Paediatrics Emergencies

Question 1

Airway

Answer 1

Secretions, foreign body, stridor, see-sawing

Open airway - jaw thrust

Position
- infant - neutral position
- children - ‘sniffing’ position
- NB - C spine control

Question 2

Breathing

Answer 2

Respiratory rate, symmetry, wheeze, work of breathing

Auscultate
Oxygen
Support breathing

Question 3

Circulation

Answer 3

Pulse rate and volume
Blood pressure
Cap refill
Glucose

Fluid
Chest compression
Defib
Large bore cannula

Question 4

Disability

Answer 4

Consciousness
Pupils
Posture

AVPU/GCS
History - seizure, trauma, poison, sepsis, diabetes

Question 5

Exposure

Answer 5

Fully expose child to enable secondary assessment, analgesia

Question 6

Anaphylaxis management

Answer 6

Medical emergency

Treat ABCDE

IM adrenaline 1:1000
- anterolateral aspect of thigh
- repeat IM at 5 minute intervals until adequate response
- do not give IV adrenaline in primary care

Give high flow oxygen
Give IV fluids
Give IV chlorphenamine 10mg + IV hydrocortisone 200mg

Question 7

Cyanosis / blue baby

Answer 7

Commonly due to congenital heart disease in neonates

Prostaglandin infusion

If suspected CHD refer to tertiary care

Question 8

Neonatal resuscitation

Answer 8

At birth, delayed cord clamping

Dry the baby

Within 30 seconds - asses tone, breathing and HR

Within 60 seconds - if gasping or not breathing, open airway and give 5 inflation breaths

Re assess if no increase in HR, look for chest movement

If no chest movement - check mask, head and jaw - repeat inflation breaths

If no increase in heart rate - look for chest movement

When chest is moving - ventilate for 30 seconds if heart not detectable or slow

If still <60bpm - start chest compression with ventilation breaths 3:1, increase oxygen 100%, consider intubation

Reasses HR every 30 seconds - vascular access and drugs

Question 9

BLS

Answer 9

Check for responsiveness

Open airway

Check breathing for 10s

Give 5 rescue breaths

Check for signs of circulation 10s - infants use brachial or femoral pulse, children use femoral pulse

Chest compressions - 15 compressions and 2 rescue breaths - rate 120 compressions per minute and 30 breaths per minute
- depress the lower half of the sternum by at least one-third of the anterior-posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child)
- in children: compress the lower half of the sternum
- in infants: use a two-thumb encircling technique for chest compression

Question 10

Sepsis management

Answer 10

Moderate to high risk:
- Lactate >2mmol/L or evidence of AKI - treat as high risk
- Lactate <2mmol/L - repeat assessment hourly

High risk:
- broad spectrum antibiotics at maximum dose without delay
- lactate >4mmol/L - give IV fluid bolus and refer to critical care
- lactate 2-4mmol/L - give Iv fluid bolus
- lactate <2mmol/L - consider IV fluids

If meningococcal sepsis
- IM benzyl in community
- IV ceft in hospital

Antibiotics
- age up to 17 years old - IV ceft
- neonates - IV benzyl and genta
- children < 3months - give additional antibiotics to cover listeria

Paediatric sepsis 6
- give high flow oxygen
- obtain IV/IO access and take bloods
- give IV/IO antibiotics
- consider fluid resuscitation
- involve senior clinicians early
- consider inotropic support early