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106 Cards in this Set
- Front
- Back
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Croup Mx |
Oral dex 0.15 mg/kg Or budesonide 2 mg neb Or soluble pred 2mg/kg up to 40mg And adrenaline neb 1:1000 0.4 ml/kg max 5 ml repeated in 30 mins relief up to 2 hrs |
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Bronchiolitis |
1-9 months RSV 60-70% parainfluenza influenza adenovirus Recurrent apnoea Yanker to nares to clear secretions O2 >94% Apnoea monitor |
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Mod asthma |
Spo2 >92% Peak flow >50% Mx 2-5 yrs 02 2-10 puffs B2 - one puff every 30-60 secs and pred 20 mg I- >5 as above pred 30-40 mg |
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Acute severe asthma |
Unable to talk recession Accessory muscle use RR 5 yrs >30 2-5 >50 HR >5 120 2-5 > 130 PEF 33-50 Mx 2-5 yrs 02 10 puffs or neb salb 2.5mg and soluble pred 20 mg >5 yrs o2 10 puffs or salb neb 5 mg and pred 30-40 mg |
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Life threatening |
Exhaustion Poor resp effort Silent chest PEF <33 % Sats <92% Reduced GCS /agitated ? Consider anaphylaxis Mx 2-5 yrs o2 salb neb every 20 mins 2.5 mg and ipratropium 0.25 mg soluble pred 20 mg or iv hydrocortisone 50 mg >5 o2 salb and ipratropium neb 5mg/0.25 mg soluble pred 30-40 mg or iv hydrocortisone 100 mg |
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Anaphylaxis |
O2 Adr every 5-10 mins IM adr >12 0.5 mg 1:1000 6-12 0.3 <6 0.15 mg or 0.01 mg/kg Neb adr 3-5 mls 1:1000 Neb bronchodilator Note epipen junior <6 is 0.15 mg Epipen >6 is 0.3 mg Remove allergen - wash hands and face |
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Meningitis |
Rash purpuric or petechia Temp Toxic shock Mx high flow 02 IM Ben pen >9 1.2 g, 1-9 600 mg <1 300 mg or cefotaxime 50 mg/kg Iv fluid 10 mls/kg Raised icp s&S 30 deg head up Check bm |
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Raised icp |
Papilloedema Bulging Fontannel Absence of venous pulsation in retinal vessels |
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coma big three |
Hypoglycaemia Sepsis Toxicity ie opiate od |
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Paeds GCS < 4 yrs |
E as normal M as normal V 5 alert babbles coos as usual 4 less than usual words 3 cries only to pain 2 moans to pain 1 nothing |
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Naloxone T1/2 |
Frequent relapse after 20 mins IM naloxone 10 mcg /kg repeating up to 100 mcg/kg IV 10 mcg/kg repeating up to 100 mcg/kg IN 1mg per nostril using atomiser |
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Glucagon dose |
6yrs 1mg <6 0.5 mg <1 month not recommended |
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BM in children in which to treat hypo |
Neonate <2.6 mmol <3 in child unless clinically suspected |
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Hyperglycaemia |
Random blood sugar >11 |
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DKA MX |
protect airway if reduced GCS May need NG if vomiting Cannula check BM ECG 5mls NS if shocked or reduced GCS - poor peripheral pulses reduced CRT ST hypotension and repeat once if signs of shock persist |
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Recurrent faints |
Think conduction abnormalities and prolonged QT syndrome |
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Cardiac failure |
Shock Cyanosis not correcting with 02 Tachycardia our of proportion to resp difficulty Raised jvp Gallop rhythm Murmur Enlarged liver Absent femoral pulses Hi of tiredness when feeding failure to thrive
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Mx HF |
high flow o2 Transport with cardiac monitoring If has an arrhythmia but stable do not treat Sit up Do not give iv fluids unless dehydrated then give 5 mls/kg cautiously and stop if deteriorates |
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Bradycardia |
Consider toxicological cause is BB Cause : increased Vagal tone - give atropine 20 mcg/kg Cause OP poisoning - give large doses atropine starting 20mcg/kg repeating 5 min intervals until hypersalivation and bradycardia relieves Cause: hypoxia - 02 support resp, shock mx, if persists adr 10mcg/kg |
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Tachycardia |
Cause- shock - treat shock Cause abN rhythm - o2 and treat for SVT/VT Cause fever/pain- treat cause and consider poisoning |
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VT |
DT cong HD/cardiac sx poisoning: TCA/ cardiac drugs, electrolyte disturbance, cardiomyopathy O2 ECG with defib pads Iv access Urgent transport VT algorhythm |
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SVT |
HR >220 No systemic cause for ST ie fever or shock Terminated suddenly Mx O2 ECG If shocked vagal manoevres - +iced cloth Adenosine 0-12 100/200/300 mcg/kg for 1st 2nd 3rd doses >12 3/6/12 mg If not shocked Vagal /valsalver/iced cloth and transport |
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TXA |
15 mg/kg |
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D assessment in an injured child |
