Flashcards in Emergencies || Deck (49):
What is a Apparent Life Threatening Event (ALTE)?
A sudden, brief and frightening change in condition in a previously well child. They then appear well immediately after
What are the common causes/presentations of ALTE (4)?
2. Absent, decreased or irregular breathing
3. Increase/decrease in tone
4. Altered level of responsiveness
No concerning features on history/exam
What is the immediate management of ALTE (2)?
2. monitor vital signs
What are the investigations done for ALTE (3)?
2. Perinasal swab for pertussis
3. Brief monitoring with continuous pulse oximetry
What is the peak age range for sudden infant death syndrome (SIDS)?
What are the risk factors for SID?
1. the infant (4)
2. the parents (5)
3. the environment (5)
1. the infant
-age 1-6 months
-appeared ill in the last 24 h
2. the parents
-smoking, alcohol, drug consumption
-high maternal parity
3. the environment
-infant sleeping prone
-infant pillow use
What is the main risk factor for SIDS?
Lying the baby to sleep in prone position
What advice would you give to parents to prevent SIDS (7)?
1. infants should sleep on back
2. avoid overheating with heavy wrapping/high room temp
3. no smoking near infant
4. parents should get help quickly if infant becomes unwell
5. parents should have baby in their room in first 6 months of life
6. avoid bringing baby to bed when tired/have had alcohol etc
7. avoid sleeping with infant on sofa/armchair
What is the common procedure done after the unexplained death of a child?
What is the pathphysiology of anaphylaxis?
IgE bind the antigen, activating mast cells and basophils which leads to the release of inflammatory mediators such as histamine.These mediators subsequently increase the contraction of bronchial smooth muscles, trigger vasodilation, increase the leakage of fluid from blood vessels, and cause heart muscle depression
What are the common agents that cause anaphylaxis in children (4)?
What is a risk factor for it?
1. 85% are food allergy i.e. nuts
2. insect stings
4. inhalant allergens
risk factor: asthma
What are the common presenting features of anaphylaxis (2)?
It is sudden onset, rapidly progressing with:
1. life-threatening airway and/or breathing and/or circulation problem
2. skin and/or mucosal signs of urticarial or angioedema
What is the emergency treatment of anaphylaxis (4)?
2. call for help, BLS if necessary
3. Adrenaline im 1:1000
4. Additional treatment:
-salbutamol if wheeze
What is the medium/long term treatment of anaphylaxis (2)?
1. detailed strategies and training for allergen avoidance
2. a written management plan with instructions for the treatment of allergic reactions and provision of an adrenaline auto-injector
What patient-held medication for immediate out of hospital treatment for anaphylactic reactions should be used?
How is anaphylaxis diagnosed?
What are the common investigations for anaphylaxis (2)?
On the basis of a person's signs and symptoms
1. Skin allergy testing
2. Blood test for specific IgE
What are the risk factors for burns/scalds (2)?
1. Young child - natural inquistiveness and lack of sense of danger
2. Teenager - risk-taking behaviour
What are the signs you should look out for in identifying evidence of airway burns (6)?
1. Soot in nasal and oral cavities
2. Cough, hoarseness or stridor
3. Coughing up black sputum
4. Breathing and/or swallowing difficulty
5. Blistering in or around mouth
6. Scorched eyebrows or hair
What is the first aid of burns/scalds out of hospital (4)?
1. Cool the area with running water for up to 20 mins but avoid hypothermia
2. Chemical burns should be copiously irrigated
3. Cling film wraps can be used after cooling
4. Pain relief
What is the immediate assessment/management of burns/scalds in ED (7)?
1. Airway and breathing - check for evidence of airway burns
2. Early intubation
3. Circulation - usually due to other areas of fluid loss, not the burn itself = give iv fluids
4. Wound care
5. Estimate burn surface area
6. Pain relief
7. Psychological support
Outline the different depths of burns (5)
1. Superficial with erythema only
2. Small superficial partial thickness burns
3. Deep partial thickness burns
4. Full thickness burns
5. Burns to face, ears, eyes, hands, feet, genitalia, perineum and major joint
Outline the treatment of the different depths of burns (5)
1. Superficial - Simple exposure
2. Small superficial partial thickness - cleaned and dressed, heal spontaneously
3. Deep partial thickness burns - reviewed by specialist burns service
4. Full thickness burns - debridement and skin grafting
5. Burns to face, ears, eyes etc - referral to specialist burns service
What must you always check for with a burns injury?
