Emergencies Flashcards
How should near drowning be Mx?
- Pt in prone position when out of water
- Give 100% oxygen
- Suspect hypothermia
- CPR against hard surface
- Maintain c-spine immobilisation
What are the causal theories of sudden infant death syndrome?
Most common at 2-3m
Obstructive apnoea:
- inhalation of milk
- airway oedema
- passive smoking
Central apnoea:
- faulty CO2 drive
- prematurity
- brainstem gliosis
Others:
- long QT interval
- staph infection
- overheating
- increased vagal tone or Magnesium increase
- immature diaphragm
What are burns and scalds, how do they present and what is a DDx?
Burn = damage to the skin or other body parts caused by extreme heat, flame, contact with heated objects, or chemicals
Scald = burn with hot liquid or steam
S+S =
- superficial 1st = red without blisters
- partial thickness 2nd = red, yellow/white, blister
- full thickness 3rd = stiff, white/brown, no blanching
- 4th = black, charred
DDx = accidental injury, child abuse
Outline the aetiology of meningitis
0-3m = group B strep, e.coli, listeria
3m-6y = strep pneumonia, Neisseria meningitidis, H.influenza
6-60y = strep pneumonia, Neisseria meningitidis
> 60y = strep pneumonia, Neisseria meningitidis, listeria
Viral (2/3) = enterococcus, EBV, adenovirus, mumps
What are the signs and symptoms of meningitis?
Early:
- Headache
- Leg pains
- Cold hands/feet
- Abnormal skin colour
- Fever
Later:
- Meningism = stiff neck, photophobia
- Kernigs sign (pain + resistance on passive knee extension with hip fully flexed)
- Brudzinski’s sign = +ve when passive forward flexion of the neck causes involuntarily raising of knees or hips in flexion
- Decreased conscious level, coma
- Seizures
- Petechial rash - non-blanching
- Sepsis = slow cap refill, decreased BP, increased temp, increased pulse
- Bulging fontanelle
How would you investigate meningitis?
Bloods = FBC, U+Es, LTF, glucose, coag (on LP don’t want the pt to bleed), BM
Blood cultures, throat swabs, rectal swabs
LP (do not perform in RICP) = CSF for microscopy, biochem, culture, PCR
CT head
CXR
VBG
Ophthalmoscopy
How would you manage meningitis?
A-E assessment
Dexamethasone 4-10mg/6h IV = reduced RICP/inflam
Start Abx
- <3m = IV cefotaxime + oral amoxicillin
- 3m-50y = IV cefotaxime
- > 50y = IV cefotaxime + oral amoxicillin
Viral = 3w acyclovir
IV fluids
Isolate for 1st 24h
Careful monitoring
Household/close contacts = rifampicin or oral ciprofloxacin
What are the complications of meningitis?
Encephalitis
Residual paralysis/focal neurology
Hearing loss
Cerebral abscess
Sepsis - DIC
Death
Outline the immune mechanism of an allergic reaction
Allergen 1st exposure - TH2 response
Allergen 2nd response = IgE cross-linking BY ALLERGEN
= mast cell degranulation
= increased vascular permeability, vasodilation, bronchial constriction
Describe the manifestations of anaphylaxis
Systemic activation of mast cells =
CVS = hypotension, tachy, syncope
Skin = angioedema, urticaria
Resp = cough, wheeze, dyspnoea, bronchospasm, hypoxia, stridor
Digestive = N+V, abdo pain, diarrhoea
How is anaphylaxis managed?
A-E
Epipen = adrenaline = vasoconstriction
Remove the trigger if possible.
Oxygen, IV fluid 20 mL/kg
Following initial resuscitation:
- Give slow IM/IV chlorphenamine
- Give slow IM/IV hydrocortisone (especially in people with asthma)
- Consider neb salbutamol/ipratropium if the person is wheezy
What is status epilepticus, its causes and presentation?
