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MC > Child Emergency > Flashcards

Child Emergency Flashcards

1
Q

Signs of serious illness

\_\_\_\_\_\_\_\_ 58%
\_\_\_\_\_49%
\_\_\_\_\_\_\_\_\_\_41%
\_\_\_\_\_\_42%
\_\_\_\_\_\_\_\_\_\_\_\_\_ 42%
A

Drowsiness

Pallor

Chest wall retraction

Temperature >38.9°C or
<36.4°C

Lump >2 cm

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2
Q

ABCDEGF of Child emergency

A
  • A irway
  • B reathing
  • C irculation
  • D isability (neurological assessment)
  • E xposure
  • F luids: in and out
  • G lucose
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3
Q

Two main groups of signs are good indicators of

serious illness

A

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

Group 2: uncommon features with high
risk requiring urgent referral

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4
Q

Group 1: common features with

reasonable risk and indicator of toxicity

A

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

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5
Q

Group 2: uncommon features with high
risk requiring urgent referral

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

apnoea, central cyanosis, respiratory grunt

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

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6
Q 
Inspiratory noises with obstruction
— \_\_\_\_\_\_—partial obstruction with
fluid
— snoring—decreased level of consciousness
— \_\_\_\_\_—partial obstruction to larynx or
trachea
A

bubbly noises

stridor

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7
Q

Secondary signs of worsening obstruction

A 
• Increased respiratory rate or effort
• Decreased oxygen saturation
• Increasing tachycardia
• Deterioration of colour
• Development of agitation or decreased level of
consciousness
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8
Q

Investigations for sick child

Culture and sensitivity
_______________
Full blood examination __________

A

All with fever

All <4 weeks
Risk factors present
Doctor uncertain

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9
Q

Investigations for sick child

Those on antibiotics
Doctor uncertain

A

C-reactive protein

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10
Q

Indications for CSF examin

A 
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)
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11
Q

________

is the usual rhythm at the time of arrest.

A

Asystole or severe bradycardia

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12
Q

How is BLS done outside the hospital

A

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

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13
Q

How to ventilate properly

A

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

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14
Q

If intubation not possible, use a needle

_______ as an emergency

A

cricothyroidotomy

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15
Q

How to do compressions in children

A

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

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16
Q

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
A

longer and stiffer, more horizontal

more anterior

cricoid ring is narrowest position

right main bronchus

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17
Q

Rule for endotracheal tube (ETT) size

(internal diameter in mm

A

• 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

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18
Q

Drugs that can be administered through the ETT

can be considered under the mnemonic NASALS:

A 
N = Naloxone
A = Atropine
S = Salbutamol
A = Adrenaline
L = Lignocaine
S = Surfactant
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19
Q

Give a single shock instead of stacked shocks

(single shock strategy) for _____

A

ventricular

fibrillation/pulseless ventricular tachycardia

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20
Q

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

A

then up to three shocks may be given (stacked

shock strategy) at

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21
Q

Monophasic or biphasic defibrillation:_______

A

first

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

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22
Q

Children

_____ old are most prone to accidental poisoning

A

1–2 years

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23
Q

The most common cause of death in comatose

patients is _______

A

respiratory failure

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24
Q

The common dangerous poisons in the past were

____ and _____

A

kerosene and aspirin

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25
Q

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

A

Lomotil, barbiturates, digoxin,

orphenadrine, quinine, potassium and iron

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26
Q

In poisoning

The modern trend is away from_______

A

emesis,

which includes not using syrup of ipecacuanha

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27
Q

What to give within an hour of poisoning

A

gastric lavage: within 1 hour but also has a

limited place in management

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28
Q

How to give activated charcoal

A

multiple dose charcoal, 5–10 g every 4 hours

or 0.25 g/kg per hour for 12 hours, is effective

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29
Q

When not to give activated charcoal

A

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

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30
Q

Contraindications for activated charcoal

A
  • stuporous or comatose
  • absent gag reflex (unless endotracheal tube in situ)
  • ingestion of corrosives: acids, alkali
  • ingestion of hydrocarbons or petrochemicals
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31
Q

Drugs not absorbed by active charcoal

A 
Acids
Alcohols (e.g. ethanol)
Alkalis (caustics)
Boric acid
Bromides
Cyanide
Iodines
Iron
Lithium
Other heavy metals
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32
Q

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

A

Whole bowel irrigation

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33
Q

What is the antidote?

Amphetamines (cause hypertension

A

Glyceryl trinitrate IV Sodium nitroprusside

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34
Q

What is the antidote?

Benzodiazepines

A

Flumazenil

Sodium bicarbonate

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35
Q

What is the antidote?

Beta blockers

A

Glucagon

Isoprenaline

36
Q

What is the antidote?