Mini neuro Pupils Posture BM treat if <3 mmol or <2.6 in neonate with 2/2.5 mls/kg |
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Moving |
Use scoops and 20 deg tilt rather than sliding |
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Spinal injuries |
Immobilise only co operative children with Neck pain Reduced ROM Injury above the clavicle Peripheral neurological deficit NB 80% are cervical commonly upper third Do not use collar - MILS and blocks and tape Transport on vac Mat or scoop Give antiemetics |
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Suspect pelvic injury |
High energy blunt trauma Blunt trauma with CVS instability Rectal bleeding Vaginal bleeding bleeding from urethra Pelvic asymmetry Pelvic pain or bruising Examine for asymmetry do not stress pelvis |
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Factors increasing risk of intra abdominal injury |
Less muscles abdominal wall less thoracic protection Less pelvic protection less intraperitoneal fat Mx o2 IV IO access analgesia and treat shock Penetrating injury - stop exsanguination dry gauze over wound/bowel HOTT algorhythm |
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HI Mx |
Beware 2ndary BI - hypoxia hypercapnoea raised ICP (ipsilateral pupil dilation dt loss of parasympathetic constrictor tone of ciliary muscles) Cushing sign - bradycardia hypertension widened pulse pressure, hypo/hyperglycaemia hypo/hyperthermia convulsions 30 deg up CPP= MAP-ICP Rx raised ICP with 20% mannitol 1.25-2-5 ml/kg or 3% NS 1-2 mls/kg Beware infants can present with s&S of hypovolaemia from HI Always if shock is present in HI assume it is from another cause |
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Clear A HI and leave at home |
No to all Persistent headache since injury Amnesia Hi of bleeding disorders Previous neurosx interventions NAI Irritability/altered behaviour Adverse social factors Visible head trauma |
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GCS 4-15 |
E and M as normal V orientated and converses 5 Disorientated and converses 4 Inappropriate words 3 Incomprehensible sounds 2 Nothing 1
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Chest injury algorhythm |
Resp distress hypoxia - give high flow o2 - consider need for Critical care support Tension signs - needle decompress and transfer Haemopneumothx iv access Open pnx chest seal and watch for tension Flail analgesia Support BVM if needed Rx shock |
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Burns |
Establish time of burning and type of fluid Cling film Smoke inhalation |
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Critical care support needed |
Life threatening Superficial >10% Full thickness >5% Involving face airway Inhalation injury Circumferential to chest neck or trunk Male sure analgesia Iv fluids 5 mls/ kg |
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Major burn |
Chemical Full thickness Burns to ears eyes hands feet genitalia major joints Electrical burns NAI Mx irrigate cover remove jewellery strong analgesia |
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Regional centre criteria |
>1% Circumferential Face hands perineum chest Inhalation injury Electrical chemical or radiation Neonatal of any size NAI concerns |
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Fluids in burns |
>15% or if transfer to be > 1 hr % x wt x 4 = 24 half given in first 8 hrs |
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Analgesia |
IN diamorph IM ket |
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SUFE |
10-17 yrs Low energy mechanism Hip thigh or knee pain and hx of trauma Limping Reduced ROM |
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Toddlers fracture |
9/12 -3 yrs Rotation around planted foot Low energy mechanism Refusal to mobilise |
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Supracondylar humeral fracture |
10 yrs Fall onto extended arm Check NVI Reduced range of elbow movement |
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Drowning mechanism |
Breath holding HR slows due to diving reflex Hypoxia then causes ST rise in bp and acidosis 20 secs- 2.5 mins breathing occurs Water hits Glotis causes laynyngospasm Secondary apnoea relaxes causing resp movements when water enters lungs Resp arrest Cardiac arrest |
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Drowning mx |
Beware vomiting - May need NG ? Spinal immobilisation Keep flat Assess hypothermia Check BM May need transfer to hospital capable of rewarming like ECMO or bypass |
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Trauma goals |
Fluids in 5mg/kg aliquots Target to radial or brachial in infants Warmed fluids Txa 15 mg /kg up to 1g Massive transfusion 20mls/kg |
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Head tilt chin lift |
Neutral position in infants Sniffing the air in children |
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Compressions |
Infant 4cm Child 5 cm At least 1/3 depth Infant encircling technique thumbs over lower half of sternum or two fingers Children - heel of one hand lower part of sternum larger children two hands One SAD fitted asynchronous compressions with vent 10-12/min 100-120 bpm Change over every 2 mins Go for help at 1 min |