Possibility of inflicted injury
Why is early intubation important with the possibility of airway burns?
There may be evolving airway swelling and intubation may be impossible with progressive obstruction of the airway
What age group is accidental poisoning common in?
What is the peak age of accidental poisoning? Where does it usually occur?
In the home
What are the different types of poisoning (4)?
2. Due to deliberate self-harm or experimentation with recreation substances - teenagers
What are the early (2) and later (1) symptoms of paracetemol overdose?
Early: Abdominal pain, vomiting
Later (12h - 24h): Liver failure
What are the early (2) and later (2)symptoms of NSAID overdose?
Early: Vomiting, tinnitus
Later: respiratory alkalosis followed by metabolic acidosis
What are the early (5) and later (6) symptoms of iron overdose?
Early: Vomiting, diarrhoea, haematemesis, melaena, acute gastric ulceration
Latent period of improvement
6-12h later: Drowsiness, coma, shock, liver failure with hypoglycaemia and convulsions
What are the symptoms of alcohol overdose (3)?
What are the symptoms and signs of methadone overdose (5)?
1. Nausea and vomiting
3. Low bp
5. cold, clammy skin
What are the symptoms of detergent overdose (5)?
1. Loss of vision
2. Burning in throat,eyes and mouth etc
3. Abdominal pain
5. Breathing difficulty
What is the immediate management of paracetamol OD (2)?
1. Measure plasma paracetemol conc
2. iv acetylcysteine if conc is high or liver function abnormal
What is the immediate management of salicylate OD (3)?
1. Measure plasma salicylate conc 2-4h after ingestion
2. Alkalinization of urine to increase excretion of salicylates
3. Haemodialysis can also effectively removes salicylate
What is the immediate management of alcohol OD (2)?
1. Monitor blood glucose and correct if necessary
2. Support ventilation is required
What is important in the management of older children and young people who have deliberately attempted to harm themselves?
Assessment for risk of a repeated attempt, irrespective of the toxicity of the ingested substance
What issues need to be addressed regarding older children who deliberately harm themselves?
Social issues/family factors
What are the risk factors for adolescents who OD or self-harm (4)?
1. Ongoing thoughts of self-harm
2. Lack of regret after attempt
3. Evidence of planning e.g. suicide note
4. Lack of protective social factors
Who should children who inadvertently poison themselves as a result of experimentation be referred to?
Substance misuse services
Which country has the highest death rates due to unintentional injury in the world?
What are the 5 major causes of unintentional injury?
1. Road traffic incidents
What is the immediate steps of treatment for a sick child who has suffered an injury/trauma (7)?
2. History of accident
4. Treat the treatable
-herpes simplex encephalitis
5. Intubate and ventilate in necessary
6. Transfer to paediatric/neurosurgical intensive care unit
What are babies and toddlers mostly likely to drown in?
Baths, paddling pools, garden ponds
What can cause acute pain in a child (6)?
1. MSK or organ damage e.g. trauma
2. Inflammatory processes from local infection
3. Obstruction e.g. intussusception
4. Vaso-occlusive disease e.g. sickle cell crisis
5. Medical intervention e.g. LP
What is the approach to managing acute pain in a child?
Recognising, responding and reassessing
How can you recognise acute pain in a child (3)?
1. Older children can describe it
2. Younger children: Observation and parental impression
3. Self assessment tools for children over the age of 3
What are the medical approaches to responding to pain (4)?
-nerve blocks etc
-mild/mod = paracetemol and NSAIDS
-strong = morphine
3. Sedatives and anaesthetic agents
-ketamine, NO etc
4. Antiepileptic and antidepressents for neuropathic pain