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Child Health > Paediatric Emergencies - Altered Consciousness, Epilepsy, Poisoning and Meningitis > Flashcards

Paediatric Emergencies - Altered Consciousness, Epilepsy, Poisoning and Meningitis Flashcards

1
Q

What can cause altered consciousness?

A

Almost anything

Head trauma
Toxins
Infection
Metabolic causes
Brain tumour
Seizure etc
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2
Q

What is important to ask about on history if a child presents with altered consciousness?

A 
Onset - Gradual or Sudden?
Previously unwell?
Feed
Trauma
PMH of seizures
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3
Q

How are children with altered consciousness managed?

A

A-E approach

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4
Q

What parts of the A-E approach are particularly important when assessing a child with altered consciousness?

A

Breathing pattern can indicate brain injury & smell breath for alcohol, toxins and ketones

C - admission bloods, clotting, lactate, culture and ABG

D - esp. pupils and glucose

E - Medical ID tag, signs of non blanching rash? Jaundice, fontanelles?

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5
Q

If the cause remains unknown after the A-E approach, what would be your next steps?

A

CT Head
EEG
Lumbar Puncture
Treat for meningitis/encephalitis if history fits

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6
Q

How would Raised Intracranial Pressure present in a child?

A 
Bulging fontanelles
Loss of Consciousness
Unequal/unreactive pupils
Headache and vomit
Abnormal resp. pattern
Hypertension and bradycardia
Muscle flaccidity
Papilloedema
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7
Q

What are the contraindications to lumbar puncture in a child?

A 
Reduced consciousness (GCS <13)
Septic shock
Likely invasive meningococcal disease
Signs of RICP
Focal neurology
Bleeding tendency
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8
Q

What is status epilepticus?

A

Any seizure lasting > 30 mins

OR

Series of seizures over a >30 min period without regain of consciousness

However for purpose of nice guidelines start treatment at 5 mins

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9
Q

What can cause status epilepticus?

A 
Epilepsy
Fever
Febrile convulsion 
Head trauma
CNS infection
Poisoning
Metabolic disturbance
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10
Q

What is done immediately when a child is in status epilepticus?

A

A-E assessment
High flow O2
Check glucose

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11
Q

What is done after 5 minutes if the status epilepticus doesn’t resolve?

A 
Buccal Midazolam 
300 mcg/kilo if <2 month
2.5mg/kg 3-11 months
5mg/kg 1-4 years
7.5mg/kg 5-9 years
10mg/kg 10-17 years

IV lorazepam
100mcg/kg <11 years old
4mg if 12-17years old

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12
Q

What would you do if status epilepticus isn’t resolving after 15 minutes even following treatment?

A

Call for senior help

IV Lorazepam 2nd dose

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13
Q

What would you do if status epilepticus hasn’t resolved after 25 minutes despite treatment?

A

Inform ITU

IV Phenytoin infusion - 20mg/kg

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14
Q

What would you do if status epilepticus hasn’t resolved after 45 minutes despite treatment?

A

Rapid sequence induction of anaesthesia

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15
Q

What investigations must be done following life supporting treatment for status epilepticus?

A 
ABG
Calcium
Magnesium
Clotting
Anti-Epileptic drug level
EEG
Imaging
Lumbar Puncture
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16
Q

When do most cases of poisoning occur?

A

Toddler accidentally ingest something they shouldn’t

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17
Q

What can be other causes of poisoning in children?

A

Adolescents - self harm

Deliberate poisoning

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18
Q

What must you establish in the history?

A

Exactly what was ingested - name, brand, concentration
When they ingested it
How much they ingested

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19
Q

What investigations should be done following a child coming in with poisoning?

A 
Urine toxicology screen
ABG
Carboxyhaemoglobin
ECG
Abdo X-Ray
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20
Q

What should the examination of a poisoned child include?

A

Inspection of oropharynx and vomitus

Assess level of consciousness

21
Q

What possible management options are there for swallowing?

