Acute presentations teaching

Question 1

Severity asthma exacerbation in children - mild/moderate, severe and LF

Answer 1

Question 2

What happens in complete airway obstruction to chest pattern?

Answer 2

See saw chest - up one end and down the other as air cannot escape, just moving up and down in chest
Or no chest movement

Question 3

What is grunting?

Answer 3

Patients own way of trying to maintain positive end expiratory pressure

Question 4

CPAP vs BiPAP

Answer 4

• CPAP provides PEEP
• BiPaP - provides PEEP and PIP

Question 5

O2 support options

Answer 5

• Non-rebreathe mask
• NIV - eg CPAP, BiPAP
• Vapotherm - high flow humidified O2
• Intubation - normal ventilation vs hgh frequency ventilation

Question 6

Croup typical age and cause

Answer 6

• Aged 6 months - 3 years
• Parainfluenza virus

Question 7

Differentiating croup vs epiglottitis

Answer 7

• Croup - distinct cough
• Epiglottitis - unwell, septic looking

Question 8

Severity of croup

Answer 8

Mild:
* Ocassional cough
* No stridor at rest
* No/mild recessions
* Child happy

Moderate:
* Frequent cough
* Stridor at rest
* Suprasternal and sternal wall recession at rest
* Child interested in surroundings

Severe:
* Frequent cough
* Prominent inspiratory and occ exp stridor at rest
* Marked sternal recessions
* Distress, lethargy, agitated
* Tachycardia

Question 9

Management of mild, moderate or severe croup

Answer 9

• Mild - oral dex, discharge if low score, or observe
• Moderate - oral dex, consider budesonide if struggling to swallow, O2 if sats under 92%
• Severe - oral dex, neb adrenaline, call for help

Question 10

When to give nebs salbutamol vs 2-10 puffs via spacer?

Answer 10

If need O2- can drive via nebs, if not just use spacer

Question 11

Management mild, severe vs life threatening asthma

Answer 11

• Mild - 10 puffs beta agonist via spacer, oral steroids
• Severe - nebulised salbutamol, ipratropium, orla steroids, consider IV Mg and aminophylline, consider referral PICU
• Same as above - steroids, nebs salbutamol, give IV Mg bolus, consdier IV salbutamol bolus, consider IV aminophylline

Question 12

When to give NAC for paracetamol overdose?

Answer 12

• the plasma paracetamol concentration is on or above a single treatment line on graph
• there is a staggered overdose
• patients who present 8-24 hours after ingestion of an acute overdose of more than 150 mg/kg of paracetamol
• patients who present > 24 hours if they are clearly jaundiced or have hepatic tenderness, their ALT is above the upper limit of normal
• acetylcysteine should be continued if the paracetamol concentration or ALT remains elevated whilst seeking specialist advice

staggered if taken over more than 1hr

Question 13

Sources for information for poisoning

Answer 13

ToxBase