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Child Health > Emergency Care > Flashcards

Emergency Care Flashcards

1
Q

Describe the BLS algorithm for paediatric resuscitation

A

Shout for help
Open airway
5 rescue breathes if not breathing normally
Then 15 chest compressions if no signs of life

Continue rescue breaths + chest compressions at ratio of 2:15

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2
Q

Which position should the head be in for optimal airway opening?

A

Infants ( < 1 year) –> neutral position

Older children –> ‘sniffing’ position

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3
Q

What are the indications for commencing chest compressions/?

A

No signs of life
No pulse
HR < 60

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4
Q

Where should you palpate the pulse in children?

A

Carotid, brachial or femoral

In infants –> brachial (carotid difficult due to short neck)

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5
Q

What should be done if there are signs of circulatory compromise in a child?

A

Establish venous access rapidly

Give a 20ml/kg bolus of normal saline (10ml/kg in DKA)

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6
Q

What should be done if rapid venous access is not possible in a child (can be very difficult to cannulate)?

A

Intraosseous access

- rapid, effective and should be considered early

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7
Q

If you hear bubbling sounds on assessment of a sick child’s breathing, what should be done?

A

Suctioning for excessive secretions

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8
Q

If you find a harsh stridor and a barking cough on examination, what is the emergency management?

A

Oral dexamethasone
Nebulised budesonide + adrenaline in severe cases

(croup)

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9
Q

If you find a soft stridor, drooling + fever in a sick looking child, what is the diagnosis + emergency management?

A

Bacterial tracheitis or epiglottitis

–> intubation by anaesthetist followed by IV antibiotics

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10
Q

If you suspect an inhaled foreign body, what would be the emergency management?

A

Laryngoscopy for removal

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11
Q

If you hear bronchial breathing on examination of a sick child, which diagnosis should be considered and what is the emergency management?

A

Pneumonia –> IV antibiotics if severe

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12
Q

When would you suspect a duct dependent lesion in an unwell neonate?

A

May be subtle when duct starting to close:
- poor feeding, sleepiness + slightly fast breathing
Or collapsed baby in cardiogenic shock

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13
Q

If you suspect a duct dependent lesion e.g. PDA, what is the emergency management?

A

IV dinoprostone

- keeps duct open until definitive management from cardiologist

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14
Q

What is the most common arrhythmia seen in children?

A

SVT

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15
Q

What is the emergency management for SVT in children?

A

Vagal manoeuvres
If clinically unstable:
- rapid bolus of IV adenosine or DC shock

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16
Q

What is the initial management of a choking child and when is further intervention required?

A

Encourage coughing

Further intervention if:

  • child cannot speak, cry or breathe
  • evidence of cyanosis
  • decreased consciousness
17
Q

What is the definitive management of choking in an infant?

A

5 back blows
- holding infant face down on forearm with hand supporting jaw to keep airway open

Then 5 chest thrusts
- infant turned over, thrusts with 2 fingers at lower edge of sternum

18
Q

What is the definitive management of choking in an older child?

A

5 back blows

Then 5 abdominal thrusts (Heimlich manoeuvre)

19
Q

If a choking child becomes unconscious, what should be done?

A

Follow BLS algorithm

open airway, 5 breaths, start CPR

20
Q

What are the 3 characteristics of DKA?

A
  1. Acidosis –> pH < 7.3 or bicarbonate below 18
  2. Ketonaemia –> blood ketones > 3
  3. Hyperglycaemia –> blood glucose usually > 11 (although some children with T1DM can develop DKA with normal glucose levels)
21
Q

What are the 3 main complications causing death in DKA?

A

Cerebral oedema
Hypokalaemia
Aspiration pneumonia

22
Q

What are the symptoms of DKA?

A

Generally unwell + lethargic
Nausea, vomiting + abdominal pain
Early cerebral oedema –> headache, irritability, confusion, drowsiness, collapse
Concurrent infection which may have precipitated DKA
If undiagnosed DM –> weight loss, polyuria, polydipsia

23
Q

What are the signs of DKA?

A 
Resp:
- deep, sighing breathing (Kussmaul breathing)
- tachypnoea
- subcostal + intercostal recessions
Circulation:
- shock
- dehydration
GI:
- abdominal pain which may be severe, mimicking a surgical abdomen
Other:
- ketotic breath
24
Q

Which investigations should be done for suspected DKA?

A

Bedside blood glucose + ketones
Blood gas
Bloods: glucose, U&Es + creatinine
12 lead ECG (potassium)

25
Q

Why does management of DKA differ between children and adults?

A

Children at a much higher risk of developing cerebral oedema in the rehydration phase of treatment

26
Q

What is the management for DKA in children?

A

ABCDE
IV fluid replacement
Followed by addition of IV insulin infusion

27
Q

Which fluid is used for replacement in DKA?

A

0.9% sodium chloride with 20mmol of potassium in each 500ml bag

28
Q

When should insulin be given in the management of DKA?

A

Delay IV insulin for 1-2 hours after beginning IV fluid therapy

29
Q

Which electrolyte abnormality is it vital to monitor for in DKA?

A

Hypokalaemia

30
Q

Which investigations should be done for a baby < 3 months with a fever?

A 
FBC
CRP
Blood culture
Urine testing
Stool culture if diarrhoea present
Lumbar puncture if looks unwell
31
Q

What is the initial management for suspected sepsis in a child?

A

Sepsis 6:

  • blood cultures
  • lactate
  • urine output
  • high flow oxygen
  • IV/IO fluid
  • IV/IO antibiotics

Children prone to hypoglycaemia when unwell –> if glucose < 3, give 2ml/kg blue of 10% dextrose

32
Q

What are the most common causes of dehydration in children?

A

Excessive fluid loss:

  • diarrhoea +/- vomiting (most common)
  • excessive sweating
  • polyuria (T1DM, diabetes insipidus)
  • burns

Inadequate fluid intake:

  • structural malformation e.g. tongue tie
  • discomfort e.g. ulcers, tonsilitis
  • respiratory distress
  • neglect
33
Q

What are the red flag signs/symptoms for dehydration?

A 
Appears unwell or deteriorating
Altered responsiveness
Sunken eyes
Reduced skin turgor
Tachycardia
Tachypnoea
34
Q

How is rehydration carried out in a dehydrated child?

A

Oral rehydration solution (ORS) 50ml/kg fluid deficit + maintenance fluids
- oral or NG tube

IV fluids

35
Q

When are IV fluids indicated for rehydration?

A

Shock is suspected or confirmed
Red flag symptoms or signs
Deteriorating despite oral rehydration therapy
A child persistently vomits the ORS

Child Health (16 decks)

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