Emergencies Flashcards
1
Q
Name four investigations if you suspected accidental poisoning in a child
A
Urine Dipsticks and Toxicology
Bloods (ABG, Drug Levels, Glucose, U&Es, LFTs, Coag, Drug levels)
ECG
XRays (Radio-Opaque tablets)
2
Q
What do you want to know from the parents about the Accidental Poisoning?
A
- Exact name of drug/chemical exposure
- Preparation and Concentration
- Probable dose as well as max possible dose
- Time since ingestion/exposure
3
Q
Name three overdoses that could cause respiratory depression
A
Antipsychotics
TCA
Alcohol
4
Q
Name three overdoses causing VT
A
Amphetamines
Cocaine
Carbemazepine
5
Q
Name three overdoses causing Miosis
A
Alcohol
Ketamine
Organophosphates
6
Q
Name three overdoses causing Mydriasis
A
Atropine
Carbon Monoxide
TCAs
7
Q
Name three overdoses causing Hypoglycaemia
A
Alcohol
Insulin
Propranolol
8
Q
How is a Paracetamol overdose managed?
A
Children taking >150mg/kg need assessment
Take bloods after 4 hours and use nomogram
Acetylcystiene
9
Q
What doses of Acetylcysteine are used in Paracetamol Overdose
A
IV load 150mg/kg
50mg/kg over four hours
100mg/kg over sixteen hours
Repeat at 24 hours
10
Q
How is Anticholinergic/Antihistaminic overdose managed?
A
Benzodiazepines (if agitation and seizures)
Physostigmine (for Anticholinergic syndrome)
11
Q
How is Benzodiazepine overdose managed?
A
If stable can just observe
Flumazenil (reverses lethargy and coma)
12
Q
How is a Beta Blocker overdose managed?
A
Glucagon (reverses bradycardia and hypotension)
Cardiac pacing may be required
13
Q
How is a CCB overdose managed?
A
Fluids and Ca2+
14
Q
How is a Carbon Monoxide poisoning managed?
A
FiO2 1.0
15
Q
How is Digoxin overdose managed?
A
Digibind
16
Q
How is a Methanol overdose managed?
A
Fomepizole
17
Q
How is a Narcotic overdose managed?
A
Naloxone
18
Q
How is an Organophosphate overdose managed?
A
Atropine
19
Q
When would you consider giving activated charcoal to a child in an accidental poisoning?
A
Presentation within one hour of ingestion
Substance is highly toxic and difficult to treat
Patient managing and protecting own airway
20
Q
What is a child’s 24h fluid requirement?
A
100ml/kg for first 10kg of weight
+50ml/kg for second 10kg
+20ml/kg for remaining weight above 20kg
Sodium = 2-4mmol/kg Potassium = 1-2 mol/kg
21
Q
What must be examined in a child presenting with abdominal pain (in the case of referred pain)?
A
Testes
Hernial Orifices
Hip Joints
22
Q
Give three surgical causes of Acute Abdo Pain
A
Acute appendicitis
Intestinal obstruction
Inguinal Hernias
23
Q
Give three medical causes of Acute Abdo Pain
A
Gastroenteritis
HSP
DKA
24
Q
Give three extra-abdominal causes of Acute Abdo Pain
A
URTI
Lower Lobe Pneumonia
Testicular Torsion
25
Define NSAP
Non Specific Abdominal Pain
Resolves in 24-48h
Less severe than appendicitis
Often accompanied by respiratory tract infection
26
How is Mesenteric Adenitis diagnosed?
Can’t be definitively diagnosed until large mesenteric nodes/normal appendix is seen on laparoscopy/laparotomy
27
Give four broad causes of Acute Joint Pain/Swelling.
```
Monoarticular disease
Post Infectious Arthritis
Juvenile Arthritis and Spondyloarthropathies
Non inflammatory
Polyarticular disease
```
28
Name four causes of monoarticular disease
Septic Arthritis
Pigmented Villonodular Synovitis (synovium overgrows)
Sickle Cell
Leukaemia
29
What is the most common cause of Polyarthropathy?
