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Special Populations > Week 6 Paediatrics (Q. 1 & 2) > Flashcards

Week 6 Paediatrics (Q. 1 & 2) Flashcards

1
Q

What is the difference between an ‘extrathoracic obstruction’ and an ‘intrathoracic obstruction’?

A
  • 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)
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2
Q

Upper Respiratory Tract Infections are generally treated with referral to GP and Paracetamol. What some sign and symptoms?

A

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
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3
Q

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

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/

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4
Q

Explain where the obstruction is for Inspiratory and expiratory stridor and snoring?

A

Inspiratory Stridor = extra thoracic obstruction
Expiratory Stridor = intra thoracic obstruction
Snoring = Nasopharyngeal obstruction

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5
Q

What is Otitis Media (Middle Ear Infection) commonly caused by?

A. Pneumonia
B. Croup
C. Influenza
D. A and C

A

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
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6
Q

What is Croup and what age bracket does it commonly appear?

A

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

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7
Q

True or False?

Males have a greater risk of Croup than females.

A

True

Risk Factors

  • Late autumn and winter
  • Males > females
  • Recurrent episodes
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8
Q

What is the Rx for Croup as per the Upper Airway Obstruction CPG P0601

A

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)

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9
Q

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

A

Haemophilus influenza type B Vaccine

Children who are not vaccinated have a greater risk of contracting Epiglottitis.

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10
Q

What are the Sx and Sx of epiglottitis?

Hint: NERDS

A 
N - No Cough
E - Expiratory Snore
R - Rapid Onset
D - Drooling and Dysphagia
S - Septic and Flushed

Epiglottitis can kill fast

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11
Q

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

A

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

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12
Q

Which is not an upper airway disorder?

A. Croup
B. Epiglottitis
C. URTI
D. Bronchiolitis

A

D. Bronchiolitis

Inflammatory obstruction and necrosis of the cells of the lower airways

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13
Q

What is Respiratory Distress Syndrome?

A

Poorly developed lung structure and lack of surfactant = RDS

SxSx

  • Appears minutes after birth
  • Respiratory distress: grunting, ↑ WOB
  • Acute pulmonary oedema
  • Cyanotic, dusky skin
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14
Q

What is the survival rate of Respiratory Distress Syndrome

A. 5 - 10%
B. 25 - 50%
C. 50 - 70%
D. 60 - 80%

A

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
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15
Q

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

A

D. Bronchodilators

Not a treatment for RDS

Bronchodilators may not actually work due to underdeveloped Beta 2 receptors

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16
Q

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

A

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

17
Q

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

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

18
Q

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
A

D. Usually bacterial

Bronchiolitis usually is a viral infection. Respiratory syncytial virus (RSV) causes more than half of all cases.

19
Q

How is a Febrile Convulsion different to Epilepsy?

A

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

20
Q

Why do we not give paracetamol for fever?

A

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

21
Q

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

A

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
22
Q

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

A

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+

23
Q

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

A

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
24
Q

What is the does of Ondansetron ODT for a Large Infant as per AV CPG’s?

A

None. NB, SI or LI do not receive Ondansetron ODT

SC = 2mg ODT
LC = 4mg ODT
25
Q

Which is more common in Diabetes presentations pre-hospitality for hyperglycaemia in paediatrics?

A. Hyperglycaemic Hyperosmolar State
B. Diabetic Keto Acidosis

A

B. DKA

Possible presentations:

Hyperglycaemia: often DKA = life-threatening condition, requires fluids and ICU treatment
Intensive care support for all cases of DKA

26
Q

What is the RASH criteria for anaphylaxis?

A

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

27
Q

What is the toxic dose of paracetamol in the paediatric setting?

A. > 100mg/kg
B. > 150mg/kg
C. > 150mcg/kg
D. > 100mcg/kg

A

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

28
Q

What occurs to the body from iron cleaner poisoning?

A. Hepatic Toxicity
B. Haemolysis
C. Destruction of GI Mucosa
D. All the above

A

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

29
Q

What is the lethal dose of salicylates (aspirin) in paediatrics?

A. > 150mg/kg
B. > 300mg/kg
C. > 500mg/kg
D. > 600mg/kg

A

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

30
Q

What does the SLUDGE acronym stand for?

A

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)

31
Q

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

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

32
Q

What does the FLACC Paediatric Pain Assessment stand for?

A 
F - Face
L - Legs
A - Activity
C -Cry
C - Consolability
33
Q

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?

A

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.
34
Q

What type of Cardiac Arrest does Upper Airway Obstruction fall under?

A

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

35
Q

The seal barking a well known Sx and Sx of Croup. What are some other Sx and Sx of Croup?

HINT: PBS RHS

A
  • Pale and Lethargic
  • Barking Cough
  • Stridor
  • Recent URTI Hx
  • Slower Onset
  • Hypoxic and Restless
36
Q

What is the pathophysiology of Croup?

A

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.

37
Q

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

A

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

38
Q

What is Meningitis and what classic symptoms?

A

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

39
Q

What is the ALS drug dose/s for Paediatric Meningococcal Septicaemia?

A

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

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