Week 6 Paediatrics (Q. 1 & 2) Flashcards
What is the difference between an ‘extrathoracic obstruction’ and an ‘intrathoracic obstruction’?
- The extrathoracic (superior) airway, which includes the supraglottic, glottic, and infraglottic regions
- The intrathoracic (inferior) airway, which includes the trachea, the mainstem bronchi, and multiple bronchial generations (which have as their main function the conduction of air to the alveolar surface)
Upper Respiratory Tract Infections are generally treated with referral to GP and Paracetamol. What some sign and symptoms?
Children experience 6-8 of these a year
Mostly young children as socialisation takes place (daycare)
SxSx
- Runny Nose
- Pharyngitis
- Fever
Rx
- Symptomatic including paracetamol for discomfort
- GP referral
True or False
Viral infections of the tonsils are more common than bacterial infections?
What are Sx and Sx of Tonsilitis and what is the Rx as per paramedics?
A. True
Tonsilitis is usually viral in origin (can be bacterial)
Severe tonsillitis may cause URTI
SxSx
- swelling on tonsils and pharynx
- may have white exudate on tonsils
- Bacterial tonsillitis may cause yellow coloured pus formation over the tonsils
Rx
- Generally viral so antibiotics not required
- Gargles, lozenges and paracetamol
https://researchpedia.info/difference-between-viral-and-bacterial-tonsillitis/
Explain where the obstruction is for Inspiratory and expiratory stridor and snoring?
Inspiratory Stridor = extra thoracic obstruction
Expiratory Stridor = intra thoracic obstruction
Snoring = Nasopharyngeal obstruction
What is Otitis Media (Middle Ear Infection) commonly caused by?
A. Pneumonia
B. Croup
C. Influenza
D. A and C
D. A and C = Commonly caused by pneumonia or influenza
Especially common in Eustachian tube dysfunction
SxSx
- Fever
- Deafness and pain in one ear
- Irritable child
- Bulging red tympanic membrane
Rx
- Most will resolve spontaneously
- Symptomatic
- Antibiotics if a bacterial infection
What is Croup and what age bracket does it commonly appear?
Acute Laryngotracheobronchitis
Croup is a Virall inflammation of the
- upper airway,
- larynx,
- trachea and
- bronchi
Common in children 6 months to 6 years
Aetiology
- According to Jacqui’s lecture, 85% of croup presentations are viral
True or False?
Males have a greater risk of Croup than females.
True
Risk Factors
- Late autumn and winter
- Males > females
- Recurrent episodes
What is the Rx for Croup as per the Upper Airway Obstruction CPG P0601
Mild
- BLS,
- Rx per severe if Pt deteriorates
Mod
- Dexamethasone 600 mcg/kg Oral (max 12mg)
- Tx
- Rx per severe if Pt deteriorates
Severe
- Adrenaline 5mg (5mL) Nebulised
- Dexamethasone 600 mcg/kg Oral (max 12mg)
- if improved –
- continue to monitor Pt
- Tx
- if unimproved –
- Repeat Adrenaline 5min intervals until improvement
- continue to monitor Pt
- Tx
Paracetamol as per the pain guideline
15mg/kg oral (if not already administered 4/24)
Epiglottitis is a severe, life-threatening and progressive infection of the Epiglottis and surrounding areas.
What is the primary cause of epiglottitis?
A. Haemophilus influenza type B Vaccine
B. Haemophilus influenzae type A
C. Haemophilus Ducreyi
D. Haemophilus Parainfluenzae
Haemophilus influenza type B Vaccine
Children who are not vaccinated have a greater risk of contracting Epiglottitis.
What are the Sx and Sx of epiglottitis?
Hint: NERDS
N - No Cough E - Expiratory Snore R - Rapid Onset D - Drooling and Dysphagia S - Septic and Flushed
Epiglottitis can kill fast
Why do we NOT inspect the airway in patients with suspected epiglottitis?
A. Increases risk of respiratory arrest
B. May spread the infection to other areas
C. Increases anxiety in the patient
D. A and C
D. A and C
Avoid examination of the airway as this may cause laryngospasm and respiratory arrest
Limit anxiety – hands off the sick child
Expedient transport to a paediatric facility
In hospital: intubation in theatre (? surgical airway) and IV antibiotics
Which is not an upper airway disorder?
A. Croup
B. Epiglottitis
C. URTI
D. Bronchiolitis
D. Bronchiolitis
Inflammatory obstruction and necrosis of the cells of the lower airways
What is Respiratory Distress Syndrome?
Poorly developed lung structure and lack of surfactant = RDS
SxSx
- Appears minutes after birth
- Respiratory distress: grunting, ↑ WOB
- Acute pulmonary oedema
- Cyanotic, dusky skin
What is the survival rate of Respiratory Distress Syndrome
A. 5 - 10%
B. 25 - 50%
C. 50 - 70%
D. 60 - 80%
C. 50 - 70%
It is the leading cause of death in newborns - primarily preterm infants
Rx includes:
- Glucocorticoid Administration during labour = enhanced lung maturation
- Mechanical ventilation with PEEP
- Exogenous surfactant administration
Which is not a Treatment for Respiratory Distress Syndrome?