Reactive Arthritis
30
Describe four diagnostic criteria for Juvenile Idiopathic Arthritis
Age of onset <16
Arthritis in >1 joint
Duration >6 weeks
Other conditions excluded
31
What are the different types of JIA?
```
Systemic
Polyarticular
Oligoarticular
Rheumatoid positive
Rheumatoid negative
```
32
JIA is a clinical diagnosis, how could it be investigated?
Bloods (ANA +be associated with increased risk of eye disease)
USS (Arthritis, Tenosynovitis, Joint Damage)
Opthalmology clinic within 6 weeks
33
How is JIA managed?
Treat acute joints as required
Promote physical activity
Methotrexate
Uveitis screening and management every 6m
34
How are acutely painful joints managed?
NSAIDs for two weeks while awaiting paeds review
Intra-articular steroids (if disability and joint restriction)
PO/IV steroids if many joints involved
35
What is the normal crying pattern of a baby?
Atleast two hours a day for first six weeks
| 70% between noon and midnight
36
Give five potential causes of a crying baby
```
Normal
Colic
CMPA
GOR
Torted Testicle
```
37
Give four red flags for a crying baby
Fever
Bilious vomiting
Sudden change in behaviour
38
Why should you check genitalia and digits in a crying baby?
In case of a hair tourniquet
39
What is an important question to ask the parents of a crying baby?
Do you feel you might harm the baby?
40
How should a crying baby be managed?
Reassure parents
Check their simple needs
Feeding
5S’s
41
What are the 5 S’s?
```
Sling
Sucking
Swaddling
Shushing
Swinging
```
42
Define Decreased Consciousness
Responsive only to voice or pain, or totally unresponsive (in regards to AVPU) OR GCS<14
43
What is the exclusion criteria for decreased consciousness?
Infants in NICU
Known conditions of reduced consciousness (epilepsy, diabetes)
Learning disabilities whose baseline is <15
44
What investigations could you do in a patient with decreased consciousness?
```
CBG
Urine Dipstick
Blood Glucose
Plasma Ammonia
FBC
```
45
What is required to diagnose Shock?
>1 of
```
Cap Refill>2
Mottled and cold
Reduced peripheral pulses
Systolic BP less than 5th centile
UO <1ml/kg/h
```
46
How is Shock managed?
10ml/kg IV bolus
Can be repeated once
47
Give four typical features of a Septic Child
Temp>38 or <36
Tachycardia
Tachypnoea
Non Blanching Rash
48
When should Hypoglycaemia be diagnosed as the cause of reduced consciousness in a child?
Capillary glucose <2.6 mmol/l
49
How should Hypoglycaemia be managed?
<4 weeks - 2ml/kg IV 10% Glucose bolus
>4 weeks - 5ml/kg IV 10% Glucose bolus
10% glucose IV infusion
50
When should Hyperammonaemia be diagnosed as the cause of reduced consciousness in a child?
Plasma ammonium >200 micromol/l
51
How should Hyperammonaemia be managed?
IV Sodium Benzoate
Check amino acids and organic acids
If refractory - consider haemodialysis
52
When should raised ICP be considered to be diagnosed as the cause of reduced consciousness in a child?
Abnormal respiratory pattern
Abnormal pupils
Abnormal posture
53
How is raised ICP managed?
Tilt head up to 20 degrees
No Hypotonic Maintenance fluids
Mannitol
Intubation
54
How should you manage reduced consciousness if cause is unknown?
Supportive
Broad Spectrum Abx and IV Aciclovir
Discuss with paediatric neurologist
55
A seriously unwell child should always be approached using A to E first. How should airways be assessed?
Neutral head position in infants
| Sniffing position in child
56
A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child less than one?
30-40
57
A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child aged 1-2?
25-35
58
A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child aged 2-5?
20-30
59
A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child aged 5-12?
15-25
60
A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child aged >12?
12-20
61
Resp Rate is an indication of Breathing Effort. What are the other two aspects?
Efficacy - chest expansion and auscultation
| Effect - Drowsiness, Agitation
62
A seriously unwell child should always be approached using A to E first. What is a Decorticate posture?
Flexed arms, extended legs
63
A seriously unwell child should always be approached using A to E first. What is a Decerebrate posture?
