Emergencies Flashcards

Question

What are the S/S of anaphylaxis?

Answer 1

Airways = swelling, hoarseness, stridor Breathing = high RR, wheeze, cyanosis, SpO2 <92%, SOB Circulation = pale, clammy, low BP, drowsy, coma, tachycardia Skin = urticaria/angioedema (usually lips, tongue and throat)

Answer 2

**EMERGENCY, ABCDE APPROACH, 2222 for PERI-ARREST CRASH CALL** *A – check for obstruction / speaking in full sentences / stridor* **1. IM adrenaline 1:1000** (in anterolateral aspect of middle third of thigh) <6m = 100-150mg 6m-6y = 150mg 6-12y = 300mg >12y = 500mg **2. +/-intubate if necessary** *B – check breathing, listen to chest, check sats, RR* **3. BLS** if unresponsive/not breathing normally **4. High flow oxygen** via 15L non-rebreathe mask *C – check pulse, BP, cap refill for circulatory collapse* **5. Insert large bore cannula (yellow for children) and give IV fluids** *D – check GCS* *E – check skin and inside mouth for urticaria and angio-oedema / abdomen SNT?* *Position > sitting up if breathing difficulty, lying flat +/- leg elevation if low BP/feeling faint, recovery position if breathing but unconscious* **Reassess response after 5 mins (ABCDE)** > repeat adrenaline if needed (5 min intervals) **Also:** IV chlorpheniramine (10mg) Salbutamol (if wheeze) IV hydrocortisone (200mg)

Answer 3

Resp and/or cardio problems persist despite 2 doses of IM adrenaline IV fluids given for shock Expert help for consideration of an IV adrenaline infusion

Answer 4

**2h after sx resolution if:** - Good response to single dose of adrenaline - Complete resolution of sx **6h after sx resolution if:** - 2 doses of adrenaline needed or, - Previous biphasic reaction **12h after sx resolution if:** - Severe reaction requiring > 2 doses - Pt has severe asthma - Possibility of ongoing reaction - Pt presents late at night - Pt in area where access to emergency access care difficult **EVERYONE** - Given autoinjector / trained how to use it - Adequate supervision following discharge

Answer 5

High BP, low HR, irregular RR

Answer 6

**Primary** = direct invasion by neurotoxic virus / reactivation of dormant virus **Secondary** = faulty immune system reaction to virus elsewhere in body

Answer 7

**If the current oral intake is not sufficient to remain hydrated** - E.g. if patient is NBM

Answer 8

- 100 ml/kg/day for the first 10kg of weight - 50 ml/kg/day for the next 10kg of weight - 20 ml/kg/day for weight over 20kg

Answer 9

- Birth to day 1: 50-60 ml/kg/day - Day 2: 70-80 mL/kg/day - Day 3: 80-100 mL/kg/day - Day 4: 100-120 mL/kg/day - Days 5-28: 120-150 mL/kg/day

Answer 10

Total fluid required / 24

Answer 11

**Child (>28d):** - First line = isotonic crystalloids + 5% glucose (e.g. 0.9% sodium chloride + 5% glucose). **Term neonate (<28d):** *Choice depends on the clinical situation:* - No critical illness = 10% dextrose +/- additives - Critical illness (e.g. infantile respiratory distress syndrome, meconium aspiration) = seek expert advice (use fluids with no/minimal sodium initially)

Answer 12

**If there is an existing fluid deficit and the oral route is not possible or impractical** - Prolonged poor oral intake - Vomiting / diarrhoea - Increased insensible losses (e.g. fever, excessive sweating) - DKA - Burn injuries

Answer 13

**If weights available:** - Well weight (kg) - Current weight (kg) / Well weight (kg) **If NO weights available:** - S/S of dehydration but no red flag features = approximately 5% dehydrated - Any red flag features of dehydration present, or child is clinically shocked = assume 10% dehydration

Answer 14

Fluid deficit (mL) = % dehydration x weight (kg) x 10

Answer 15

Total fluid requirement (mL) = maintenance fluids (mL) + fluid deficit (mL)

Answer 16

**If the patient is shocked** *Types of shock and their underlying causes include:* - **Hypovolaemic:** gastroenteritis, burns, DKA, heatstroke, haemorrhage - **Distributive:** sepsis, anaphylaxis, neurological injury (neurogenic) - **Cardiogenic:** congenital heart disease, arrhythmia - **Obstructive:** cardiac tamponade, tension pneumothorax, congenital heart disease

Answer 17

- Standard fluid = 0.9% sodium chloride IV or IO (if IV not possible) in a standard bolus of 10-20mL/kg over <10 minutes - Smaller boluses may be required in: neonatal period, DKA, septic shock, trauma, cardiac pathology (e.g. heart failure) - After bolus administered, volume status should be re-assessed (HR, RR, CRT). If patient still shocked = urgent senior advice - After 3 boluses - danger of pulmonary oedema

Answer 18

- Appears unwell/deteriorating - Altered responsiveness (irritable, lethargic) - Sunken eyes - Tachycardia / tachypnoea - Reduced skin turgor - Dry mucous membranes (not reliable if the child is mouth breathing or just after a drink) - Decreased urine output

Answer 19

*Clinical shock is defined by the presence of one or more of:* - Decreased level of consciousness - Pale or mottled skin - Cold extremities - Pronounced tachycardia - Pronounced tachypnoea - Weak peripheral pulses - Prolonged capillary refill time - Hypotension Children have a large physiological reserve. They will compensate until they become very unwell and then deteriorate rapidly. **Hypotension is a sign of decompensated shock and indicates that the child is critically unwell**

Answer 20

- Jittery movements - Increased muscle tone - Hyperreflexia - Convulsions - Drowsiness or coma

Emergencies Flashcards

(44 cards)