paeds emergnecies

Question 1

what are normal vital signs

Answer 1

RR:
infant -30-40
young children 25-30
older children 20-25

HR
infants 160-110
young children 140-95
older children 120-80

SBP
Infants 70-90
young children 80-90
older children 90-110

Question 2

where do you check pulse in infants

Answer 2

> 1 - carotid, femoral

<1 - brachial, femoral

Question 3

Signs in moderate and severe resp distress

Answer 3

mild:
tachycardia
RR >50
accessory muscles
flaring nostrils
don't feed

severe:
cyanotic
exhaustion 
O2 < 92%
partial pressure CO2 rising

Question 4

Most common causative organisms for sepsis

Answer 4

coagulase negative strep
s.aureus
non-pyogenic streptococcus
strep pneumoniae
(also E.coli)
(In newborn GBS + E.coli)

Question 5

what is non-blanching purpuric rash a sign of

Answer 5

meningococcal septicaemia

Question 6

what is the paeds sepsis six

Answer 6

Give high flow O2
obtain IV access + bloods (gas and lactate, glucose, cultures)
Give IV Abx
consider fluid resusc (restore to normal physiological parameters urine output >0.5ml/kg/hr)
involve senior clinicians
consider iontropic support

Question 7

what counts as high risk for paeds sepsis

Answer 7

Behaviour:
no response to social clues
doesn't wake
weal, high pitched cry
HR
tachycardia
RR
tachypnoea
grunting 
apnoea
O2 <92%

IMMEDIATE TRANSFER
review by senior clinician immediately

Question 8

Who to do LP on in context of sepsis

Answer 8

<1 month

1-3 months who appear unwell or WCC <5 or >15x10^9/L

Question 9

mx of high risk sepsis pt

Answer 9

immediate review by senior
Give BSA immediately
if meningococcal:
IM benzylpenicillin in community
IV ceftriaxone
neonates <72 hours (IV benzylpenicillin + gent)
neonates >72 hours (IV flucloxacillin + gent)

VBG:
blood gas (glucose, lactate)
blood culture
FBC
CRP
U+E
creatinine
clotting screen 

lactate:
> 4 IV fluid bolus immediately and consider inotropes
2-4 - IV fluid bolus immediately
<2 consider IV fluids

Question 10

mx of moderate risk sepsis pt

Answer 10

VBG:
blood gas -glucose and lactate
culture
FBC
CRP
U+E
creatnine

lactate:
>2 treat as high risk
<2 repeat structured assessment hourly

these pt need senior review within 3 hours

Question 11

mx anaphylaxis

Answer 11

ABC
if unresponisve and not breathing start CPR immediately
give IM adrenaline, reassess at 5 mins and re-administer accordingly til response

Question 12

mx of status epilepticus

Answer 12

1. 
secure airway
ABC
high flow O2
check BM 
confirm that it's a seizure

2. (5 min)
   If IV access - lorazepam
   if no access - buccal midazolam, rectal diazepam
3. at 15 mins
   no response - second doe of IV lorazepam
   call for help
   start preparing phenytoin
4. 25 mins
   seek senior anaesthetist
   phenytoin infusion
5. 45 mins
   anaesthetise w/ thiopental sodium