Emergency

Question 1

What age do Acute Life Threatening Events more commonly occur in?
What are the main features? (4)

Answer 1

<10wks

Apnoea
Colour change
Muscle tone change
Choking/gagging

Question 2

What are the common causes of ALTEs? (5)

And less common causes? (6)

Answer 2

Common: 
Seizures
Infections (RSV, pertussis)
Upper airway obstruction
Reflux
Idiopathic

Uncommon: 
Cardiac arrhythmia
Breath-holding
Anaemia
Heat stress
Central hypoventilation syndrome
Cyanotic spells (intrapulm shunt)

Question 3

How are ALTEs managed?

Answer 3

Detailed Hx/Ex (any probs with baby/care giving)
Admit overnight: baseline Ix + sats/resp/ECG
Teach parents resuscitation
FU appt (paed nurse/paediatrician)

Question 4

List the DDx for acute upper airway obstruction (10)

Answer 4

Viral croup
Epiglottitis
Foreign body
Anaphylaxis
Bacterial tracheitis
Smoke inhalation
Retropharyngeal abscess
Infectious mononucleosis (severe LN swelling)
Measles 
Diphtheria

Question 5

What is the basic management for acute upper airway obstruction (5)

Answer 5

DO NOT examine throat
Stay calm - reduce anxiety
Observe any signs of hypoxia/deterioration
Severe - neb adrenaline
Resp failure - urgent intubation / anaesthetist

Question 6

What are the 4 main systems / effects of anaphylaxis?

Answer 6

Skin
CV - increased permeability, reduced CV tone, angioedema
Resp - bronchospasm, laryngospasm
GI - poss bloody diarrhoea

Question 7

What are the RFs for more serious consequences of anaphylaxis? (6)

Answer 7

Younger (smaller airway)
Asthmatic
Hypotension
Bradycardia
Chronic GI symps (risk vom)
PMH/FH allergies/anaphylaxis

Question 8

What are the main Dx criteria of anaphylaxis (2)

Answer 8

Acute onset of skin +/or mucosal symps (tingling mouth/ runny nose/ itchy eyes/ flushed)

Signs of end-organ dysfunction (resp compromise/ low BP/ hypotonia/ syncope/ incontinence)

Question 9

What may be seen in an ABC assessment in anaphylaxis?

Answer 9

A - swelling/ hoarseness/ stridor
B - tachypnoea/ wheeze/ cyanosis/ sats<92
C - pale-clammy/ hypotension/ drowsy-coma

Question 10

What Ix may be considered to establish cause of ALTE? (4 ASAP + 7)

Answer 10

ASAP:
Cardioresp monitoring
O2 sats
Glucose 
Blood gases

Other:
FBC/ U&Es/ LFTs/ Lactate
Urine MC+S
EEG
ECG (QT abn)
Barium swallow/oesophageal pH
CXR
LP

Question 11

What are some of the common allergens causing anaphylaxis?

Answer 11

Foods 
Preservatives/additives
Drugs
Biologicals (e.g. vaccine/venom)
Other (e.g. latex)

Question 12

Describe the immediate management for anaphylaxis (5)

Describe the medium-long term management (5)

Answer 12

Help → Supine → adrenaline → estab airway + give O2 → IV fluids + steroids → monitor BP/sats/ECG

Epipen for future
Avoid allergen
Antihistamines (if mild)
Steroids (prevent late phase)
Immunotherapy (desensitise pt to allergens)

Question 13

List some common investigations for anaphylaxis (2+4)

Answer 13

Serum histamine (raised)
Serum tryptase (raised)

C1INH
Urine VMA
Serum serotonin
Cutaneous antigen testing

Question 14

Which age group are most at risk of poisoning/ingestion/overdose?

Answer 14

Walking toddlers (2-3y/o)
NB may be risk of abuse/neglect

Question 15

How may paracetamol overdose present?

