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Flashcards in EMERGENCY Deck (28)
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1

Pharmacological Tx for anaphylaxis in children

Adrenaline IM
500 mcg > 12
300 mcg > 6
150 mcg <6
→ repeat after 5 mins if no effect

Chlorphenamine
10mg > 12
5mg > 6
2.5 < 6

Corticosteroids: IV hydrocortison: can take several hours to take effect
200 mg > 12
100 mg > 6
50mg <6
(Think hydro H20 = 200)

+-
Salbutamol (inh), ipratropium bromide (inh), aminophylline (IV)

2

What blood test should order that is specific to anaphylaxis

Mast cell tryptase

3

Before discharing this child, what must you put in place/do

- Refer to paeds
- Educate parents on epi pens and BLS

4

If a child is choosing but they can cough, what do you do?

Encourage to cough

5

If their cough is ineffective but they are conscious

5 black blows
5 abdo thrusts

6

How to give infants blows & thrusts

blows: You are in seated position, infant is head-downwards, prone. Support head by placing thumb at angle of jaw and 2 fingers of same hand on other side of jar (do not compress soft tissues under jaw)

Check compression: supine baby, use free arm to support infants back and encircle occiput with hand

7

How do children infant breath before 6 months

Obligate nasal breathers→ blocking nasal passage could cause airway compromise
common in e.g. URTI or Congenital narrow airway passages

8

There are 3 categories for observations and signs of breathing- what are they

Effort
→ RR, Recession, nostril ect
Efficacy
→ Expansion, air entry, dullness, O2 Sats
Effect
→ HR, Cap refill. skin colour, mental status

9

What are the pre-terminal signs for RESP?

Silent chest
Cynosis
O2 sat < 85% on air

10

How many rescue breaths in children

5

11

Recognition of circulation

Vital signs:
HR, Pulse volume, BP

Membranes:
Cap refill, Temp, colour

Organ perfusion:
Effect on breathing
Mental status → if can't do AVPU = agitated or drowsy?
UO

12

Normal urine output:

- Infants > 2ml/kg
- Children: 1ml/kg

13

Response for circulation

- IV access
- Blood → culture, VBG (lactate & ionised sodium), bloods, glucose stick test
- 12 Lead ECG
- Fluid bolus 20mls/kg

14

Preterminal Circualtion signs

Hypotension
Bradycardia

15

Paediatric sepsis 6

1. Give O2
2. Obtain IV or intraosseous access + blood
- Blood culture
- Blood glucose - treat low blood glucose
- Blood gas (+ FBC, lactate, CRP)
3. Antibiotics
4. Consider fluid resus
- 20ml/kg over 5-10mls
- Caution for fluid overload: check crepitations & hepatomegaly
5. Involve senior clinicians early
6. Consider inotropic support early
- normal physiologic parameters not restored after 40mls/kg
- Adrenaline or dopamine

16

Recognition of disability

AVPU
Pupils
Blood glucose
Evidence of seizure activity

17

Response for disability

Protect airway
ET tube if GCS < 8
Recovery position if airway not protected
Give glucose if < 4 mmol/L
- 2ml/kg 10% Dextrose
Tx seizure → IV lorazepam, Buccal midazolam, rectal diazepam

18

What is the septic screen for children

- Blood culture
- Bloods; FBC, U&E, LFTs CRP, ESR
- Blood VGB (lactate, pH)
- CXR
- LP
- Urine analysis + culture
- Stool culture

19

What do you Tx meningitis with in neonates

Penicillin
Gentamicin

20

Children

Cefotaxime
Ceftriaxone

21

Contraindications to LP

Local infection
Unconscious or ↓GCS or < 8
Meningococal septicemia
Bleeding disorder
Abnormal posture
Resp abnormality

Seizure > 10 min, ↓ GCS
Pupils abnormal
↑ICP, ↑BP, paillodema
Neurological focal
Extremis- shock, CVS compromise

22

Seizure Mgmt in child

Airway + High flow oxygen
DONT FOTGET GLUCOSE

Step 1
(after 5 mins)
- IV access → 0.1mg/kg lorazepam IV or IO
- No access → Buccal Midazolam or PR Diazepam 0.5mg

Step 2
(after 10 mins)
- IV lorazepam + call senior help
- Prepare phenytoin

Stem 3
(10 mins after step 2)
Seek ICU/anaesthetic
Phenytoin 20mg/kg IV/IO over 20 mins

Step 4
RSI with thiopentone

23

Recongition in Exposure

Expose the patient
Check temp
Full Hx & Ex
Drug & Fluid chart
Input/output chart, feeding chart
Inv results

24

Response

Senior advice
Management plan
SBARR

25

Estimate weights per age
- 0-12 months

(age x 0.5) + 4

26

Estimate weights per age
- 1-5 years

(age x 2) + 8

27

Estimate weights per age
- 6-12 years

(age x 3) + 7

28

Body Surface Area

Square root: Height (cm) x weight (kg)/3600