Extended arms and legs
64
A seriously unwell child should always be approached using A to E first. What are the normal ranges of pulse rates in a child aged 0-3 months?
100-150
65
A seriously unwell child should always be approached using A to E first. What are the normal ranges of pulse rates in a child aged 3-6 months?
90-120
66
A seriously unwell child should always be approached using A to E first. What are the normal ranges of pulse rates in a child aged 6-12 months?
80-120
67
A seriously unwell child should always be approached using A to E first. What are the normal ranges of pulse rates in a child aged 1-10 years?
70-130
68
What is a Secondary Assessment of a child?
Reassess the response to initial measures
Take a focussed history
Detailed examinations
Further investigations
69
If when assessing airways and breathing in an acutely unwell child you heard bubbling what would be your diagnosis and management?
Excess Secretions
Suctioning
70
If when assessing airways and breathing in an acutely unwell child you heard harsh Stridor/barking cough what would be your diagnosis and management?
Croup
Oral Dexamethasone, Nebulised Budesonide, Adrenaline
71
If when assessing airways and breathing in an acutely unwell child you heard Soft Stridor/the child was drooling what would be your diagnosis and management?
Epiglottitis/Bacterial Tracheitis
Intubation and IV Abx
72
If when assessing airways and breathing in an acutely unwell child you heard sudden Stridor what would be your diagnosis and management?
Foreign body aspiration
Laryngoscopy and removal
73
If when assessing airways and breathing in an acutely unwell child you heard Stridor after allergen exposure what would be your diagnosis and management?
Anaphylaxis
IM adrenaline, IV Hydrocortisone, IV Chloramphenamine
74
If when assessing airways and breathing in an acutely unwell child you heard a wheeze what would be your diagnosis and management?
Acute Asthma
Bronchodilators
75
If when assessing airways and breathing in an acutely unwell child you heard Bronchial Breathing what would be your diagnosis and management?
Pneumonia
IV Abx
76
PDA Closure in infants with CHD May appear similar to sepsis/IEM. Give four clinical features and the management.
Poor Feeding
Sleepiness
Slightly fast breathing
Collapsed in cardiogenic shock
IV Dinopristone
77
If when assessing Circulation in an acutely unwell child you discovered an SVT what would be your management?
Vagal manouvres initially
IV Adenosine/DC Shock
78
Give two common causes of a limp in a child <3y
Fracture/Soft Tissue Injury
| DDH
79
What are you concerned about with sprains in children?
Injury to growth plate
80
What is a Toddler’s Fracture?
Subtle undisplaced spiral fracture
Often caused by sudden twist
81
Give three causes of a limp in a child aged 3-10y
Transient Synovitis
Fracture/Soft Tissue Injury
Perthes
82
Give five causes of a limp in a child aged 10-19
```
SCFE
Perthes
Osgood Schlatter
Sever’s Disease
Chondromalacia Patellae
```
83
Name two haematological conditions that can cause joint pain
Sickle Cell
| Haemophilias
84
How is children’s pGALS different to adults?
Further assessment of foot and ankle
Assessment of TMJ
Assessment of Elbow
Assessment of Cervical Spine
85
Name three screening questions in pGALS
Any pain/stiffness
Any difficulty getting dressed
Any problems with stairs
86
What specific gaits are you observing for in pGALS?
Trendelenberg
Waddling
Tip Toe
87
Give three red flags in an Acute Limp
Night time pain
Redness and swelling
Palpable mass
88
What is the most likely diagnosis of an acute limp in under 3s and over 9s respectively?
Septic Arthritis
SCFE
89
Define ALTE (AKA BRUE - Brief Unresolved Unexplained Event)
An episode that is frightening to the observer during which a combination of apnoea/choking/gagging/colour change are reported. Lasts less than one minute and resolves spontaneously
90
50% of causes of BRUE remain unknown. Describe four possible.
GORD
Seizures
OSA
CHD
91
Name two risk factors for BRUEs
Infants less than two months old
If less than 30d it’s more likely to be serious or repeated
92
How would you investigate a low risk child who has had a BRUE?
