Ch 6 Paediatric emergencies

Question 1

Assessement of seriously ill child (ABC)

Answer 1

A - airways; check if patent, use manoeuvres - head tilt, jaw thrust, use adjuncts e.g. LMA
B - breathing; listen to lungs, give 100% high flow oxygen
C - circulation; check peripheral & central cyanosis, cap refil, pulses, BP. Insert 2 large bore cannulae, take blood and start on 0.9% saline 20ml/kg up to 60 ml/kg > inotropes if non-responsive

Question 2

3 categories of shock

Answer 2

Hypovolaemic - dehydration, DKA, blood loss, gastroenteritis
Cardiogenic - arrythmias, HF
Fluid redistribution - septicaemia, anaphylaxis

Question 3

Early features of shock (4)

Answer 3

these are compensatory mechs: tachypnoea, tachycardia, cool peripheries, sunken eyes/fontanelle, reduced skin turgor, oliguria

Question 4

Late features of shock (4)

Answer 4

Decompensated - Kussmaul breathing (acidotic), bradycardia, hypotension, confusion, anuria

Question 5

Shock management (2)

Answer 5

IV saline (0.9%), blood if trauma

Question 6

Definition & features (6) of septicaemia

Answer 6

D - bacterial infection in blood (most common meningoccoccal)
F - fever, infection history, lethargy, poor feeding, tachycardia, tachypnoea, hypotension, purpuric rash, shock

Question 7

Ix (3) & management (3) of septicaemia

Answer 7

Ix - U&E, FBC, CRP, blood gas, blood cultures

Management - ABs, fluids, inotropic support, FFP for bleeding due to DIC

Question 8

Coma assessment - AVPU

Answer 8

A - alert
V - responds to voice
P - responds to pain
U - unresponsive
(GCS

Question 9

Management of raised ICP (4)

Answer 9

treat with head positioned midline
Tilt head end of bed by 30 degrees
Fluids (isotonic) + osmotic diuretics e.g. mannitol
maintain normothermia & normal BP
intubate/ventilate if GCS

Question 10

Define status epilepticus

Answer 10

Seizures lasting > 30 min

Or seizures occuring so frequently that dont retain consciousness between them

Question 11

Management of status epilepticus (6)

Answer 11

1st resusc, then try to stop seizure asap:
ABC
check blood glucose if Lorazepam (0.1mg/kg)
10 min later if no response > IV phenytoin (20mg/kg over 20 min) +/- PR paraldehyde (0.4ml/kg)
If no response in 20 min transfer to PICU + induction with thiopental + mechanical ventilation

Question 12

Anaphylaxis mangement (6)

Answer 12

(mostly due to food allergies)
ABCDE
IM/IV adrenaline (if 12 give 500)
IM/IV hydrocortisone + chlorphenamine + high flow O2 + IV crystalloids (20ml/kg)

Question 13

SIDS defintion

Answer 13

suddent & unexpected death in infant for which no adequate cause is found after thorough post-mortem examination, most commonly occuring 2-4 months of age

Question 14

SIDS RFs in terms of: infant (3), parental (5), environmental (2)

Answer 14

Infant - low BW, male, age 1-6 months
parental - low income, high parity, single young mother, smoker mother, overcrowded house
environmental - sleeping prone, overheating, bottle feeding

Question 15

SIDS prevention (3)

Answer 15

infants sleep on back
dont smoke during pregnancy
avoid overheating