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Recovery position |
If been there for > 30 mins turn over onto other side |
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Commonest rhythm in cardiac arrest |
Asystole dt prolonged hypoxia and acidosis Occasional p waves seen often bradycardia first Check leads attached |
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Pea |
Often pre asystolic state Common causes : Hypovolaemia Hypoxia Trauma with tension or tamponade Hypothermia Electrolyte abN hypocalcaemia and CCB OD PE |
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Adr use |
0.1 mg/kg iv or IO 1:10000 flush 2-5 mls which is 0.1 mls Alpha adr Emerg iv mediated vasoconstriction increased aortic diastolic pressure and coronary perfusion in chest compressions Enhances contractile state of heart Stimulates spontaneous contractions |
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Once rosc |
Inc RR to 12-24 |
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Sodium bicarbonate |
Used in tca OD and hyperkalaemia 1mmol/kg 1 ml/kg of 8.4% Nb - not to be given in same cannula as calcium - inactivated adr and dopamine |
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CCB OD |
Calcium 0.2 ml/kg of 10% ca chloride |
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VT VF causes |
Sudden collapse Hypothermia TCA od Cardiac disease Rx 4 j/kg adr after 3rd and alternate shocks and amio 5mg/kg 3rd and 5th shock |
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Pad sizes |
4.5 cm for <10 kg 8-12 cm > 10 kg If adult pads and infant ap positioning |
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Alternative to amiodarone |
Lidocaine 1mg/kg iv or io |
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Mg dose |
25-50 mg/kg For hypomg or polymorphic vt/torsades |
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Shock resistance |
Change pad positions If rosc but then deteriorates back to vt/vf continue the cycle If further amio needed 300mcg/kg/hr to max 1.5 mg/kg/hr or max 1.2 g in 24 hrs |
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Etco2 levels during cpr |
<2 kpa 15mmhg need better cpr |
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O2 sats post rosc |
94-98% |
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TCA |
Hypoxia Hypovolaemia High spinal injury Tension Tamponade |
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Arrest from high spinal cord injury treat with adr or not? |
With as reverses loss of sympathetic tone |
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How much fluid is expelled from neonates lungs during birth |
35 mls |
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Neonatal lung inflation pressures |
-40 and -100 cm h2o (-3.9 and -13kpa) |
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Medullary reflexes cease |
20 minutes |
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Neonates |
Dry unless <32 wks Healthy - pink resp Reg HR 120-150 Primary apnoea - blue RR irreg or inadequate HR>100 Terminal apnoea - blue/white RR absent HR <100 |
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Which arm for pre ductal |
Right Acceptable 2 mins 60% 3 70 4 80 5 85 10 90% |
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Neonatal drugs |
Adr 10 mcg/kg up to 30 mcg/kg for second dose Bicarbonate 1-2 mg/kg Dextrose 2.5 ml/kg 10% |
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traffic light for serious illness Green |
Colour N Activity N social cues smiles content stays awake/awakens quickly strong N cry/not crying Resp - none Circulation/hydration N skin and eyes moist Muc memb Other none |
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Serious illness traffic lights Amber |
Colour pallor Activity not responding to N cues, no smile, wakes with prolonged stimulation, decreased activity rr nasal flaring - 6-12/12 >50/min, >12/12 40/min, sats < 95% crackles on chest Circ/hydration tachy <12/12 > 160, 12-24/12 >150, 2-5 >140, crt >2 secs dry muc memb poor feeding reduced PU Other temp >39 3-6/12 fever for 5/7 rigours, swollen limb/joint, non wt bearing |
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Severity illness traffic light Red |
Colour pale mottled/blue Activity no response to social cues, appears I’ll, does not wake, weak high pitched cry RR grunting >60 chest indrawing circ/hydration reduced skin turgur Other <3/12 temp > 38, non blanching rash, bulging fontanelle, neck stiffness, status, focal neuro signs, focal seizures |
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Congenital heart disease presentationn |
Sudden collapse Shock hypoxia Resp failure Causes - ductus arteriosus closure at/by 2 wks Rx as per shock 5 mls/kg. Cautiously |
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Renal disease presentations |
Hypertension Hypertensive encephalitis Immunosuppression Raised urea creatinine and potassium Breathlessness - May be due to overload |
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Trache |
