Paediatric emergencies: Flashcards
(31 cards)
In anaphalaxis, what is released in response to antigens
- Histamine
- Leukotrienes
- Prostaglandins
What systemic responses occur during anaphylaxis?
- Increased secretions from mucousmembranes
- Increased bronchial smooth muscle tone
- Decreased vascular smooth muscle tone
- Increased capillary permeability (oedema)
List 3 signs of anaphylaxis:
- Urticarial/erythematous/itchy rash
- Lip/face swelling
- Wheeze
- Stridor
Outline the management of anaphylaxis:
1) High flow oxygen
2) Remove allergen
3) IM adrenaline (0.01ml/kg, ‘1 in 1000’) can be repeated every 5 mins
OR
Nebulised adrenaline (5ml ‘1 in 1000’)
4) If reduced air entry give Nebulised/IV salbutamol
5) Rehydrate if circulation affected - 20ml/kg bolus
What should be given after resuscitation in anaphylaxis?
1) IV hydrocortisone (4mg/kg)
2) Antihistamine (e.g. chlorphenamine)
3) Observe for rebound symptoms
Give 4 features of meningitis:
- Neck stiffness
- Photophobia
- Kernigs sign (pain/resistance on passive knee extension with hips fully flexed)
- Bulging fontanelle in infants
What is Kernigs sign?
Pain/resistance on passive knee extension with hips fully flexed
Give 4 features of sepsis:
- Non-blanching rash
- Reduced level of consciousness
- Shock
- Multi-organ failure
What organism likely causes meningococcal sepsis?
Gram negative infection - Neisseria meningitidis
In meningococcal septicaemia, what Abx should be started for those >1 month?
Cefotaxime
In meningococcal septicaemia, what antibiotics should be started in neonates?
- Benzylpenicillin (staphs/streps)
- Gentamycin (gram -ve)
- Amoxicillin (?)
What are close contacts of those with Meningococcal septicaemia given?
Rifampicin
What is DKA defined by?
- Hyperglycaemia
- Ketonuria
- Metabolic acidosis (+/- respiratory compensation)
Outline of management of DKA:
1) A - Patent airway, insert NGT if vomiting/reduced consciousness
2) B - 100% oxygen
3) C - Correction of hypovolaemic shock (correctly SLOWLY for 48hrs)
4) DEFG - commence IV insulin, close monitoring of BM and Na/K, beware of cerebral oedema
What does Kussmauls breathing mean?
Deep sighing
What is a feared complication of DKA and what can be done to minimise its chances of occurring?
Cerebral oedema - minimise chances by slow rehydration/ slow correction of metabolic abnormalities
What 2 other complications can result during DKA?
- Hypokalaemia (preventable by careful monitoring and management
- Aspiration (Insert NGT in children with decreased consciousness)
What it the percentage dehydration based on in children?
On their weight
List 5 features in a history of someone with DKA:
- Polyuria
- Polydipsia
- Weight loss
- Vomiting
- Abdominal pain
- Tiredness
What would you see upon examination of someone with DKA?
- Dehydration
- Smell of ketones
- Kussmaul breathing
- Confusion
- Decreased level of consciousness
What investigations would you perform in someone with suspected DKA?
- BM
- ABG
- Urine dip/urinalysis
- HbA1C
- U+E
- FBC
- Blood culture
What investigation results would you see in someone with DKA?
- BM - >11mmol/L
- Metabolic acidosis: pH <7.3, HCO3 <15
For those in DKA, what would you want to observe on an ECG for changes?
T-waves
Outline the classifications of dehydration:
- Mild (<5%) - just clinically detectable
- Moderate (5-8%): dry mucus membranes, decreased skin turgor
- Severe (>8%): above + sunken eyes, poor capillary refill
