Emergency Medicine

Question 1

what risk factors are there for neonates for sepsis?

Answer 1

prematurity
prolonged rupture of membranes
maternal intrapartum pyrexia
maternal colonisation of group B strept

Question 2

what are some risk factors of sepsis in children?

Answer 2

immunocompromised - chemo, drugs for autoimmune disorders
history of fever
Non-specific symptoms such as lethargy, nausea and vomiting, headache and abdominal pain also occur commonly.

Question 3

what are some signs of sepsis ?

Answer 3

hypotension, tachycardia, cool peripheries, confusion
Signs of the source of infection, such as crackles on chest auscultation or an area of cellulitic skin
non-blanching rash is suggestive of meningococcal disease

Question 4

what are some DD of sepsis ?

Answer 4

uncomplicated infection
leukaemia 
aplastic anaemia 
malignancy 
autoimmune disorder (JIA)
Kawasaki disease

Question 5

what lab tests should be done for sepsis ?

Answer 5

blood gas 
FBC 
CRP
blood culture 
urinanalysis 
stool culture 

CXR
Abdo US
LP

Question 6

what should lab testing be done on an under 5 yr?

Answer 6

if there are any red features present

Question 7

state some red features ?

Answer 7

pale mottled blue skin
no response to social cues 
weak high pitched cry 
grunting 
tachypnoea 
chest indrawing 
reduced skin turgor  
non blanching rash 
bulging fontanelles 
neck stiffness 
focal near signs

Question 8

what are children prone to during sepsis/infection?

Answer 8

hypoglycaemia

Question 9

how should hypoglycaemia be treated in children?

Answer 9

2ml/kg bolus of 10% dextrose if blood sugar is <3mmol/L.

Question 10

during sepsis what would th blood gas results show?

Answer 10

metabolic acidosis

Question 11

what are 3 characteristics of DKA?

Answer 11

acidosis pH <7.3 or HCO3 <18

ketonaemia blood ketones >3

hyperglycaemia >11mmol/l

Question 12

what is the chemical name of ketones ?

Answer 12

beta-hydroxybutyrate

Question 13

what three complications can occur with DKA?

Answer 13

cerebral oedema, hypokalaemia and aspiration pneumonia.

Question 14

what is the mortality for cerebral oedema?

Answer 14

25%

Question 15

what breaks down to form ketones?

Answer 15

adipose tissue

Question 16

what are some risk factors for DKA in children?

Answer 16

Non-compliance with insulin treatment or a high sugar diet
Intercurrent illness, especially infection
Rapidly changing insulin requirements during puberty
Failure of insulin pump

Question 17

what is the breathing described as in DKA?

Answer 17

Kussmauls respiration

Question 18

what are DD for DKA?

Answer 18

Hyperosmolar Hyperglycaemic State
dehydration
sepsis
new presentation of T1DM

Question 19

what investigations should be done for DKA?

Answer 19

bedside blood glucose and ketones
venous blood gas
FBC, U&Es, Creatinine
12 lead ECG

Question 20

what pH is classed as acidosis ?

Answer 20

<7.3

Question 21

what pH is classed as severe DKA?

Answer 21

<7.1

Question 22

what are children at a higher risk of developing compared to adults following DKA?

Answer 22

cerebral oedema

Question 23

what fluid bolus should DKA shock children receive ?

Answer 23

fluid bolus of 10ml/kg 0.9% sodium chloride.

Question 24

how do you calculate fluid deficit for a child?

Answer 24

body weight x %fluid deficit x 10

Question 25

what are the fluid maintenance for children with DKA <10kg 10-40kg >40kg

Answer 25

If the child weighs less than 10kg, give 2ml/kg/hour If the child weighs between 10 and 40 kg, give 1ml/kg/hour If they weigh more than 40kg, give a fixed volume of 40ml/hour

Question 26

what dose of IV insulin should be given for DKA?

Answer 26

0.05 – 0.1 units/kg/hour of a soluble insulin

Question 27

what monitoring should be done during K replacement ?

Answer 27

ECG

Question 28

when can IV insulin be changed to subcutaneous insulin can then be started and IV insulin stopped one hour later?

Answer 28

blood ketones are less than 1mmol/litre or pH is normal.

Question 29

what are some complications of DKA?

Answer 29

cerebral oedema hypokalaemia aspiration pneumonia hypoglycaemia

Question 30

what is the leading cause of death of children presenting with DKA?

Answer 30

cerebral oedema

Question 31

what signs and symptoms can be suggestive of cerebral oedema?

Answer 31

Headache, confusion, irritability, increasing drowsiness, hypertension with bradycardia and focal neurological signs such as cranial nerve palsies and papilloedema

Question 32

what could cause decreased fluid intake or increased fluid loss in children?

Answer 32

structural malformation discomfort respiratory distress neglect D/V excessive sweating polyuria burns

Question 33

what are some red flags of dehydration ?

Answer 33

``` Appears unwell or deteriorating Altered responsiveness Sunken eyes Reduced skin turgor Tachycardia Tachypnoea ```

Question 34

what fluid bolus should be used in shocked children?

Answer 34

20ml/kg 0.9% saline

Question 35

in what circumstances should children be given IV fluid?

Answer 35

shock is suspected red flag symptoms present despite oral rehydration child is vomiting oral rehydration

Question 36

what is fluid maintenance for children after dehydration ?

Answer 36

100ml/kg for first 10kg bodyweight 50ml/kg for second 10kg bodyweight 20ml/kg for every kg above 20kg bodyweight

Question 37

what is the initial bolus for children with DKA?

Answer 37

10ml/kg due to the risk of cerebral oedema.

Question 38

what medication can be given if a duct dependent lesion is suspected?

Answer 38

IV dinoprostone

Question 39

what is the most common arrhythmia seen in children?

Answer 39

SVT

Question 40

what is the management of SVT?

Answer 40

trial of vagal manoeuvres followed by a rapid bolus of IV adenosine or synchronous DC shock

Question 41

over how long should fluids be corrected for children

Answer 41

over 48hrs