Seizures lasting more than 5 minutes or more than 3 seizures in one hour
S+S = tonic-clonic, tonic, clonic or myoclonic seizures, LOC
Causes =
- Intake of substance accidental/intentional, meds
- Infection = bacterial meningitis, encephalitis (travel - malaria)
- Hypoglycaemia = DM (insulin over use, illness), new-borns, metabolic disorders
- Febrile convulsion (common 6m-6y, generalised tonic-clonic short, swift recovery, complex/atypical) - usually triggered by the initial rise in temp
SOL = AV malformation, bleed, hypotensive encephalopathy, tumour
- Electrolyte abnormalities = hypoCa, hyperNa, hypoNa, hypoMg, hypoGly (SAIDH, fluid loss, Ca metabolism)
- Epilepsy = not associated with fever, but at higher risk of seizure when ill
- Vascular = stroke (MRI, MR angiogram)
- Cerebral hypoxia = significant resp/cardio failure
- Hepatic encephalopathy, renal encephalopathy, metabolic encephalopathy (mitochondrial)
- Congenital brain abnormalities
- Jaundice - kernicterus
What is paediatric trauma/injury, how does it present and what is its DDx?
Traumatic injury that happens to an infant, child or adolescent
S+S = bleeding, wound, LOC, N+V, impaired movement, balance, and/or coordination, dizziness, fatigue, headache
DDx =
- Non-accidental injury (NAI) (infants)
- Falls (toddlers)
- RTAs and sports injuries (older, adolescents)
Mx = primary survey, initial resuscitation, secondary survey, emergency treatment, definitive care
What are the types of poisoning in children?
1 = accidental ingestion of poisonous substance
2 = deliberate ingestion (overdose) of a mentally destressed child needing help
3 = deliberate poisoning of children (type of child abuse), safeguarding
What are the S+S of overdose/poisoning?
- feeling and being sick
- diarrhoea
- stomach pain
- drowsiness, dizziness or weakness
- high temperature of 38C (100.4F) or above
- chills (shivering)
- loss of appetite
- headache
- irritability
- difficulty swallowing (dysphagia)
- breathing difficulties
- producing more saliva than normal
- skin rash
- blue lips and skin (cyanosis)
- burns around the nose or mouth
- double vision or blurred vision
- mental confusion
- seizures (fits)
- loss of consciousness
- coma, in severe cases
How should overdose/poisoning be assessed?
Hx - what, where, when, how much/estimate
Exam
A-E - ?time critical (LOC, hypotension, arrhythmias, hypothermia/hyperthermia)
Blood paracetamol levels
Outline the Mx of overdose/poisoning
Remove the source of chemical
Alcohol = oral glucose for hypoglycaemia
TCA = ECG monitoring, charcoal, sodium bicarb, benzo for fits
Iron = charcoal contraindicated, bowel irrigation, chelation
Paracetamol = IV/IM naloxone to reduce respiratory depression
What is paediatric pyrexia, its causes and how does it present?
An infant or child is considered to have a fever if their temperature is 38°C or higher
Causes = bacterial, viral infection, Kawasaki disease, malignancy
S+S = >38, seizures, sweating, chills and shivering, headache, muscle aches, loss of appetite, irritability, dehydration, general weakness.
How should paediatric pyrexia be Ix?
Hx = addition Sx, perinatal complications, immunisations, recent antipyretic/Abx, prematurity,
Assess using traffic light system = colour, activity, respiratory, hydration, red flags
Electronic/infrared thermometers
Outline the management for paediatric pyrexia
Oral fluids
Paracetamol
Ibuprofen
Abx
The majority of fever is caused by self-limiting viral infection
What is sepsis, its causes and presentation?
Sepsis is a dysregulated response to infection which may result in organ damage and death
Causes = N. meningitides (meningococcus), strep pneumoniae (pneumococcus), staph aureus, group A and B streptococcus, E. coli
S+S = fever, lethargy, N+V, headache, abdo pain
How should suspected sepsis be Ix?
Exam =
- shock (hypotension, tachycardia, tachypnoea, cool peripheries, confusion)
- non-blanching rash
- fever
- signs of = meningitis/encephalitis, pneumonia, UTI, abdo pain/distention
Ix =
- FBC, CRP, lactate, glucose, U+Es, blood culture and urine testing
- stool culture is diarrhoea
- urine output
- LP (before Abx if time)
Use traffic light system in febrile children
What is a DDx for sepsis?
Leukaemia
Aplastic anaemia
Malignancy = lymphoma
Autoimmune = juvenile idiopathic arthritis
Kawasaki disease (children with prolonged fever)
How should sepsis be Mx?
Sepsis 6
- Give high flow oxygen
- IV/IO access = b/c, glucose, lactate, FBC, U+Es
- IV/IO antibiotics = cefotaxime
- IV/IO fluid = if hypoBP/lactate <2, 20ml/kg (10ml/kg neonates)
- Monitor UO (with catheterisation if necessary)
- Consider inotropic support = dopamine, epinephrine
Ensure senior doctor attends
