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Paediatric Emergency Medicine > PEM - neuro, opthal, ENT, dental, radiology, renal, resus > Flashcards

PEM - neuro, opthal, ENT, dental, radiology, renal, resus Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Causes of Raised ICP

A

Increased CSF fluid
- decreased absoprtion (Obstruction, communicating)
Swollen contents
- infection: meningitis, encephalitis
- Cerebral oedema: metabolic, vasogenic, ischaemic, axonal injury
- Increased venous pressure: venous sinus thrombosis
Space occupying lesion: tumours, haematoma, absess/cyst
Decreased volume: depressed skull fracture

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2
Q

Simple febrile seizure, characteristics

A
  • generalised tonic-clonic
  • < 10 min
  • Complete recovery in 1 hr
  • not reoccuring in same illness
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3
Q

Management of seizure

A

> 5 min seizure / unknown length
Monitoring, BSL
Benzodiazepine - midazolam 0.1 mg/kg IV/IM (0.3mg/kg buccal)
5 min - repeat benzodiazepine
5 min - levetiracetam 40 mg/kg IV (max 3g) over 5 min
5 min after infusion - phenytoin IV 20mg/kg over 20 min, max 50mg/min
5 min after infusion - intubation

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4
Q

Dose of midazolam in seizures

A
  1. 1 mg/kg IM / IV

0. 3 mg/kg IN / Buccal

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5
Q

Predictors of ICU admission in diagnosis of muscular weakness

A
  • bulbar palsy
  • Vital capacity < 20 mls/kg
  • > 30% reduction in vital capacity
  • Flaccid quadriparesis
  • Rapidly progressive weakness
  • Autonomic cardiovascular instability
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6
Q

Guillian-Barre: clinical findings

A

Motor weakness
Absent reflexes
Ascending pattern.
Cranial nerve abnormalities

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7
Q

Predictors of intubation in Guillian Barre

A

Vital capacity <= 20mls/kg
Max insp pressure <= 30 cmH2O or exp pressure <= 40 cmH2O
Tidal volume < 5 mls/kg
Sustained increase of pCO2 > 50
Rising RR or O2 requirement.
Increased accessory muscle use or paradoxical diaphragm movements.

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8
Q

Features of infantile botulism and treatment

A

Exposure to honey. Bulbar palsy, descending. lack of facial expression.

No antibiotics.
BabyBIG (botulism IG)
NG feeding
Respiratory support

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9
Q

Features of transverse myelitis

A

Flaccid paralysis –> increased tone.
Sensory level (often midthoracic)
Back pain, neck stiffness / fever.
Bladder / bowel disturbance

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10
Q

DDx of ataxia

A

Post-viral acute cerebellar ataxia - dysarthria, hypotonia
Poisoning - altered consciousness and vomiting
Tumours - posterior fossa, paraneoplastic
Trauma - NAI, concussion
Metabolic - BSL, Na, Ammonia, B12, IEM
Infectious - CNS, larbrynthitis
Vascular - stroke, vasculitis
Immune - MS, ADEM

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11
Q

Absence of red reflex

A

large retinal detachment
large vitreous haemorrhage
dense cataract
retinoblastoma

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12
Q

Distinguishing features of orbital cellulitis

A

Systemic features, sinusitis
Red eye
Painful eye movements / diplopia
Proptosis

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13
Q

Neonatal conjunctivitis management and differential

A

Swab
IV ceftriaxone (Gonorrhoea, 24-48 hrs)
PO azithromycin or erythromycin (Chlamydia 5-14 days)
Other - staph/strep (D5-7) or HSV

DDx:
congenital nasolacrimal duct obstruction (not red / inflamed)

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14
Q

How do you identify keratitis, causes and management

A

Corneal opacity, without overlying epithelial defect.
Pain, erythema, photophobia and reduced visual acuity
+/- hypopyon

Staph/strep 
Pseudomonas (contact lenses)
Fungi (garden trauma) 
HSV (dendritic) 
Varicella (skin rash)

Mx: ophthalmologist for scrapings prior to abx

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15
Q

Indications for referral in eyelid trauma

A 
Bite trauma 
Involves lid margin 
Medial 1/3 of eyelid 
Levator aponeurosis (proptosis)
Orbital fat exposed 
Significant tissue loss
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16
Q

Indications for antibiotic treatment in otitis media

A

Only 1 hearing ear
Indigenous
Cochlear implant
Otherwise well child without improvement at 2-3 days

Consider (other sources suggest)
- age < 2

17
Q

Useful numbers and otitis media treatment

  • NNT with antibiotics to reduce pain
  • NNH with antibiotics
  • NNT to prevent 1 mastoiditis
A
  • NNT 20
  • NNH 10
  • prevent mastoiditis NNT 5000
18
Q

Indications to antibitoics in tonsilitis

A

Indigneous australia, maori / pacific islander
Personal or FHx rheumatic heart disese
Immunosupressed
Aged >= 4 yrs

19
Q

Intercostal catheter size in child

A

4 x ETT (age / 4 + 4)

