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Child Health COPY COPY > Paediatric Emergencies - Fever, Anaphylaxis and Shock > Flashcards

Paediatric Emergencies - Fever, Anaphylaxis and Shock Flashcards

1
Q

How is fever defined and how is it measured in a child?

A

> 38 degrees

Measured with electronic tympanic membrane thermometer

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2
Q

What questions are important to ask a feverish child?

A

How long have they been febrile?
Any localising symptoms - cough, D&V, painful limb, abdominal pain, headache
Recent foreign travel

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3
Q

What investigations would you request for a feverish child?

A

Inflammatory markers - WCC, Neutrophils, CRP
Swabs for microscopy and culture
Chest X-Ray?
Septic screen

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4
Q

What can a fever of more than 1 week be characteristic of?

A 
TB
Kawasaki disease
Malaria
Typhoid
Autoimmune non-infectious disorders
Malignancy
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5
Q

What are some common major illnesses that cause fever?

A

Meningitis
Pneumonia
UTI
Septicaemia

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6
Q

What are some common minor illnesses that cause fever?

A

URTI
Non specific viral infection
Gastroenteritis

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7
Q

What signs/symptoms are indicative of “serious sepsis”? (Stupid phrase, all sepsis is serious 🙄)

A

ILLNESS

Irritability
Lethargy
Low cap refill
Neutropenia or neutrophilia
Elevated or low temperature

Serious
Sepsis

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8
Q

What types of causes can lead to pyrexia of unknown origin?

A

Infective
Inflammatory
Malignancy
Factitious fever

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9
Q

What inflammatory causes lead to pyrexia

A

Kawasaki disease
RA
Crohn’s

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10
Q

What system is used to assess a fever?

A

Traffic light system

Green - send home with advice
Amber - Send home with safety net or to hospital for assessment
Red - urgent hospital assessment

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11
Q

What categories are in the NICE traffic light system for identifying serious fever?

A 
Colour
Activity
Respiratory
Hydration and Circulation
Other
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12
Q

How does colour of the patient determine their relative level of risk?

A

Green - normal colour
Amber - pallor reported by parent/carer
Red - pale, mottled, ashen or blue

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13
Q

How would a child at low risk of serious illness be acting?

A

Respond normally to social queues
Content and smiling
Stay awake or awaken quickly
Strong normal cry or not crying

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14
Q

What actions would place a child at medium risk of serious illness?

A

Not responding normally to social cues
Walking only with prolonged stimulation
Decreased activity
Not smiling

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15
Q

What activities would place a child in the high risk category of serious illness?

A

No response to social cues
Appear ill to healthcare professional
Unable to rouse/won’t stay awake
Weak, high-pitched or continuous crying

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16
Q

What respiratory changes would place a child at medium risk of serious illness?

A 
Nasal flaring
Tachypnoea:
6-12 month >50
>12 months >40
O2 says <95%
Crackles
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17
Q

What respiratory changes would place a child at high risk of serious illness?

A

Grunting
Tachpnoea >60
Moderate or severe chest in drawing

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18
Q

What changes to hydration and circulation places someone in the amber category (for serious illness)?

A

Dry mucous membranes
Poor feeding - infants
Cap refill >3s
Reduced urine output

Tachycardia:
<1 year - >160bpm
1-2 years - >150bpm
2-5 years - >140bpm

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19
Q

How do you test cap refill in a newborn infant?

A

Press on sternum for 5 seconds

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20
Q

What hydration changes would you expect to see if a child was at high risk of serious infection?

A

Reduced skin turgor

21
Q

What other signs could place a child in the amber category (serious illness)?

A 
Fever >= 5 days
Rigors if 3-5 months
Temp >=39
Swelling of limb or joint
Non weight bearing
New lump >2cm
22
Q

What other signs would place a child in the red category for serious illness?

A 
0-3 months temp >=38
Non blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures
Bile stained vomit
23
Q

What is shock?

