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FRCEM final SBA > PEM > Flashcards

PEM Flashcards

(48 cards)

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1
Q

DKA severity

A

Mild: pH 7.20-7.29 +/- Bicarb 20, dehydration -5%

Moderate: pH 7.1-7.19 +/- Bicarb 15, dehydration -5%

Severe: pH <7.1 +/- Bicarb 10, dehydration -10%

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2
Q

APGAR

A

One point each, 7 is ok

Appearance (colour)
0 pale/blue
1 blue peripheries
2 pink

Pulse
0-no pulse
1 >100
2 <100

Grimace (responsiveness)
0 nil
1 some movement
2 Cry

Activity (tone)
0 limp
1 some flexion
2 flexed

Resp
0 no cry
1 weak cry
2 strong cry

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3
Q

NICE criteria for admission for bronchiolitis

A

Apnoea-observed or reported
50-75% of normal oral fluid intake
Persistent Sats <92%
Resp distress: grunting, marked chest recession, RR>70

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4
Q

NICE RF for severe bronchiolitis

A

age<3 months
chronic lung disease
haemodynamically unstable heart disease
immunosuppressed
Prem esp <32/40
neuromuscular disorders

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5
Q

Weight calc <1yo

A

0.5kg/month +4kg

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6
Q

weight calc 1-5yo

A

2kg/yr +8kg

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7
Q

weight calc 6-12

A

3kg/yr + 7kg

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8
Q

Old weight est

A

2x(age+4)

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9
Q

Finger count weight est

A

left hand-age/yrs, odd numbers from 1, right hand weight in kg, start at 10kg & go up by 5kg each finger

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10
Q

est ETT size

A

Age/4 + 4 uncuffed, (-0.5 for cuffed)

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11
Q

Cardiversion Energy est

A

4 joules per kg

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12
Q

Fluid bolus

A

10ml/kg

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13
Q

IV glucose bolus

A

2ml/kg of 10% dex

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14
Q

lorazepam

A

100mcg/kg

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15
Q

Adrenaline in arrest

A

0.1ml/kg of 1:10 000

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16
Q

Adrenaline dose-anaphylaxis

A

1:1000
<1yo: 50-100mcg/0.05-0.1ml
1-5yo: 150mcg/0.15ml
6-12: 300mcg/0.3ml
>12: 500mcg/0.5ml

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17
Q

BRUE definition

A

<1yo ,1min of unexplained-change to breathing/apnoea/cyanosis/pallor/reduced tone then returns to baseline

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18
Q

Criteria for low risk BRUE

A

> 60 days old
Delivered 32/40 or more/ 45 or more weeks post conception
Normal examination
No CPR by a healthcare provider

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19
Q

Energy for paeds DC cardioversion

A

1J/kg, then 2J/kg upot to 4J/kg is considered.

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20
Q

US findings in pyloric stenosis

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A

pyloric sphincter >4mm thick & 16mm long

21
Q

Pyloric stenosis more common in m or f

22
Q

Paediatric GCS <2

Study These Flashcards
A

Eye opening
E4 Spontaneous
E3 To voice
E2 To pain
E1 None
C Eyes closed (by swelling or bandage)

Verbal
V5 coos, babbles
V4 irritable cry
V3 Cries to pain
V2 Moans to pain
V1 No response to pain
T Intubated

Motor
M6 spontaneous puposeful movements
M5 withdraws to touch
M4 Withdraws to pain
M3 Flexion to pain (decorticate)
M2 Extension to supraorbital pain (decerebrate)
M1 No response to supraorbital pain (flaccid)

23
Q

Red flags for neonatal risk of early infection

Study These Flashcards
A

Maternal IV ABX during labour
Concurrent pregnancy with proven infection

24
Q

Kocher’s criteria for ?septic arthritis

Study These Flashcards
A

Investigate further if any of the following 4 criteria are present
-WCC>12
-ESR>40
-Inability to weight bear
-Hx of fever

