min: vascular acces? Yes–> lorazepam (IV/IO), no–> midazolam (buccal) or diazepam (rectal).

15 min: lorazepam (IV/IO) call for senior help. Prepare phenytoin. Reconfirm it is an epileptic seizure.

25 min: seek aneasthetic/ICU advice, consider rectal paraldehyde, Phenytoin IV/IO over 20 min. Or if already on phenytoin give phenobarbitone IV/IO over 5 min.

45 min: rapid sequence induction of anesthesia with thiopental

Question 24

initial assesment and managemetn of coma?

Answer 24

ABCDE
Examination: raised intracranial pressure? abnormal breathing, posture, pupils, fundi (papilloedema or retinal hemorrhage). Bradycardia and hypertension suggest impending brain stem herniation.

Treat the treatable: hypoglycemia, poisoning, DM, septicemia/meningitis, herpes simplex encephalitis.

Intubate and ventilate if neceessary

Question 25

Whats the most common cause of death in children under the age of 1?

Answer 25

sudden infant death syndrome