A

Clinical syndrome resulting from a failure of the cardiovascular system leading to poor tissue perfusion

24
Q

What are the phases of shock?

A

Compensated - blood flow increased and maldistributed to vital organs
Uncompensated - microvascular perfusion compromised
Irreversible - vital organs not perfumed and irreparable damage caused

25
Q

What are the most common causes of shock?

A

Hypovolaemia

Septicaemia

26
Q

What are the early signs of shock?

A 
Tachycardia
Postural hypotension
Tachypnoea
Cool and mottled
Agitated
27
Q

What are the signs of shock classically seen at diagnosis?

A 
Weak fast pulse
Hypotension
Tachypnoea and grunting
Clammy and blue
Decreased GCS
28
Q

What are the late signs of shock?

A 
Thready pulse
Comatose
Blue/white appearance
Rapid deep breathing - metabolic acidosis
Oliguria
29
Q

What are the 4 types of shock?

A

Cardiogenic
Hypovolaemic
Distributive
Obstructive

30
Q

What is cardiogenic shock and what causes it?

A

Pump failure

CHD
Arrhythmia
Metabolic disturbance
Heart failure

31
Q

What causes hypovolaemic shock?

A

Burn
Diarrhoea
GI Bleed
DKA

32
Q

What causes distributive shock?

A

Mass vasodilatation

Sepsis
Anaphylaxis

33
Q

What causes obstructive shock?

A

Tension pneumothorax
PE
Valve stenosis

34
Q

How is cardiac output calculated?

A

Stroke Volume x Heart Rate

35
Q

How is shock managed?

A

A-E Approach

Give O2
Elevate legs
Control temperature and glucose
IV 20ml/kg saline

DEPENDS ON CAUSE - treat the cause

36
Q

How much IV saline should you give to children in shock before moving onto the next step?

A

40-60ml/kg with no improvement

37
Q

What is the next step of management for shock after giving fluids?

A

Elective intubation and ventilation
Start inotropes
Transfer to ICU

38
Q

What causes anaphylaxis?

A

Degranulation of mast cells and basophils with systemic release of inflammatory mediators, capillary leak, mucosal oedema and smooth muscle contraction

39
Q

What central nervous system signs and symptoms are seen in anaphylaxis?

A 
Lightheaded ness
Loss of consciousness
Confusion
Headache
Anxiety
40
Q

What respiratory signs are seen in anaphylaxis?

A

Shortness of breath
Wheeze/strider
Hoarseness
Cough

41
Q

What GI symptoms are seen in anaphylaxis?

A

Painful swallow
Cramp abdominal pain
D&V

42
Q

What skin signs are seen in anaphylaxis?

A

Hives
Itchiness
Flushing

43
Q

What happens to the heart and vasculature in anaphylaxis?

A

Tachycardia

Low blood pressure

44
Q

What other things are seen in anaphylaxis?

A 
Swelling of conjunctiva
Runny nose
Swelling of lips, tongue or throat
Pelvic pain
Loss of bladder control
45
Q

How is anaphylaxis treated immediately?

A

A-E and call for help!
Remove trigger

IM adrenaline 10micrograms/kg
20ml/kg fluids

Repeat every 5 mins if no improvement

100% O2 by face mask

46
Q

How is anaphylaxis treated once stable?

A

IV Hydrocortisone
Goes up in same age ranges
25mg, 50mg, 100mg, 200mg

IV Chlorphenamine 
1-5 months = 250 micrograms/kg
6 months - 5 years = 2.5mg
6 - 11 years = 5mg
12-17 years = 10mg

Consider salbutamol

47
Q

What test is done to determine anaphylaxis?

A

Mast cell tryptase measured at:
1 - At resus
2 - 1-2 hours after
3 - 24 hours after

48
Q

What are the differentials for anaphylaxis?

A

Sepsis
Asthma
Panic attack

Child Health COPY COPY (30 decks)

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