ECG
| Perinasal swab for Pertussis
93
How would you investigate a high risk child who has had a BRUE?
```
ECG
Perinasal swab
CXR
Blood Gas
Bloods
```
94
How would you manage a BRUE?
Reassure parents
Observe for a period of time
Low risk - safety net, offer BLS training
High risk - Paeds admission and overnight sats monitoring
95
Give three indications for a head CT in Head and Neck trauma
Suspicion of NAI
Signs of Basilar skull #
Focal Neurological Signs
96
Why are children more at risk of internal damage in trauma?
Elasticity of children’s ribs reduces risk of fractures but allows transfer of energy to internal structures
97
What is the definitive management for severe trauma?
Transferred to PICU
Significant head injuries -> regional neurosurgical unit (haematoma evacuated within 4h)
98
Define Bell’s Palsy
Acute paralysis of muscles of facial expression (may be unable to close eye on affected side)
99
Describe the pathophysiology of Bells Palsy
Normally unilateral but can be a bilateral LMN lesion, secondary to oedema as it passes through temporal bone
Can be Idiopathic, Viral, or due to Lyme Disease
100
How should you examine a patient with Bells Palsy?
Check the other functions of facial nerve (impaired taste, hyperacusis)
Full neuro examination
101
Name two differentials for Bells Palsy
Compressive lesion in Cerebellopontine angle (all functions of facial nerve affected)
Painful vesicles on tonsillar region and external ear - Herpes Virus
102
How is Bells Palsy managed?
PO Prednisolone for 5d if within first week of presentation
IV Aciclovir (if Varicella)
Lubricating eye drops (to prevent conjunctival infection)
103
What are the reversible causes of Cardiac Arrest (4Hs and 4Ts)?
Hypoxia, Hypovolaemia, Hypothermia, Hyperkalaemia
Tamponade, Thrombosis, Toxins, Tension Pneumothorax
104
Describe the BLS of a child
1) 5 rescue breathes
2) Check brachial pulse
3) 15 compressions: 2 rescue breaths
Be can refill not to hyperventilate (reduces venous return and eventually perfusion)
105
Describe the ALS management of shockable rhythms (VF, pVT)
4J/Kg shock every 2 minute cycle
After 3rd shock give Adrenaline 10 micro gram/kg and Amioderone 5mg/kg
Give adrenaline on alternating cycles
106
Describe the ALS management of non shockable rhythms (PEA, Asystole)
CPR
| IV 10microgram/kg Adrenaline every 3-5 minutes
107
Give 6 causes of Dehydration
```
GI - Gastroenteritis
Oropharyngeal - Tonsillitis
Endocrine - DKA
Inadequate Intake - Tongue Tie
Increased Output - Burns
Other - Febrile Illness
```
108
What would you see clinically at 5% dehydration?
Abnormal Cap Refill
Abnormal Skin Turgor
Abnormal Resp Pattern
109
State three symptoms of mild to moderate dehydration
Restlessness
Sunken Eyes
Thirst
110
State three symptoms of severe dehydration
Lethargic
Poor Drinking
Rapid Pulse
111
How can skin turgor be used to indicate Dehydration?
Normal - skin retracts immediate
Mild to Mod - Slow, Skin retracts in <2 seconds
Severe - skin fold retracts in >2 seconds
112
Give three red flags of dehydration
Altered responsiveness
Tachypnoea
Tachycardia
113
What investigations should be carried out on a dehydrated patient?
Urine tests (Ketones, Glucose, Specific Gravity)
Bloods (U and Es, Glucose)
ECG
114
How is Mild to Moderate dehydration treated?
IV therapy not required as long as oral fluids are tolerated
| Dioralyte or Breast Milk
115
When would you rehydrate a patient with IV fluids in dehydration? What do you have to consider?
If shock is suspected
Red flags despite oral fluids
Persistent vomiting of Oral Fluids
Sodium levels
116
Intraosseous fluid rescucitation is given if venous access is impossible due to circulatory collapse. Where is the preferred insertion point?
Proximal Tibia
117
How do you calculate a fluid deficit?
Weight x %dehydrated x 10ml
118
How can you monitor a dehydrated child’s response to fluids?