Calcium blocker

A

Calcium chloride IV or

Calcium gluconate IV

37
Q

What is the antidote?

Carbon monoxide

A

Oxygen 100%

Hyperbaric oxygen

38
Q

What is the antidote?

Cyanide

A

Hydroxocobalamin
Dicobalt edetate
Sodium nitrite IV
Sodium thiosulphate IV

39
Q

What is the antidote?

Digoxin

A

Digoxin-specific
antibodies
Magnesium sulphate

40
Q

What is the antidote?

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

Chelating agents, e.g.

dimercaprol

41
Q

What is the antidote?

Heparin

A

Protamine IV

42
Q

What is the antidote?

Methanol, ethylene glycol

A

Ethanol (ethyl alcohol)

43
Q

What is the antidote?

Organophosphates

A 
Atropine
Pralidoxime (2-PAM)
44
Q

What is the antidote?

Paracetamol
acetaminophen

A

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

45
Q

What is the antidote?

Phenothiazines

A

Benztropine

46
Q

What is the antidote?

Potassium

A

Calcium gluconate
Sodium bicarbonate
Salbutamol aerosol

47
Q

What is the antidote?

Tricyclic antidepressants

A

Sodium bicarbonate IV

48
Q

What is the antidote?

Warfarin

A

Fresh frozen plasma

Vitamin

49
Q

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

A

pylorus

50
Q

If a blunt FB has been stationary for 1 month

without symptoms, remove at ________

A

laparotomy

51
Q

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

A

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

52
Q

Febrile Sz

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

URTI

9–20 months

2–3%

53
Q

Abx for bact men in children

A

• 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
Q

Abx for bact men in neonates

A

• ampicillin (or benzylpenicillin) + cefotaxime

55
Q

Abx for meningococcemia

A

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
Q

Whom to give prophylaxis in pts with meningo

A
  • live in the household and <24 months
  • have kissed patient in the previous 10 days
  • have attended the same day care centre
57
Q

How to give meningo prophylaxias

A 
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
Q

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

A

Acute epiglottitis

59
Q

________ 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

A

Epiglottitis

60
Q

________ is distinguished by a harsh inspiratory

stridor, a hoarse voice and brassy cough.

A

Croup

61
Q

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.

A

epiglottitis

62
Q

______________ confirms the

diagnosis of epiglotitis

A

A swollen, cherry-red epiglottis recognised

on examination of the nasopharynx

63
Q

Abx for epiglotitis

A

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
Q

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

A

Croup

65
Q

Cause of Croup

A

caused by parainfluenzal and other viruses

e.g. RSV

66
Q

What grade of croup?

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

A

Grade 1 croup

67
Q

Tx of Gr 1 croup

A

consider oral steroids (e.g. dexamethasone

  1. 15–0.3 mg/kg/dose or prednisolone 1 mg/kg/
    dose) if stridor and chest wall retraction develop
68
Q

What grade of croup?

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

A

Grade 2 croup

69
Q

Grade 2 croup Tx

A

• 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
Q

What is Gr 3 croup

A 
Severe croup (inspiratory stridor at rest, use of
accessory muscles, patient restless and agitated).
71
Q

What is the first line of tx for gr3 croup

A

Adrenaline is first-line therapy:

72
Q
  • An acute viral illness usually due to RSV
  • The commonest acute LRTI in infants
  • Usual age 2 weeks to 9 months
A

Bronchiolitis

73
Q

PE of Bronchiolitis

A

Hyperinflated chest: barrel-shaped, usually

subcostal recession

74
Q

CXR of bronchiolitis

A

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

75
Q

Causes of acute heart failure in children

A
  • congenital (e.g. VSD)
  • cardiomyopathy
  • tachyarrhythmias
  • postprocedural myocardial dysfunction
76
Q

_______ 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

A

Bronchoscopy

77
Q

How to give NE in anaphylaxis

A

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

78
Q

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

A

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
Q

Intraosseous infusion is
preferred to an intravenous cutdown in children
under_____

A

5 years

80
Q

Site of Intraosseous infusion

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

distal end of tibia

proximal end of tibia

81
Q

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

A

Intussusception

82
Q

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

A

Pyloric stenosis

83
Q

Bile-stained vomitus indicates urgent referral to

consider possible ___________ and ______

A

intestinal malrotation and mid-gut

volvulus

84
Q

Failure to pass meconium beyond 24 hours: may

represent _______

A

congenital intestinal atresia and stenosis,

meconium ileus or Hirschsprung disease

85
Q

risk factor for SIDs

A 
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
Q

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

A

Apparent life-threatening episod

87
Q

Guidelines for home apnoea monitoring

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

MC (90 decks)

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