A. Glucocorticoid Administration during labour = enhanced lung maturation
B. Mechanical ventilation with PEEP
C. Exogenous surfactant administration
D. Bronchodilators
D. Bronchodilators
Not a treatment for RDS
Bronchodilators may not actually work due to underdeveloped Beta 2 receptors
Which is true for Pneumonia?
A. Results from shared contact via sex and ulcerative wounds, cuts or menstrual blood
B. Only affects the elderly and paediatrics
C. Requires no in hopsital Rx
D. Bacterial infection more serious than Viral Pneumonia
D. Bacterial infection more serious than Viral Pneumonia
Leading cause of death and illness in young children, elderly and immunosuppressed
Viral is more common than bacterial
Results from inhalation of microbes dispersed in ambient air
What is bronchiolitis?
A. Swelling and inflammation leading to overinflation of the lungs
B. Severe, life-threatening and progressive infection of the epiglottis
C. Eustachian tube dysfunction
D. An acute episode of airway constriction due to a pathogen
A. Swelling and inflammation leading to overinflation of the lungs
Epithelial cells of the respiratory tract become swollen and inflamed –> obstruction –> progression over inflation of the lungs
What is not true regarding bronchiolitis?
A. Most common < 2-year-olds B. Often preceded by URTI C. Bronchodilators are used as an Rx option D. Usually bacterial E. Most common in winter months
D. Usually bacterial
Bronchiolitis usually is a viral infection. Respiratory syncytial virus (RSV) causes more than half of all cases.
How is a Febrile Convulsion different to Epilepsy?
Seizure occurring with fever in infancy or childhood without evidence of other underlying cause
or
sudden change in your child’s body temperature, and is usually associated with a fever
Epilepsy: recurring seizures due to a chronic abnormality in the cerebral cortex
Why do we not give paracetamol for fever?
During fever, a protein called pyrogen is generated. This increases the synthesis of a compound called prostaglandin in the hypothalamus, raising its temperature set point. Paracetamol acts as an antipyretic and inhibits the synthesis of prostaglandin
As a consequence, the lower body temp, reduces the effect of fever –> to increase body temp to kill the pathogen
What is the Midazolam does for a Small Child suffering from Status Epilepticus?
A. 2.5 - 5mg IV
B. 2.5mg IM
C. 1mg IV
D. 0.5 mg IM
B. 2.5mg IM
Midazolam IM
- Medium Child (5 - 11 years) Midazolam 2.5 - 5 mg IM
- Small child (1 - 4 years) Midazolam 2.5 mg IM
- Small and Large Infant (< 12 months) Midazolam 1 mg IM
- Newborn Midazolam 0.5 mg IM
Pain in the iliac fossa associated with anorexia, vomiting, bowel changes, low-grade fever in paediatrics is?
A. Diverticulitis
B. Ulcerative Colitis
C. GORD
D. Appendicitis
D. Appendicitis
The appendix sits in the lower right side of the abdomen (stomach). It is quite small and is a normal part of the bowel, but it is not thought to have an important role in the body.
3-4 / 1000 children
Usually presents age 5+
What is Intussusception?
A. Oesophageal complication
B. Failure of the Cardiac Sphincter
C. One part of the bowel telescopes into another
D. Rare care of appendicitis
C. One part of the bowel telescopes into another = bowel obstruction
- Common at 3-12 months old
- Patient presents episodic inconsolability, pallor, dehydrated, blood or mucus in stool, vomiting green liquid (bile), distended abdomen
- Mx generally requires surgery
What is the does of Ondansetron ODT for a Large Infant as per AV CPG’s?
None. NB, SI or LI do not receive Ondansetron ODT
SC = 2mg ODT LC = 4mg ODT
Which is more common in Diabetes presentations pre-hospitality for hyperglycaemia in paediatrics?
A. Hyperglycaemic Hyperosmolar State
B. Diabetic Keto Acidosis
B. DKA
Possible presentations:
Hyperglycaemia: often DKA = life-threatening condition, requires fluids and ICU treatment
Intensive care support for all cases of DKA
What is the RASH criteria for anaphylaxis?
Sudden onset of illness (minutes to hours)
–AND–
Two or more of R.A.S.H.:
- Respiratory distress (SOB, wheeze, cough, stridor)
- Abdominal symptoms (nausea, vomiting, diarrhoea, abdomonal pain/cramps)
- Skin/mucosal symptoms (hives, welts, itch, flushing, angioedema, swollen lips/tongue)
- Hypotension (or altered conscious state)
–OR–
• Isolated hypotension (relative to age) with exposure to a known antigen
What is the toxic dose of paracetamol in the paediatric setting?
