Emergencies Flashcards
(31 cards)
Define status epilepticus
Continuous seizures lasting more than 30 minutes, or intermittent seizures lasting more than 30 minutes without full recovery of consciousness in between
Why is it important to terminate seizures ASAP
Seizures of longer duration associated with worse outcomes and treatment resistant
Aim of management for status epilepticus
Prevent prolonged seizures >5mins) developing into convulsive status epilepticus with early termination
Management protocol for status epilepticus
Time from onset 0 mins:
Airway, Oxygen, Glucose
5mins:
IV Lorazepam
Buccal Midazolam If no IV access
15 mins:
IV Lorazepam
Call senior help
Reconfirm epileptic seizure
25 mins:
IV Phenytoin
Seek anaesthetist advice
IV Phenobarbitone
45mins:
Rapid sequence induction of anaesthesia with thiopental
Reliable Methods of measuring temperature in <5 year olds
Electronic thermometer in axilla
Chemical dot thermometer in axilla
Infrared tympanic thermometer
Amber features in children with fever
Colour: pallor reported by parent
Activity: not responding normally, reduced activity, no smile, wakes only with prolonged stimulation
Breathing: Tachypnoea >50 in <1 or >40 in >1, nasal flaring, <95% oxygen, crackles
Hydration: reduced feeding, dry tears, dry mucous membranes, reduced urine output, CRT >3, tachycardia
Other: swollen limb/joint, non-weight bearing, >39 in 3-6 months, fever >5 days, rigor
Red features in children with fever
Colour: pallor, mottled, ashen, cyanosis
Activity: no response, unable to rouse, does not stay awake when roused, High-pitched/continuous cry
Breathing: tachypnoea >60, chest recession
Hydration: reduced skin turf or
Other: fever >38 in <3 months, Focal neurology, seizures, non-blanching rash, bulging fontanelle, neck stiffness
What are the values for tachypnoea according to age group
<12 months = >50
>12 months = >40
What are the values for tachycardia
>160 = <12 months >150 = 12-24 months >140 = 2-5 years
Clinical features of Kawasaki disease
Fever >5 days
Bilateral conjunctival injection
URT Mucous membrane changes - mucous membrane injection, strawberry tongue, dry cracked lips
Cervical lymphadenopathy
Peripheral skin changes - oedema, desquamation
Polymorphous rash
Clinical features of herpes simplex encephalitis
Focal neurological
Focal seizures
Reduced level of consciousness
Clinical features of meningitis
Non blanching rash Bulging fontanelle Neck stiffness Seizures Reduced level of consciousness
Management of low risk fever in children
Routine assessment: RR, HR, T, Pulse ox Management at home Advice: Offer regular drinks/feeds Seek medical advice if - reduced drinking, fit, non blanching rash, fever >5 days, child gets worse, parents have concerns, if concerned they are unable to look after child
What advice do you give about use of antipyrexials
Only use if child is distressed Ibuprofen or paracetamol alternatively Do not use with the aim to reduce Body temp or prevent febrile convulsions Do not use aspirin (reye syndrome) Do not over/underdress child Avoid sponging
Management of intermediate/high risk fever in children
Medical assessment within 2 hours
Parenteral abx if suspect meningococcal disease - Benzylpenicillin, Third gen cephalosporin (ceftriaxone, cefotaxime)
Urgent referral to hospital
Investigations in hospital for children with intermediate/high risk fever
FBC CRP U+E Blood culture Urinalysis CXR LP
When should you perform lumbar puncture in children with fever
All <1 month old
1-3 months unwell, raised wcc
All children with red features
What are the mechanisms of poisoning in children
Accidental
Deliberate
Iatrogenic
Intentional/abuse
Age group of poisoning in children
<5 year olds
most serious in <2s
Adolescents
Common causative agents of poisoning
Opioids Paracetamol Salicylates Tricyclics Beta blockers, CCB, Digoxin Iron Oral hypoglycaemics
Bleach, washing up tablets Liquid Nicotine Petroleum Ethylene glycol (antifreeze) Carbon monoxide Essential oils (diffusers) organophosphate pesticides
Outline the management of poisoning
A-E assessment Resuscitation +/- defibrillation Secondary assessment - Hx - exam - Ix Clinical management - conservative - medical
What do you assess in Disability
Level of consciousness - AVPU
Posture - hypotonia, decorticate (flexed), decerebrate (extended)
Pupil size + reflex
What information do you need to gather in secondary assessment of poisoning
Identify agent (parents, patient) Determine toxicity: - toxicity of agent from NPIS - dose of ingestion - time of last ingestion - presence of symptoms
What is the term for clinical signs that help identify the agent on examination
Toxidromes
Set of signs of different classes of drugs in overdose
