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paediatrics > Emergency med > Flashcards

Emergency med Flashcards

1
Q

deaths per year anaphylaxis

A

20

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2
Q

type of reaction anaphylaxis

A

type 1 hypersensitivity

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3
Q

type 1 hypersensitivity

A

1st exposure - Th2 cells primed, IL4 released causes B cells to switch IgM to IgE..bind to mast cells and basophils..sensitised to allergen
2nd exposure - IgE crosslinks and causes mast cell degranulation and release of mediators…vasodilation, bronchoconstriction, permeability of endothelium

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4
Q

triggers of anaphylaxis

A

drugs - abx, NSAIDS
injections
venom
food - shellfish, nuts, peanuts, eggs
exercise induced anaphylaxis
idiopathic

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5
Q

higher risk anaphylaxis

A

existing comorbidities - asthma, CVD
exposed to same allergen again - food triggers

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6
Q

increased severity anaphylaxis

A

exercise
fever
acute infection
premenstrual status
emotional stress

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7
Q

ddx anaphylaxis

A

life threatening asthma
septic shock
hereditary angioedema
vasovagal episode

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8
Q

adult and children >12 adrenaline

A

IM 500 micrograms

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9
Q

child 6-12 adrenaline

A

300 micrograms

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10
Q

6mths to 6yrs adrenaline

A

150 micrograms

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11
Q

<6mths adrenaline

A

100-150 micrograms

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12
Q

management anaphylaxis

A

give IM adrenaline very 5 mins until infusion started
A to E
Take a blood sample for mast cell tryptase testing immediately after starting treatment to support diagnosis
paeds - biphasic response can occur so must be admitted (within 72 hrs)

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13
Q

febrile seizure definition

A

“A seizure associated with a febrile illness not caused by an infection of the central nervous system, without previous neonatal seizures or a previous unprovoked seizure and not meeting the criteria for other acute symptomatic seizure, which occurs in children aged 6 months to 6 years”

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14
Q

most common neurological condition in paeds

A

febrile convulsions

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15
Q

risk factors febrile convulsions

A

pathophysiology unknown
family hx - twins tudies
viral infections (URTI, LRTI nad otitis media most common)
socio economic class
seasonal prevalence
zinc and iron deficiency

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16
Q

hx febrile seizure

A

> 38 degrees
6 mths to 6yrs
tonic-clonic seizure
constitional sx suggesting infection

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17
Q

simple v complex seizures

A

simple
<15 mins
generalised tonic clonic
isolated event

complex
>15 mins
focal or focal with secondary generalisation
recurrence within 24hrs
may suffer from todd’s paresis after

18
Q

febrile status epilepticus

A

a subgroup of complex febrile seizure where the seizure duration exceeds 30 minutes, or there are multiple seizures lasting a total of 30 minutes without recovery between each one

19
Q

red flags of CNS infection

A

History of lethargy, irritability or decreased feeding
Prolonged post-ictal altered consciousness or neurological deficit (lasting >1 hour)
Any physical signs of meningitis/encephalitis e.g. bulging fontanelle, neck stiffness, photophobia, focal neurological signs (in children younger than 18 months, symptoms and signs of meningeal irritation, such as meningism and photophobia, may be absent)
Previous/current treatment with antibiotics which may have masked full clinical presentation of meningitis
Incomplete immunisation in children 6-18 months against Haemophilus influenzae B and Streptococcus pneumoniae

20
Q

prolonged febrile seizure

A

ecurrent seizure without complete resolution in between must be treated (8). A seizure longer than 5 minutes should be treated as it is unlikely to spontaneously resolve

21
Q

management febrile seizure

A

<5 mins - not require meds
>5 mins - benzo

22
Q

midazolam paeds

A

neonate - 300 micro/kg
1-2 mths - 300 micro/kg ip tp 2.5mg
3-11 mths -2.5 mg
1-4 yrs - 5mg
5-9 yrs - 7.5 mg
10-17 - 10-20 mg

23
Q

diazepam paeds

A

neonate - 1.25-2.5mg
1mth - 1yr - 5mg
2-11 yrs - 5-10mg
12-17yrs - 10-20mg

24
Q

risk factors for recurrent febrile seizures

A

Age at onset under 18 months.
Shorter duration of fever before seizure (<1 hour).
Relatively lower grade of fever associated with seizure (<40C).
Multiple seizures during the same febrile illness.
Day nursery attendance.
Family history of febrile seizure in a first degree relative.

25
Q

3 predictors for epilepsy

A

Family history of epilepsy.
Complex focal seizure.
Neurodevelopmental impairment.

26
Q

risk factors for paeds shock

A

Sepsis: Beware viral sepsis

Immunocompromised
Very young children
Anaphylaxis:

Personal or family history of allergies or atopy
Recent history of new medication (7)
Dehydration:

Young children (<6 months)
Warm weather
Concurrent illness (gastroenteritis, N+V and diarrhoea)
Use of diuretics
Cystic fibrosis
Hirschsprung’s disease

27
Q

complications secondary to ischaemia from shock

A

Central nervous system failure
Respiratory failure (from muscle fatigue or acute respiratory distress syndrome)
Acute kidney injury
Gastrointestinal ischemia
Disseminated intravascular coagulation (DIC)
Metabolic derangements
Death

28
Q

risk factors paeds sepsis

A

neonates and babies under 3mths
prematurity
hx of prolonged rupture of membranes
maternal intrapartum pyrexia
maternal colonisation with group B strep
immunocompromised children

29
Q

sepsis 6 paeds

A

Take blood cultures
Check blood lactate
Monitor urine output (with catheterisation if necessary)
Give high flow oxygen
IV/IO fluid
IV/IO antibiotics
Children are particularly prone to hypoglycaemia when unwell and this should be promptly corrected with a 2ml/kg bolus of 10% dextrose if blood sugar is <3mmol/L.

30
Q

sepsis complications

A

developmental delay
audiological issues
limb ischaemia

31
Q

choking prevalence

A

most common 1 to 4 age group mortality
peak frequency in 1-2 yrs

32
Q

ddx choking

A

acute epiglottis
croup
laryngomalacia
whooping cough

33
Q

management choking

A

do not do finger sweep
head tilt chin lift
encourage coughing
five back blows, check after each one
chest thrusts

34
Q

brief resolved unexplained event

A

: ‘An event occurring in an infant younger than 1 year when the caregiver reports a sudden, brief, and now resolved episode of ≥1 of:

Cyanosis or pallor
Absent, decreased, or irregular breathing
Marked change in tone (hyper- or hypotonia)
Altered level of responsiveness (3)’

35
Q

prevalence BRUE

A

more in boys
mean age 8 weeks

36
Q

pathophysiology BRUE

A

50% cause identified - GORD most common
others -
head injuries, URTI, arrhytmias, electrolyte disturbances, meningitis, suffocation

37
Q

risk factors BRUE

A

infants <2 mths old
infants <30 day old
prematurity

38
Q

hx BRUE

A

clear description of event
relation to feeding
previous episodes
sleep
systems enquiry
pmhx in births, immunisations, development
fhx
social history - ie non accidental injury

39
Q

examination BRUE

A

general exam - in dysmorphic features, any bruises or skin marks
resp, CVS, abdo and neurological

40
Q

investigaitons BRUE

A

ECG, pernasal swab for pertussis
CXR
blood gas
lab profile

41
Q

BRUE management

A

BLS
admission

42
Q
A

paediatrics (17 decks)

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