+ NSAIDs

Answer 15

Older, gastric irritation + liver failure after 3-5d

Mild N+V, elec abns
Large ingestion: Tachypnoea, Multi-Organ Failure, Abdo pain, Seizures, Coma, Tinnitus, Nystagmus

Question 16

How may Iron overdose present?

Answer 16

Initially: D+V, haematemesis, melaena, acute GI ulcer
Later: drowsy, coma, shock, liver failure, hypogly, convulsions
Long-term: gastric strictures

Question 17

How may methadone overdose present? (5)

Answer 17

Pinpoint pupils, N+V, constipation, Low BP/HR/RR

Question 18

How may alcohol overdose/ingestion present? (3)

Answer 18

Hypoglycaemia
Resp failure
Coma

Question 19

How may detergent ingestion present? (4)

Answer 19

Dyspnoea
Dysphagia / oral+cheek pain
Abdo pain
N+V

Question 20

Outline the general immediate management of overdose/ingestion (3)

Answer 20

ID poison
Assess agents toxicity (e.g. blood levels)
Removal? Only if <1hr

Question 21

What options are available for poison removal in ingestion (3)

Answer 21

Activated charcoal
Gastric lavage (for large ingestions)
Induced vomiting

Question 22

What other forms of management should be considered (as well as the clinical)

Answer 22

Assess social circumstances

Contact A&E + CAMHS if needed

Question 23

List some Epidemiological RFs for overdose/ingestion (3)

List some clinical RFs (6)

Answer 23

Epidem:
Social class/ Living alone/ Men

Clinical: 
Psychiatric illness
Alc dependance
PMH self-harm
FH depression/alc/suicide
Chronic physical illness 
Recent adverse events eg bereavement

Question 24

List the infantile causes of SIDS (5)
List the parental causes (3)
List the environmental causes (2)

Answer 24

1-6m
Male
Low birth wt / preterm
Multiple births
GI reflux

Poor/overcrowded
Mum <20/single/high parity
Maternal smoking during preg

Face down
Overheating

Question 25

What advice can be given to parents about avoiding SIDS (4)

Answer 25

Put sleep on back Avoid overheating Feet at foot of bed (so don't slip under covers) Stop smoking

Question 26

What are the RFs for burns/scalds (7)

Answer 26

``` Low economic status Household crowding High population density Low maternal education levels Psychological stress in fam Single/younger mums (esp unemployed) <5yrs (thinner skin) ```

Question 27

What features may be seen in burns/scalds? (5)

Answer 27

``` Blisters Pain Peeling skin Shock Airway obstruction ```

Question 28

Describe the initial management for burns/scalds in ED

Answer 28

Assess severity | Assess depth of burn (deep req skin graft + burns unit)

Question 29

What are the main principles of burns/scald management (5)

Answer 29

``` Pain relief IV fluids Wound care (ongoing) Psych support Consider safeguarding ```

Question 30

How are electrical burns different to normal burns/scalds? (2)

Answer 30

Most occur hands/mouth | Injuries also from being thrown from electrical source (if AC)

Question 31

What things are assessed in paediatric trauma ABCD

Answer 31

A+B: airway obstruction/ wheeze/ stridor/ RR + effort/ bilateral air entry C: HR/ BP/ CRT/ Sats+cyanosis D: Consciousness/ Posture (tone)/ Pupils

Question 32

How is paediatric ACB managed in trauma?

Answer 32

A: Jaw thrusts/ Neck collar (only immobilise after normal cervical Xray/neuro Ex) B: High flow O2 mask/ ventilate C: Stop any bleeding/ Fluid bolus/ FBC+Cross-Match

Question 33

In a head injury, what 4 things may indicate Potentially Severe / Severe?

Answer 33

Persisting coma Deteriorating GCS Seizures (w/o full recovery) Focal neurological signs

Question 34

What is the management for Mild / Potentially Severe / Severe head injuries?

Answer 34

Mild → discharge home w. written advice Potentially → monitor to avoid secondary damage Severe → resus/CT/neurosurg