25
Westley Croup score
Mild (croup score 0-2) Moderate (croup score 3-5) Severe (croup score 6-11) Impending respiratory failure (croup score 12-17) -Stridor (none0, upon agitation 1, at rest 2) -Level of consciousness (normal 0, decreased 5) Cyanosis (none-0, w/ agitation-+4, at rest +5) air entry (reduced-1, markedly reduced 2) chest wall retractions (mild1, moderate2, severe 3)
26
3 criterion for nephrotic syndrome
oedema 3+ proteinuria or urine protein to Cr ratio of >200mg/mmol Hypoalbuminaemia <25g/L
27
Criteria for atypical UTI
If any of the following non E.coli raised Cr Bladder/abdo mass no response following 48hr ABX Seriously ill septicaemia Poor urine flow
28
SALTER Harris classification
1-Slipped 2-Above, through metaphysis (proximally) 3-Lower, through epiphysis (distally) 4-Together, through metaphysis & epiphysis 5-R-ruined/crushed Higher number worse prognosis.
29
Acceptable pre ductal sats
2mins 65% 5mins 85% 10mins 90%
30
Dose of intranasal diamorphine
0.1mg/kg monitor 20mins after
31
paeds paracetamol dose
initial 20mg/kg <10kg-10mg/kg, max 30mg/kg/day 10-50kg- 15mg/kg, max 60mg/kg/day >51kg- 1g, 4g max per day.
32
European peadiatric rheumatology soc. diagnostic criteria for HSP
palpable purpura plus one of the following: -bld/protein in urine -renal involvement -abnormal renal histopathology -arthralgia
33
Diagnostic criteria for pertussis
Cough for 2/52 AND a least one of the following: -inspiratory whooping -coughing fits apnoea +/- vomiting in infants -post pertussive vomiting without another cause.
34
Intussuseption M:F
M2:1F
35
Intussuseption Ix
Ultrasound
36
Perthes disease
4-12yo avascular necrosis of femoral head 5x more common in boys Most sensitive clincal sign is pain on intenal rotation 10-15% bil RF maternal smoking & prematurity conservative Mx-can remodel, but older & more severe may have osteotomy.
37
SUFE
teens 3x more common in boys klein's line, along lateral neck, should transect the lateral epiphysis, if it does not, this is Trowthewn's sign
38
UK vaccination schedule
8 weeks DipTP/HIB/IPV/Hep B, rotovirus, Men B 12 weeks DipTP/HIB/IPV/Hep B pneumococcal, rotovirus 16 weeks DipTP/Hib/Hep B, Meb B 1 year Hib/Men C, Men B, pneumococcal, MMR 3 years, 4 months DipTP/MMR 12 HPV 2+ intranasal flu Extra flu for clinically vulnerable TB for those w/grandparents from countires w/ high rates of TB & those that live in parts of the UK w/ incidence of >40:100 000 Hep B at birth 4 weeks & 12 months for those born to infected mothers. Pregnant women: flu 16/40 ptussus 28/40 RSV
39
kawasaki's disease
<5yo WARM CREAM Temp >4/7 AND 4 out of this 5 -Conjuntivitis, no exudate -Rash- polymorphus, worst in groin -Erythema-palms & soles w/ swelling, then desquamation -Adenopathy-unilateral -Mucus membrane-dry cracked lips, strawberry tongue 5x more common in females 2mg/kg of IVIG & aspirin echo aim to treat before D10
40
Incomplete kawasaki's
fever & 2-3 from CREAM or >7 fever in <6month old without a source check CRP & ESR, if raised... Check alb, ALT, plts, WCC, Hb If fingers desquamating, get echo.
41
Criteria for ABX in otitis media
<3/12 <6/12 & febrile Systemically unwell Complications <2 yo & bil Otorrhoea Can give delayed course for ottrrhoea or bil <2 Give amox or clary if pen allergic or erythromycin in pregnancy
42
PEM Dose of adenosine
<1yo: 150mcg/kg, increase 100mcg every 1-2mins. Max for neonates is 300mcg/kg 1-12yo:100mcg/kg increased by 100mcg/kg every 2 mins up to 500mcg/kg 12+: 3mg, then 6mg, then 12mg
43
PEM Dose of amiodarone
5mg/kg over 20 mins Should be given before 3rd DC cardioversion, while getting in touch with a paediatric cardiologist.
44
PEM dose of atropine
<12yo: 20mcg/kg 12+yo: adult dose
45
PEM bradycardia algorithm
<1yo <80bpm >1yo <60bpm Oxygenate If still unconscious start CPR Give atropine Then give adrenaline 10mcg/kg, rpt if req. Very rarely transcutaneous pacing
46
PEM magnesium dose (torsade de point)
25-50mg/kg max dose 2g, given over 15-20mins
47
PEM: SVT/VT threshold for DC cardioversion
Compensated -vegal manoeuvres, consider adenosine Decompensated -reduced LOC -weak peripheral pulses -CRT >2s -Systolic BP <5th centile for age <1month:<50, <1yo: <70, <5yrs: <75, <10yr: <80 infant HR >220 child HR >180 Narrow or broad needs shock (1j/kg), unless chemo cardioversion is going to be quicker for some reason. Sedate w/ ket if conscious (IM or intranasal ok) adenosine if SVT 2nd shock 2-4j/kg amiodarone before 3rd shock.
48
Injuries that raise suspicion of NAI
Bruising in non-mobile infants. * Bruising on non-bony parts of the body. * Bruising of similar shape and size. * Multiple bruises or bruises in clusters. * Laceration in a non-mobile infant. * Thermal injury in a non-mobile infant. * Thermal injury where the mechanism doesn’t fit or suggests forced submersion. * Fractures with no suitable mechanism, especially if multiple fractures or occult fractures, such as rib fractures in infants. * Intracranial injury.

FRCEM final SBA (25 decks)

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