```
General well-being
Fontanelle tension
Capillary Refill
BP
Urine Output
```
119
What is the normal urinary output of different age groups?
<1yr - 2ml/kg/h
Toddler - 1.5ml/kg/h
Older - 1ml/kg/h
Adult - 0.5ml/kg/h
120
Describe the epidemiology of Epistaxis
Bimodal - Children (naturally narrow airways, nose picking) and Elderly (Anticoagulant therapy)
Under 2 is very rare and should be referred to ENT
121
Describe the pathophysiology of Epistaxis
Usually in Littles Area
Caused by trauma, mucosal irritation, clotting disorders
122
What vessels coalesce in Littles Area?
Internal Carotid (Anterior Ethmoidal, Posterior Ethmoidal)
External Carotid (Sphenopalantine, Greaater Palantine, Superior Labial)
(5)
123
What should be a consideration in children with epistaxis?
Foreign Body
If unilateral offensive discharge mixed with blood
124
Epistaxis is a clinical diagnosis (unless recurrent or large volumes). Describe the first aid management.
Lean child forward and punch soft part of nose for >15 minutes
After 15 minutes check for cessation
If not then hold again and put ice pack on back of neck
125
How is Epistaxis managed in primary care?
Local anaesthetic to septum
Cautery with silver nitrate
If continuing - ENT will place packing
126
What would you advise the patient with Epistaxis on discharge?
Naseptin Ointment BD for 2 weeks
Avoid: Strenuous activity, bending forwards, hot drinks
127
Define Febrile Convulsions
Seizure accompanied by fever (>38) without CNS infection, occurring between 6m -5y
128
What are the three types of Febrile Convulsions?
Simple - Generalised tonic Clonic, <15 mins
Complex - partial, >15 mins, recurrent within 24
Status Epilepticus - >30 minutes, no full recovery
129
The cause of Febrile Seizures is relatively unknown. What are some potential causes
Family History (in 24%)
Viral Infections
Otitis Media
Post Immunisaton
130
One of the main differentials for Febrile Convulsions if Reflex Anoxic Seizures. What is this?
```
A precipitant (such as minor bump) causes a vagally mediated asystole
Child becomes floppy then tonic Clonic seizures
```
131
What differentials are important to rule out with Febrile Convulsions?
Meningitis
| Sepsis
132
How would you investigate Febrile Convulsions?
Bloods (FBC, ESR, Glucose, UEs, Coag, Culture)
Urine Microscopy and Culture (<18m or complex)
LP
133
Usually a child with Febrile convulsions can be managed at home. What should you advice the parents?
What febrile seizures are
How to treat the fever at home
What to do if the child has a fit (recovery position)
Seizure>5 minutes call 999
134
Hypothermia is a temperature <36 degrees and is normally caused by immersion or excess exposure. Give two reasons why children are predisposed
Large SA/V
| Thermoregulatory response altered
135
Give four presenting features of Hypothemia
Body shivers
Numb extremities
Lack of coordination
Mental confusion
136
How can you prevent Hypothermia in a child?
Dry skin
Cover head
Minimise exposure in examinations
Avoid cold fluids
137
What are the rewarming strategies for children?
Gastric or bladder lavage with 42 degrees saline
| Dialysis warming
138
Name 8 different types of Hyperthermia
```
Heat Stress
Heat Fatigue
Heat Syncope
Heat Cramps
Heat Oedema
Heat Rash
Heat Exhaustion
Heat Stroke
```
139
What is Heat Stress?
If temperature climbs and you’re unable to cool yourself by sweating
Mx - get to a cool area and drink water
140
What is Heat Stroke?
Body temperature above 40 degrees
Fainting is often the first sign
Cool bath and ice bags under arms and groin
141
What is Heat Syncope?
Reduced blood pressure after exertion
Cool down and place legs in air, rehydrate
142
What are Heat Cramps?
Secondary to electrolyte imbalance
143
What is Heat Oedema?
Thought to be due to reduced RAAS action leading to fluid build up in extremities
144
Why is Hyperthermia not the same as fever?
