Anaphylaxis / emergency Flashcards by Eilidh Seaton

What type of reaction is anaphylaxis

Type 1 IgE

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What is acute symptoms

Facial swelling
Tight throat
Breathing issue
Urticaria
Oedema
Itch 
Wheeze
Stridor
Laryngeal obstruction
Collapse

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How do you monitor

Pulse
Sats
ECG
BP

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What can tell if had allergic reaction

Serum tryptase

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How do you assess

A - swelling / stridor
B - RR / wheeze / fatigue / cyanosis / sats
C - pale / clammy /low BP / low HR / coma

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How do you treat

Remove allergen + raise legs 
ABCDE
IM adrenaline 
High flow O2 trauma mask
IV acesss
Fluid
IV Hydrocortisone
IV Chlorophenamine

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When do you intubate

If obstruction

Call anaesthetist early

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How much adrenaline and how often and what dose for children

1 in 1000
Every 5 minutes
Can still detioriate after so keep giving

<6 = 0.15ml
6-12 = 0.3ml
>12 = 0.5ml

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How much fluid

20ml / kg 0.9% saline bolus

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How much hydrocortisone

200mg >12
100mg >6-12
50 mg >6 months-6
25mg <6 months

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How much chlorophenaimine

10mg >12
5mg 6months-12
2.5mg <6months

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When do you discharge

Diet review
Avoid nuts if unclear trigger
Skin prick test
Epipen 
Train how to use
Anti-histamine
Emergency plan
Allergic clinic referral

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What is most common cause of arrest

Respiratory

Hypoxia due to choking

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What do you do

Airway
Breathing
5 rescue breaths
Check pulse
CPR 15:2

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What is agonanl breathing

Occurs first few minutes of cardiac arrest

Brain stem reflex

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What is most common cause of death

SIDS

What are major RF

Prone sleeping
Smoke during pregnancy 
Premature / LBW
Bed sharing
Hyperthermia

What are minor RF

Male
Social class
Drugs

What is protective

Breast
Room sharing
Dummies
Keep babies lying on back
Don't cover head 
Avoid smoking / co-sleeping

What do you screen for siblings for

Sepsis

Errors of metabolism

What causes non-blanching rash

Bleeding under skin

What is petechiae

<3mm non blanching spot caused by burst capillary

What is purpura

> 3mm non blaching rash due to bleeding from vessel

What is differential

Meningococcal septicaemia= main
HSP
ITP
Acute leukaemia
HUS
Trauma / NAI 
VIral illness
- Most likely cause even if non-blanching 
- Esp if child well

How do you investigate

``` Refer and admit for observation +- bloods FBC - Will detect cytopenia - ITP / leukaemia U+E - If think HSP or HUS - HSP more purpura on buttock - HUS if recent diarrhoea CRP / ESR - If think sepsis Coag screen - DIC from sepsis ``` ``` Blood culture Meningococcal PCR LP BP Urine dip ```

How do you manage

Any child with non-blanching rash needs urgent referral

Child vitals

OK | See surgery

Assessment

ABCDE

If unwell baby coming in, <3 months, with resp distress and off vitals what are your DDX

``` Sepsis = top of list Bronchiolitis / pneumonia Duct dependent cardiac Metabolic NAI - head Congenital ```

What happens

``` SENIOR HELP ABCDE - Oxygen, airway or breathing - May get RSI + intubate - IV or IO - Take bloods and gas - Fluid volus - Inotrope - Ax - CXR / USS / CT ```

What is rare but think

Cardiology | - Prostaglandin infusion will keep the duct open

Child fallen onto abdo, bruised and very unwell what is Dx

Ruptured spleen until proven otherwise as big blood supply and less protection Could be anything

What are red flags in children to refer

``` Parental concern Co-morbid Cold hand / feet Decreased urine No fluid intake No source of fever Cold / clammy / patchy Non-blanching rash Lethargic ```