A. > 100mg/kg
B. > 150mg/kg
C. > 150mcg/kg
D. > 100mcg/kg
B. > 150mg/kg
Acute prehospital complications are rare
- Antidote in hospital N-acetyl-cysteine (NAC)
- oral acticated charcoal if cooperative and < 1 hour since ingestion
AV dosage for mild pain is Paracetamol 15 mg/kg
oral if not already administered
What occurs to the body from iron cleaner poisoning?
A. Hepatic Toxicity
B. Haemolysis
C. Destruction of GI Mucosa
D. All the above
C. Destruction of GI Mucosa
Toxic dose 60-120mg/kg,
Lethal dose >120mg/kg
Toxic mechanism = destruction of GI mucosa
- Vomiting, diarrhoea, hypovolaemia, bleeding
GI upset likely in the prehospital setting
Late signs: metabolic acidosis and coma
Activated charcoal not useful
Fluid replacement with crystalloid necessary
Antidote in hospital: desferrioxamine
What is the lethal dose of salicylates (aspirin) in paediatrics?
A. > 150mg/kg
B. > 300mg/kg
C. > 500mg/kg
D. > 600mg/kg
C. > 500mg/kg = lethal
Toxic is > 300mg/kg
Presentation - Vomiting, hyperventilating, respiratory alkalosis, metabolic acidosis
Coma and seizures in severe toxicity
In hospital Mx: urinary alkalisation and haemodialysis
What does the SLUDGE acronym stand for?
Early symptoms of organophosphates = SLUDGE
Salivation Lacramination Urination Diarrhoea Emesis (GI)
Late Signs Coma Bradycardia and hypotension Seizures Paralysis
Antidote: large quantities of atropine (MICA / hospital)
What is the Paediatric dose of Naloxone?
A. Naloxone 10 mcg/kg (max. 400 mcg) IM B. Naloxone 1.6 mg – 2 mg IM C. Naloxone 100 mcg IV D. Naloxone 400 mcg IM (single dose only)
A. Naloxone 10 mcg/kg (max. 400 mcg) IM
Classic triad:
Altered conscious state, respiratory depression, pinpoint pupils
Children should be Tx to Hospital post opiate OD.
Oral opiates can have a longer duration than naloxone
What does the FLACC Paediatric Pain Assessment stand for?
F - Face L - Legs A - Activity C -Cry C - Consolability
Musculoskeletal
What differences do we see between paediatrics and adults regarding fractures?
A. Bones are softer and pliable = more likely to bend than break
B. Spine C1 and C2 injuries are more common
C. Ligaments are stronger, so a break is more likely to occur than a strain
D. All the above?
D. All the above
Extra Info
- Injuries to internal organs generally seen with Sx of external trauma
- Tissue healing is better than adults
- If paediatric presents with 3 + fractures ribs, query child abuse (blunt trauma rarely cases rib fractures in children)
- C1 and C2 injuries are more common in neck injuries than adults.
What type of Cardiac Arrest does Upper Airway Obstruction fall under?
PEA reversible causes
- Upper airway obstruction
Extra Info -
We do not inspect the airway of Paediatrics suffering from Epligotitis as it Increases the risk of respiratory arrest
The seal barking a well known Sx and Sx of Croup. What are some other Sx and Sx of Croup?
HINT: PBS RHS
- Pale and Lethargic
- Barking Cough
- Stridor
- Recent URTI Hx
- Slower Onset
- Hypoxic and Restless
What is the pathophysiology of Croup?
Croup causes swelling of the larynx, trachea, and large bronchi due to infiltration of white blood cells.
Swelling results in partial airway obstruction which, when significant, results in dramatically increased work of breathing, and the characteristic turbulent, noisy airflow known as stridor.
Which is TRUE regarding Meningococcal
A. Type B and C are both vaccinated against
B. A Purpuric rash that is subtle in appearance and presents as a single spot.
C. Does not require PPE
D. ALS - Ceftriaxone 50mg/kg IV
B. Purpuric rash is subtle in appearance and present as a single spot.
Purpura aka Petechiae or Petechial
The vaccine is for type C only, you cannot be vaccinated against type B
You must wear PPE and Paramedics must have medical follow up post exposure
What is Meningitis and what classic symptoms?
Inflammation of the Meninges that causes thick, exudative CSF which leads to blockages and meningeal symptoms
- Photophobia
- Nuchal Rigidity (stiff neck)
- Headaches
- Fever
- Phonophobia
Meningitis can lead to an altered conscious state and seizures
What is the ALS drug dose/s for Paediatric Meningococcal Septicaemia?
Ceftriaxone 50mg/kg IM (max. 1000mg)
- Dilute 1000 mg with 3.5mL Lignocaine 1%
- Administer into upper lateral thigh
Ceftriaxone
Contras: Allergy to Cephalosporin Antibiotics
Lignocaine
Contras: Known Hypersensitivity