Hyperthermia is responding to external changes rather than infection
145
Define Hypogylcaemia
Blood value <3 if symptomatic, or <2.6 if asymptomatic
146
Name three endocrine causes of hypoglycaemia
GH Deficiency
CAH
Hypopituitarism
147
Name two metabolic causes of hypoglycaemia
Glycogen storage disease
| Galactosaemia
148
Name three toxic causes of hypoglycaemia
Alcohol
Salicyclates
Insulin
149
Name three hepatic causes of hypoglycaemia
Hepatitis
Cirrhosis
Reyes Syndrome
150
Name three neonatal causes of hypoglycaemia
Poor maternal nutrition
Poorly controlled maternal diabetes
HDN
151
What are you looking for OE in a hypoglycaemic child?
Short stature
Failure to thrive
Hepatomegaly
Symptoms in relation to feeding
152
How would you manage Hypoglycaemia?
Asymptomatic - PO Glucose/Gel
Symptomatic - 2ml/kg 10% Dextrose IV, followed by continuous infusion
No response - Glucose, Hydrocortisone
IN neonates - if asymptmatic then encourage feeding and continue to monitor, if symptomatic then dextrosr
153
Malnutrition is a common cause of child mortality. How does Iron Deficiency present?
Microcytic hypochromic anaemia
Koilonychia
Fatigue
Angular stomatitis
154
Malnutrition is a common cause of child mortality. How is Iron Deficiency treated?
PO 4-6mg/kg Iron daily
155
Malnutrition is a common cause of child mortality. How does Vitamin A Deficiency present?
Usually associated with fat malabsorption states
Xerophthalmia
Night Blindness
Follicular Hyperkeratosis
156
Malnutrition is a common cause of child mortality. How does Vitamin D Deficiency present?
Rickets
157
Malnutrition is a common cause of child mortality. How is Vitamin D Deficiency managed?
Vitamin D
Calcium
Phosphate
158
Give three causes of Vitamin K deficiency
Congenital
Fat malabsorption
Small bowel bacterial overgrowth
159
Malnutrition is a common cause of child mortality. How does Vitamin K Deficiency present?
Bleeding
160
Malnutrition is a common cause of child mortality. How is Vitamin K deficiency managed?
IV 1mg Vitamin K
161
What is the main cause of Vitamin B1 deficiency?
Dietary deficiency - eg rice diet
162
Malnutrition is a common cause of child mortality. How does Vitamin B12 deficiency present?
Megaloblastic anaemia
Peripheral Neuropathy
Motor weakness
163
Malnutrition is a common cause of child mortality. How is Vitamin B12 deficiency managed?
1mg IM Vit B12 every 1-3 months
164
How does Scurvy present?
Petichiae
Ecchymoses
Bleeding gums
Motor weakness
165
How is Scurvy managed?
PO Vitamin C QDS for four days, then BD
166
Malnutrition is a common cause of child mortality. How does Vitamin E deficiency present?
Haemolytic Anaemia
| Visual impairment
167
Malnutrition is a common cause of child mortality. How does Folic Acid deficiency present?
Megaloblastic anaemia
Thrombocytopenia
Irritability
168
Give three causes of folate deficiency
Small bowel disease
Malignancy
Anticonvulsants
169
Give three causes of Zinc deficiency
Prematurity
Chronic Diarrhoea
Acrodermatitis Enteropathic (genetic error)
170
Malnutrition is a common cause of child mortality. How does Zinc Deficiency present?
Periorofacial and Anal dermatitis
Diarrhoea
Alopecia
171
How should you examine a child with suspected Protein Energy Malnutrition?
Examine mid arm circumference rather than weight due to oedema
172
What is Kwashiorkor?
Severe deficiency of protein/amino acids leading to growth retardation, diarrhoea, oedema and abdominal distension
173
What would investigations occur Kwashiorkor show?
Low albumin
Low Calcium, magnesium, phosphate
Low glucose
Low Hb
174
What is Marasmus?
Severe calorie deficiency with preserved height, low weight and wasted appearance
175
How do you managed Protein Energy Malnutrition?
Correct dehydration and electrolyte imbalance
Treat underlying infections
Treat specific nutritional deficiencies
Slow oral refeed
176
Why do Paediatric patients fare better in Paracetamol overdose?
