Emergency

Question 1

What is a ALTE a combination of? (4)

Answer 1

Apnoea
Colour change
Altered tone
Choking and gagging

Question 2

Common causes ALTE (4)

Answer 2

Infection - RSV, pertussis
Seizures
GOR
Upper airway obstruction

Question 3

Uncommon causes ALTE (6)

Answer 3

Cardiac arrhythmia
Breath-holding 
Anaemia 
Heat stress 
Central hypoventilation syndrome 
Cyanotic spells form intrapulmonary shunting

Question 4

Common Ix ATLE (3)

Answer 4

O2 sats 
Resp
ECG  
All overnight Ix 
\+ baseline Ix

Question 5

Immediate Mx acute illness (6)

Answer 5

Detailed Hx
Thorough exam
Admit to hospital
Episode = usually brief w/ rapid recovery
Overnight sats, resp, ECG to be norm for discharge
Teach parents RE follow-up + resus

Question 6

PS Anaphylaxis (6)

Answer 6

Angiodema
bronchospasm 
bronchorrhea 
laryngospasm 
Incr vascular perm
Decr vascular tone

Question 7

Common agents anaphylaxis (7)

Answer 7

Food 
ABx - penicillin 
NSAIDs
Opiates 
Biologicals - venom 
Preservatives - MSG
Latex

Question 8

RF for more serious anaphylaxis attack (5)

Answer 8

Younger (smaller airway) 
Asthma 
Chronic GI Sx 
HoTN
FH

Question 9

EpiPen regime anaphylaxis

Answer 9

Adrenaline 1:1000 IM 
Repeat every 5 mins if needed
Removed lid (blue to sky)
Place into upper outer thigh 
Swing + insert until it clicks 
Hold in place for 3 s 
Massage area for 10s

Question 10

Mx anaphylaxis - A (2)

Answer 10

Establish airway

Intubate if needed

Question 11

Mx anaphylaxis - B (3)

Answer 11

15L high flow O2
Wheeze? Neb salbutamol
O2 sats

Question 12

Mx anaphylaxis - C (5)

Answer 12

IV fl  20ml/kg saline 
IV chlorphenamine 
IV hydrocortisone 
ECG
BP

Question 13

Ix anaphylaxis (4)

Answer 13

Mast cell tryptase test
Skin prick test
Serum specific IgE
PO food challenge

Question 14

What is non-accidental OD?

Answer 14

Child abuse

Question 15

Which children are at greatest risk of accidental poisoning? (3)

Answer 15

Poor parental input
Risk of abuse or neglect
Toddlers who can walk but don’t understand consequences ingestion

Question 16

What % adolescents self harm?

Answer 16

7%

Question 17

What are the most common forms of self harm? (2)

Answer 17

Cuts

Burning

Question 18

Poison - alcohol - effect (3)

Answer 18

Hypoglycaemia
Coma
Resp failure

Question 19

Mx alcohol poisoning (3)

Answer 19

Measure blood level for severity
Monitor blood gluc
IV dextrose

Question 20

Poison - paracetamol - effect (2)

Answer 20

Gastric irritation 
Liver failure (3-5 days)

Question 21

Mx paracetamol poisoning (3)

Answer 21

Check plasma conc 4hrs after
If >150 - IV acetylchristine
Monitor PTT, LFT

Question 22

Poison - NSAIDs - effect (4)

Answer 22

Abdo pain/ vomiting
Gastric ulcer/haematemesis
AKI
Seizures/coma

Question 23

Mx NSAIDS poisoning - (2)

Answer 23

<2hrs - activated charcoal

Orogastric lavage

Question 24

Poison - methadone - effect (6)

Answer 24

Resp depression 
Constricted pupils 
Constipation 
N + V
HoTN
Confusion/coma

Question 25

Mx - methadone poisoning (2)

Answer 25

IV Naloxone | Activated charcoal <2hrs

Question 26

Poison - detergents - effects

Answer 26

Inflamm + ulcers UGI

Question 27

Mx detergents poisoning

Answer 27

Gastric emptying + decontamination by NGT

Question 28

RF in adolescents who OD (6)

Answer 28

``` Men Decr social class Isolation Psychiatric/physical illness Prev Hx Alcohol/Dx abuse ```

Question 29

What is SIDS

Answer 29

No cause of death on post-mortem

Question 30

At what age is SIDS most common

Answer 30

2-4 months

Question 31

RF SIDS (10)

Answer 31

``` LBW/Premature Male Multiple births Parents - low income Poor housing Single mother Young maternal age Maternal smoking during/after preg Baby sleeping face down Infant overheats ```

Question 32

Advice to parents RE SIDS (5)

Answer 32

``` Sleep on back _ feet to foot position Keep baby in your bedroom Avoid sleeping with them on sofa/arm chair Avoid overheating them Don't smoke ```

Question 33

RF Burns + scalds (6)

Answer 33

``` Majority occur in low SE status Low education levels High pop density Psycho stress Single parents Young mothers ```

Question 34

PS Burns/scalds (5)

Answer 34

``` Damaged skin; blisters,peels Shock Airway obstruction Wheezing Swelling ```

Question 35

Features of superficial burn

Answer 35

Skin epithelialized from surviving cells

Question 36

Features of partial thickness burn

Answer 36

Damage to dermis, blistering, pink

Question 37

Features of full thickness burn

Answer 37

Skin + dermis destroyed, white + charred, painless

Question 38

Tx scalds/burns - initial

Answer 38

Run under cold water at least 5 mins | Wrap in cling film

Question 39

Mx scalds/burns

Answer 39

IV morphine Tx shock - fl Tentanus booster if needed `

Question 40

Which burns should be investigated for safeguarding concerns (3)

Answer 40

Recurrent Severe Hx not reasonable

Question 41

Preventative measures for parents for burns (7)

Answer 41

``` Smoke alarms Education Stop drop + roll Close supervision High chairs Keep electrical chords out of reach Careful placement of hot items ```

Question 42

Drowning - M:F

Answer 42

M:F = 3:1

Question 43

Immediate Mx drowning (4)

Answer 43

M2M resus + CHx compression Cover + warm If water inhaled - hospital - pulm oedema - resp distress Pneumonia may develop