Child Emergency Flashcards Preview

MC > Child Emergency > Flashcards

Flashcards in Child Emergency Deck (87):
1

Signs of serious illness

________ 58%
_____49%
__________41%
______42%
_____________ 42%

Drowsiness

Pallor

Chest wall retraction

Temperature >38.9°C or
<36.4°C

Lump >2 cm

2

ABCDEGF of Child emergency

• A irway
• B reathing
• C irculation
• D isability (neurological assessment)
• E xposure
• F luids: in and out
• G lucose

3

Two main groups of signs are good indicators of
serious illness

Group 1: common features with reasonable risk and indicator of toxicity

Group 2: uncommon features with high
risk requiring urgent referral

4

Group 1: common features with
reasonable risk and indicator of toxicity

A = poor Arousal, Alertness and Activity
B = Breathing difficulty
C = poor Circulation (persistent pallor, cold legs
to knees)
D = Decreased fluid intake and/or urine output

5

Group 2: uncommon features with high
risk requiring urgent referral

• Respiratory: ____
• GIT: ____
• CNS: convulsions
• Skin: petechial rash

apnoea, central cyanosis, respiratory grunt

persistent bile-stained vomiting, mass
>2 cm other than hydrocele or umbilical hernia,
significant faecal blood

6

Inspiratory noises with obstruction
— ______—partial obstruction with
fluid
— snoring—decreased level of consciousness
— _____—partial obstruction to larynx or
trachea

bubbly noises





stridor

7

Secondary signs of worsening obstruction

• Increased respiratory rate or effort
• Decreased oxygen saturation
• Increasing tachycardia
• Deterioration of colour
• Development of agitation or decreased level of
consciousness

8

Investigations for sick child

Culture and sensitivity
_______________
Full blood examination __________

All with fever



All <4 weeks
Risk factors present
Doctor uncertain

9

Investigations for sick child

Those on antibiotics
Doctor uncertain

C-reactive protein

10

Indications for CSF examin

Suspected meningitis (infant
drowsy, pale and febrile)
Convulsion in febrile child and:
• source of fever unknown
• receding drowsiness and
pallor
• infant <6 months, child
>5 years
• prolonged convulsion
(>10 minutes)
• postictal phase longer than
usual (>30 minutes)

11

________
is the usual rhythm at the time of arrest.

Asystole or severe bradycardia

12

How is BLS done outside the hospital

Basic life support outside the hospital
setting is 30: 2 compression ventilation
ratio, including two initial rescue breaths.
The ratio of 30:2 is recommended for all
ages regardless of the number of revivers
present

13

How to ventilate properly

Ventilate lungs at about 20 inflations/min with
bag-valve-mask or mouth to mask or mouth to
mouth. An Air-viva using 8–10 L/min of oxygen
is ideal if available

14

If intubation not possible, use a needle
_______ as an emergency

cricothyroidotomy

15

How to do compressions in children

Use two fingers or thumbs for infants <1 year
and heel of one hand for children 1–8 years.
If >8 years use a two-handed technique

16

Differences in children’s airways for intubation:

• epiglottis_______
• larynx _____ → difficult to intubate
‘blind’
•_______ → cuffed tube
not required
• shorter trachea → increased risk intubating
_________
• narrow airway → increased airway
resistance

longer and stiffer, more horizontal

more anterior

cricoid ring is narrowest position

right main bronchus

17

Rule for endotracheal tube (ETT) size
(internal diameter in mm

• ETT (mm) = (age in years ÷ 4) + 4
or the size of the child’s little finger or nares

• ETT length (cm) oral = (age in years ÷ 2) + 12;
nasal—add 3 cm

18

Drugs that can be administered through the ETT
can be considered under the mnemonic NASALS:

N = Naloxone
A = Atropine
S = Salbutamol
A = Adrenaline
L = Lignocaine
S = Surfactant

19

Give a single shock instead of stacked shocks
(single shock strategy) for _____

ventricular
fibrillation/pulseless ventricular tachycardia

20

Where the arrest is witnessed by a health care
professional and a manual defibrillator is available,
________ the first defibrillation attempt

then up to three shocks may be given (stacked
shock strategy) at

21

Monophasic or biphasic defibrillation:_______

first
shock—2 J/kg, subsequent shocks—4 J/kg.