Better ability to conjugate with surface
Enhanced NAPQI detoxification
Greater Glutathione stores
177
How would you manage Paracetamol overdose?
Activated charcoal if within one hour
N-Acety Cystiene over 3 infusions (same as adult doses but less fluid to compensate)
178
What is Erb’s Palsy?
Damage to the upper brachial plexus (ie 5th and 6th cranial nerves)
179
Name three risk factors for Erbs Palsy
Macrosomia
Maternal propulsive forces
Excess shoulder traction in labour
180
How does Erbs Palsy present?
Waiters tip
Adducted, pronated and internally rotated
Absent biceps reflex
181
How is Erbs palsy managed?
Intermittent immobilisation and positioning to prevent contractures
Physiotherapy
Electrical stimulation
Referral to neurosurgeon if persisting >3m
182
What is Klumpke’s Paralysis?
Much less common than Erbs
Due to damage of C7,C8 and T1
183
How does Klumpkes palsy present?
Hand weakness
Loss of grasp
Horners Syndrome if T1 affected
184
How is Klumpkes palsy managed?
Same as Erbs
185
What can cause radial nerve palsies in children?
Dislocation of Humoral head
Humoral shaft fractures
Radial bone fractures
Injections in small babies
186
How does Radial a Nerve Palsy present?
Above elbow - everything drops
At elbow - wrist drop and unable to supinate
Below elbow - wrist drop
187
How is radial nerve palsy investigated?
Nerve conduction studies
| USS
188
How is a radial nerve palsy managed?
If it is due to a fracture it normally resolves spontaneously
Splints
Anti inflammatories
189
Name two causes of Ulnar Nerve palsies in children
Elbow dislocation
| Poorly healed supracondylar fractures
190
How do Ulnar Nerve palsies present?
Ulnar Claw
Less pronounced the higher the lesion due to FDP paralysis (Ulnar Paradox)
191
How are Ulnar Nerve Palsies managed?
NSAIDs and wait
Surgery if not treated
192
Give three causes of Median Nerve Palsy in children
Wrist trauma
Post Colles
Ganglions
193
How do Median Nerve Palsies present?
Weak pronation
Weak wrist flexion
Thenar atrophy
194
Give two causes of Olfactory nerve damage
Trauma
| Meningitis
195
Give a cause of monocular and bilateral optic nerve damage
Monocular - MS
| Bilateral - Raised ICP
196
Give a cause of Oculomotor nerve damage
Raised ICP
197
How does Oculomotor nerve damage present?
Fixed dilated pupil that won’t accommodate
Then ptosis
198
How does CNIV nerve damage present?
‘Down and Out’
199
Give a cause of Trigeminal Nerve palsy. How would it present?
Bulbar Palsy
Reduced sensation and jaw clenching
200
Give three causes of Facial Nerve Palsy
Bells Palsy
Otitis Media
Lyme Disease
201
Give two causes of Vestibulocochlear nerve damage
Loud Noises
| Pagets Disease
202
Give two causes of femoral nerve damage in children
Post Breech
| Hip fracture
203
How do Femoral Nerve palsies present?
Buckling knees (eg on stairs)
Numbness of medial thigh and calf
Quadriceps wasting
204
How is Femoral Nerve Palsy managed?
Exercises
Knee Bracing
Percutaneous nerve stimulation
205
Give one cause of sciatic nerve damage in infants (rare in developed countries)
Gluteal injections
206
How does Sciatic nerve damage present?
Lower limb pain
Foot drop
Abnormal gait
207
Name three causes of Respiratory Arrest
Airway Obstruction
Decreased Respiratory Effort
Muscular weakness
208
When is a patient at risk of respiratory muscle fatigue?
If breathing at a rate exceeding 70% of maximum ventilation for an extended time
209
Name three causes of upper airway obstruction
Tongue displacing in oropharynx
Foreign Body
Mucous
210
Give three causes of lower airway obstruction
Aspiration
Bronchospasm
Drowning
211
What is the Paediatric Maintenance fluid of choice?
0.9% Sodium Chloride + 5% Glucose