A

Activated charcoal - 1g/kg within 1 hour of ingestion
Specific treatments for certain drugs and toxins
Gastric lavage
Ipecacuanha
Bowel irrigation

22
Q

What must be done if the poisoning is due to deliberate self harm?

A

Admit to hospital for psychiatric assessment

23
Q

What can Iron overdose cause and how is it treated?

A

Shock and Gut Haemorrhage

IV Desferrioxamine

24
Q

What can paracetamol overdose cause and how is it treated?

A

Liver failure

IV N-Acetylcysteine

25
Q

What do salicylate overdose cause and how is it treated?

A

Widespread cellular damage and cardiac dysrhthmias

Ethanol
Dialysis if severe
Alkalinize urine with bicarbonate
Anti-arrhythmic

26
Q

How is ecstasy overdose treated and what does it cause?

A

Hyperpyrexia and rhabdomyolysis and dysrhythmia

Active cooling
Benzodiazepines

27
Q

What group of organisms normally causes meningitis?

A

Viruses

28
Q

What do you do differently for viral meningitis than for bacterial?

A

Treat the same as you can’t differentiate between them clinically

29
Q

What are the main bacteria that cause meningitis is neonates?

A

Grou B Strep
E Coli
Listeria Monocytogenes

30
Q

What are the main bacteria that cause meningitis in infants?

A

Neiserria Meningitidis

Strep Pneumoniae

31
Q

What are the main bacteria that cause meningitis in children?

A

Neiserria Meningitidis
Strep Pneumoniae
Haemophilus Influenzae

32
Q

What is meningitis?

A

Inflammation of the leptomeninges and CSF

33
Q

In what ways can meningitis spread?

A

Direct spread - penetrate skin and skull or nasal mucosa

Haematological

34
Q

What symptoms would make you wary of meningitis?

A 
Headache
Vomiting
Stiff neck
Photophobia
Purpuric rash
Altered mental state
Kernig and Brudzinski's signs
Pain
Fever
Cold extremities and long cap refill
35
Q

What is Kernig’s sign?

A

Can’t straighten leg when hip is flexed to 90 degrees due to back pain

36
Q

What is Brudzinski’s sign?

A

Patient’s hip and knees flex when neck is flexed

37
Q

What investigations must you do if you query meningitis?

A

Bloods - CRP, FBC, Coag screen, PCR for N Meningitidis, glucose

Lumbar puncture unless contraindicated

Nasal swabs

38
Q

When should you start treatment if you query meningitis?

A

Straight away!

Don’t wait for investigations

39
Q

What signs on lumbar puncture are indicative of bacterial meningitis?

A

Raised protein, neutrophils

Low glucose

40
Q

What signs on lumbar puncture are indicative of viral meningitis?

A 
Protein raised or normal
Glucose low (but not as low as bacterial)
Raised lymphocytes
41
Q

What are the main risk factors for neonatal meningitis?

A

Premature birth
Low birth weight
Traumatic delivery

42
Q

How does neonatal meningitis present?

A

Non specific symptoms!

Raised or lower temp
Respiratory distress
Hypotension
Bradycardia
Poor feed
43
Q

What are the short term complications of meningitis?

A 
Acidosis
Low K+, Ca2+, Mg2+ and glucose
Coagulopathies
Seizures
Raised ICP
44
Q

What are the long term complications of meningitis?

A 
Hearing loss
Scars from necrosis
Limb loss
Renal failure
Psychosocial problems
45
Q

How do you manage a patient with meningitis in the short term?

A

Resus with A-E approach
IV Ceftriaxone for 7 days
Dexamethasone

IV Cefotaxime + Amox for <3 months

46
Q

What antibiotic would you use for H Influenzae B and for how long?

A

IV Ceftriaxone for 10 days

47
Q

What antibiotic would you use for S Pneumoniae and for how long?

A

IV Ceftriaxone for 14 days

48
Q

What antibiotic would you use for L Monocytogenes and for how long?

A

IV Amoxicilin for 21 days

Gentamicin for 7 days

49
Q

What antibiotic would you use for Gram -ve bacilli and for how long?

A

IV Cefotaxime for 21 days

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