22

Children
_____ old are most prone to accidental poisoning

1–2 years

23

The most common cause of death in comatose
patients is _______

respiratory failure

24

The common dangerous poisons in the past were
____ and _____

kerosene and aspirin

25

In a UK study the main cause of deaths from
poisoning were (in order) tricyclics, salicylates,
opioids including _______

Lomotil, barbiturates, digoxin,
orphenadrine, quinine, potassium and iron

26

In poisoning

The modern trend is away from_______

emesis,
which includes not using syrup of ipecacuanha

27

What to give within an hour of poisoning

gastric lavage: within 1 hour but also has a
limited place in management

28

How to give activated charcoal

multiple dose charcoal, 5–10 g every 4 hours
or 0.25 g/kg per hour for 12 hours, is effective

29

When not to give activated charcoal

never administer activated charcoal in
children with an altered conscious state
without airway protection (use only where
benefits outweigh the risks of aspiration) 7

30

Contraindications for activated charcoal

• stuporous or comatose
• absent gag reflex (unless endotracheal tube in situ)
• ingestion of corrosives: acids, alkali
• ingestion of hydrocarbons or petrochemicals

31

Drugs not absorbed by active charcoal

Acids
Alcohols (e.g. ethanol)
Alkalis (caustics)
Boric acid
Bromides
Cyanide
Iodines
Iron
Lithium
Other heavy metals

32

It is usually limited to iron and lead,
and slow-release drug preparations that don’t bind to
charcoal.

Whole bowel irrigation

33

What is the antidote?

Amphetamines (cause hypertension

Glyceryl trinitrate IV Sodium nitroprusside

34

What is the antidote?

Benzodiazepines

Flumazenil
Sodium bicarbonate

35

What is the antidote?

Beta blockers

Glucagon
Isoprenaline

36

What is the antidote?

Calcium blocker

Calcium chloride IV or
Calcium gluconate IV

37

What is the antidote?

Carbon monoxide

Oxygen 100%
Hyperbaric oxygen

38

What is the antidote?

Cyanide

Hydroxocobalamin
Dicobalt edetate
Sodium nitrite IV
Sodium thiosulphate IV

39

What is the antidote?

Digoxin

Digoxin-specific
antibodies
Magnesium sulphate

40

What is the antidote?

Heavy metals (e.g. Pb, As,
Hg, Fe)

Chelating agents, e.g.
dimercaprol

41

What is the antidote?

Heparin

Protamine IV

42

What is the antidote?

Methanol, ethylene glycol

Ethanol (ethyl alcohol)

43

What is the antidote?

Organophosphates

Atropine
Pralidoxime (2-PAM)

44

What is the antidote?

Paracetamol
(acetaminophen)

Acetylcysteine (IV) (effective
within 12 hours) consider
up to 36 hours

45

What is the antidote?

Phenothiazines

Benztropine

46

What is the antidote?

Potassium

Calcium gluconate
Sodium bicarbonate
Salbutamol aerosol

47

What is the antidote?

Tricyclic antidepressants

Sodium bicarbonate IV

48

What is the antidote?

Warfarin

Fresh frozen plasma
Vitamin

49

The natural passage of most objects entering the
stomach can be expected. Once the _______ is
traversed the FB usually continues

pylorus

50

If a blunt FB has been stationary for 1 month
without symptoms, remove at ________

laparotomy

51

If not in stomach these (especially lithium batteries)
create an emergency if in the oesophagus because
__________

electrical current generated destroys mucous
membranes and perforates within 6 hours (must be
removed endoscopically ASAP).

52

Febrile Sz

• The commonest cause is an_______
• Commonest age range _____
• Epilepsy develops in about_______of such children

URTI

9–20 months

2–3%

53

Abx for bact men in children

• ceftriaxone 100 mg/kg up to 4 g, IV statim then
daily for 3–5 days
or
cefotaxime 50 mg/kg up to 2 g, IV statim then 6
hourly for 3–5 days

54

Abx for bact men in neonates

• ampicillin (or benzylpenicillin) + cefotaxime

55

Abx for meningococcemia

benzylpenicillin 60 mg/kg IV (max. 1.8 g), 4 hourly
for 3–5 days. Give IM if IV access not possible
or
ceftriaxone 100 mg/kg IV or IM (max. 4 g) statim
then daily for 5 days

56

Whom to give prophylaxis in pts with meningo

• live in the household and <24 months
• have kissed patient in the previous 10 days
• have attended the same day care centre

57

How to give meningo prophylaxias

prophylaxis—rifampicin dose:
adult — 600 mg bd for 3 days
child <1 month—5 mg/kg
child >1 month—10 mg/kg
give bd for 2 day

58

A toxic febrile
illness, with sudden onset of expiratory stridor,
should alert one to this potentially fatal condition

Acute epiglottitis

59

________ is characterised by fever, a soft voice,
lack of a harsh cough, a preference to sit quietly
(rather than lie down) and especially by a soft stridor
with a sonorous expiratory component