20
Q

Red flags for organic illness in acute behavioural disturbance

A

Fever
Clouded consciousness
Fluctuating mental state
Behaviour - personality change, sleep disturbance
Speech - muddled, fragmented
Perception - illusion, visual or tactile hallucinations
Paranoid ideation

21
Q

Medications for acute behavioural disturbance in adolescents

A

Hyperaroused - quetiapine 5mg/kg
Psychotic, agressive or agitatied - olanzapine < 40 kg 5mg, > 40 kg 10 mg
Droperidol 0.1-0.2 mg/kg (max 10mg) IM, Repeated at 15 min

22
Q

Medications for acute behavioural disturbance in pre-adolescent

A

PO
Quetiapine 5-10 mg/kg PO (max 10mg/kg in 24 hrs)
Olanzapine < 40 kg 2.5-5mg, > 40 kg 5-10 mg single dose
Risperidone 0.02-0.04 mg/kg (max 2mg) one dose.

Parenteral Sedation
Droperidol 0.1-0.2 mg/kg IM (max 10mg), repeat in 15 min

15 min still unsettled
Midazolam 0.1-0.2 mg/kg IM or IV
Ketamine 4mg/kg IM or 1mg/kg IV

Avoid benzos - disinhibition without sedation in this group (autism / behavioural disturbance)

23
Q

Emergency medicine role in sexual assault

A 
Recognition 
Treatment of physical injury 
Consider toxicology screening 
Sexual Assault Service referral 
Medical 
- emergency contraception 
- antibiotic / antiviral 
Child protection
24
Q

Indications for medical admission in eating disorders

A 
Arrhythmia Or QTc > 450 msec 
BP - SBP < 80 por postural drop >= 20
C - HR < 50, postural HR increase >= 30, 
Dehydration 
Electrolyte - K < 3
Hypothermia < 35.5

Weight < 75% predicted or rapid LOW
Eating disorder behaviour out of control.

25
Q

Causes of Upper GI bleeding

A 
Maternal: swallowed blood, NSAID 
Neonate: 
- trauma 
- vascular malformation 
Young child
- oesophagitis 
All 
- gastritis and erosions, PUD 
- Mallory Weiss tear
- bleeding disorder 
- duplication cyst 
- Oesophageal varicies 
- drug induced ulcers / NSAIDS (adolescent)
26
Q

Causes of lower GI bleeding

A 
Swallowed maternal blood
Enterocolitis (necrotising, ischaemic, protein sensitive)
Gastroenteritis 
Obstruction 
Congenital (duplication, vascular malformation, Meckels)
Anal fissure 
Medical (HUS, vascular, IBD)
Polyps, haemorrhoids, rectal prolapse
27
Q

Management of oesphageal variceal bleeding

A

PPI
IV Vitamin K 2-10 mg
Ceftriaxone
IV somatostatin / octreotide 1 mcg/kg IV bolus (50mcg), then infusion

28
Q

GI foreign bodies that should be removed

A

At presentation

  • any oesophageal FB
  • button battery > 20 mm and < 6 yrs
  • > 5 cm (3 cm < 12 months) object
  • sharp object

Button battery

  • high risk (<6 yrs or > 15 mm) _ repeat x-ray in 4 days to localise
  • low risk repeat x-ray in 10-14 days.
29
Q

AXR findings consistent with intussusception

A

Absence of air in RUQ
Intracolonic mass / cresent sign
No air/fluid level in caecum
fistal obstruction with dilated small bowel
free air - riglers sign (double wall), football sign

30
Q

Red flags in gastroenteritis

A 
< 6 months of age 
high fever 
bilious vomits 
significant abdominal pain 
absence of diarrhoea 
blood in vomit / stool 
reduced consciousness
31
Q

What is rapid NG rehydration prescription

A

25 mls/kg/hr ORS over 4 hrs (up to 300 mls/hr), then increase to 6 hrs)

32
Q

Red flags for constipation

A 
Fever 
Vomiting 
Bloody diarrhoea 
Failure to thrive 
Abdominal distention 
Anal canal stenosis 
delayed meconium passage 
polydipsia/polyuria
33
Q

Differential diagnosis and key features for paediatric haematuria

A 
Post strep GN - preceeding GAS infection (throat, skin)
Rash / arthritis - HSP, SLE 
Diarrhoea +/- petehiae - HUS 
Travel - schisosomiasis / TB 
Abdominal mass - wilms tumour
34
Q

Features of haemolytic uraemic syndrome

A

Thrombotic microangiopathy

Haemolytic anaemia - schisocytes, raised LDH, low haptoglobin, raised bilirubin. reticulocytosis 
microangiopathic - thrombocytopaenia 
Negative coombs 
Normal coagulation 
Urinalysis - haematuria / proteinuria
35
Q

Diagnostic criteria for HSP

A

Palpable purpura
Normal platelet count / coagulation
one or more of
- abdominal pain
- arthralgia / arthritis
- renal involvement (proteinuria / haematuria)
- histopath - leucoclastic vasculitis with IgA deposits (GN)

Paediatric Emergency Medicine (2 decks)

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