Epiglottitis

60

________ is distinguished by a harsh inspiratory
stridor, a hoarse voice and brassy cough.

Croup

61

Children with _______usually sit still with their
mouth open, drooling saliva, and their eyes follow
you around the room because limited head movement
protects the compromised airway.

epiglottitis

62

______________ confirms the
diagnosis of epiglotitis

A swollen, cherry-red epiglottis recognised
on examination of the nasopharynx

63

Abx for epiglotitis

cefotaxime 25 mg/kg up to 1 g IV for 5 days
8 hourly
or
ceftriaxone 25 mg/kg to max. 1 g/day IV daily for
5 days

64

______ refers to a symptom complex with a harsh,
brassy cough, usually with an inspiratory stridor and
with or without respiratory difficulty

Croup

65

Cause of Croup

caused by parainfluenzal and other viruses
e.g. RSV

66

What grade of croup?

(barking cough, no stridor or stridor at
rest without chest retraction, hoarse voice):

Grade 1 croup

67

Tx of Gr 1 croup

consider oral steroids (e.g. dexamethasone
0.15–0.3 mg/kg/dose or prednisolone 1 mg/kg/
dose) if stridor and chest wall retraction develop

68

What grade of croup?

(inspiratory stridor when upset or at
rest with chest wall retractions):

Grade 2 croup

69

Grade 2 croup Tx

• oral steroids
dexamethasone 0.6 mg/kg
or
prednisolone (tablets or oral solution)1 mg/kg
(2–3 doses) and/or (for children 2 or more years)
budesonide 100 mcg × 20 puffs or 2 mg nebulised
• nebulised adrenaline

70

What is Gr 3 croup

Severe croup (inspiratory stridor at rest, use of
accessory muscles, patient restless and agitated).

71

What is the first line of tx for gr3 croup

Adrenaline is first-line therapy:

72

• An acute viral illness usually due to RSV
• The commonest acute LRTI in infants
• Usual age 2 weeks to 9 months

Bronchiolitis

73

PE of Bronchiolitis

Hyperinflated chest: barrel-shaped, usually
subcostal recession

74

CXR of bronchiolitis

Hyperinflation of lungs with depression of
diaphragm—but chest X-ray should not be used for
diagnosis or routinely performed

75

Causes of acute heart failure in children

• congenital (e.g. VSD)
• cardiomyopathy
• tachyarrhythmias
• postprocedural myocardial dysfunction

76

_______ is necessary in almost every child
where there is a strong suggestion of an inhaled FB.
It is difficult and requires an expert with appropriate
facilities

Bronchoscopy

77

How to give NE in anaphylaxis

(repeat adrenaline every 5 minutes as necessary)
if no improvement set up a continuous infusion
(1 mg adrenaline in 1000 mL N saline)

78

Mx of drowning
• decompress stomach with nasogastric tube
• support circulation with _____
• _______
• correct electrolyte disturbances (e.g. hypokalaemia

IV infusion of colloid solution and dopamine 5–20 mc g/kg per minute

mannitol 0.25–0.5 g/kg IV if cerebral oedema

79

Intraosseous infusion is
preferred to an intravenous cutdown in children
under_____

5 years

80

Site of Intraosseous infusion

• Adults and children over 5: _______
• Children under 5: ______

distal end of tibia

proximal end of tibia

81

Characteristic
features include sudden-onset pallor which persists,
episodic crying and vomiting. Rectal bleeding and an
abdominal mass

Intussusception

82

_________, which appears from 2 weeks
to 3 months of age, should be suspected with
projectile vomiting, acute weight loss and alkalosis

Pyloric stenosis

83

Bile-stained vomitus indicates urgent referral to
consider possible ___________ and ______

intestinal malrotation and mid-gut
volvulus

84

Failure to pass meconium beyond 24 hours: may
represent _______

congenital intestinal atresia and stenosis,
meconium ileus or Hirschsprung disease

85

risk factor for SIDs

Risk factors
• Prone sleeping position
• Smothered airways (debatable)
• Artificial feeding (possible)
• Passive smoking (before or after birth)
• Hyperthermia or excess warmth
• Extreme prematurity <32 weeks
• Parental narcotic/cocaine abuse
• Intercurrent viral infections

86

_______or ‘near-miss SIDS’, is defined as a ‘frightening’
encounter of apnoea, colour change or choking. At
least 10% will have another episode

Apparent life-threatening episod

87

Guidelines for home apnoea monitoring

• ALTE
• Subsequent siblings of SIDS victims
• Twin of SIDS victim
• Extremely premature infants