Can deteriorate with Equipment failure LRTI Obstruction/displacement Secretions causing lower airway collapse |
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DKA mx |
Give iv fluids of 5 mls/kg only if shocked and reassess regularly. Only if prolonged delay O2 |
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Sickle cell crisis |
O2 rehydrate Morphine Transfer |
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Cvp line fracture mx if concerns re air emboli |
Cover with saline soaked gauze Give 100% o2 |
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Mx of infected peritoneal dialysis catherer |
Treat ABC O2 5mls/kg iv fluids if needed |
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Safeguarding children articles |
Art 3 best interest is most important consideration Art 9 children have a right not to be separated from their parents unless in their best int Art 12 seek child’s opinion before making decisions that affect their future Art 19 legislative administrative social and educational means should be taken to protect children from all forms of violence injury abuse incl sexual and negligence Art 37 no child shall be subjected to torture cruel or inhuman degrading treatment or punishment |
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Safeguarding |
Pre hospital care must be vigilant for neglect in all children present at the scene whether they are the or or not |
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Neglect |
Failure to meet a child’s basic physical/ psychological needs and likely to impair child’s health or development Occurs in pregnancy Failure to provide food/clothing/shelter includes exclusion from home/abandonment Protect from physical/emotional harm Ensure adequate supervision Access to appropriate medical care or treatment |
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Physical abuse |
Hitting Shaking Throwing Poisoning Burning/scalding Drowning Suffocating Munchousens |
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Sexual abuse |
Forcing/enticing to take part in sexual activities Physical contact Penetrative/non penetrative Non contact - looking at or in production of sexual images/ watching sexual activities Grooming |
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Emotional abuse |
Worthless Unloved Inadequate Limitation of experience and overprotection Seeing/hearing I’ll treatment of another Bullying /cyber bullying |
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Risk factors for abuse in parent |
Poor relationship with lack of loving interaction between parent and child Parental abuse DV LD unstable parental relationship Young single unsupportive substitutive parent MEntal illness personality disorders
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Risk factors for abuse in children |
Prematurity Separation and impaired bonding Physical or mental handicap Behavioural problems Difficult temperament or personality Soiling/wetting the bed ADHD Screaming or crying intermittently and inconsolably |
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What form do you fill in for aafeguarding |
Cause for concern |
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Types of pain scale |
Alder Hay triage pain scale - all ages. Colour pain scale Faces scale Pain ladder Wong baker faces pain rating scale FLACC behavioural pain assessment scale |
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Pain mx in shock |
There is no use for IM routes |
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Intranasal drug volumes should be below what volume |
0.4 mls If more is needed divide between nostrils |
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Paracetamol dose iv po or |
Iv >10kg 15mg/kg max 1g <10kg 7.5 mg/kg max 30 mg/kg/day Po and pr 15 mg/kg max 1g |
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Ibuprofen |
5 mg/kg max 400mg TDS |
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Diclofenac |
Po 1mg/kg max 50 mg Pr same |
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Tramadol |
1mg/kg 50 mg max |
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Oramorph |
1-3/12 50-100 mcg/kg 4 hrly 3-6/12 100-150 mcg/kg 4 hrly 6-12/12 100-200 mcg/kg 4 hrly > 1 yr 200-300 mcg/kg 4 hrly |
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Morphine |
Iv 50 mcg/kg blouses up to 200 mcg/kg |
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Fentanyl |
Iv 0.25 mcg/kg up to 1 mcg/kg IN 1 mcg/kg max volume 0.4 mls per nostril |
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Ket |
Iv 0.25-0.5 mg/kg IM 2-4 mg/kg IN 3 mg/kg |
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Paed triage |
Using adult criteria or paeds tape |
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When are errors more likely |
Hungry Angry Late Tired Or I’m safe Illness Medication Stress Alcohol Fatigue Emotion |
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Defib pad sizes |
8 yrs to Adults 13 cm 8 cm small children 4.5 cm infants |
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Common presentations of inborn errors of metabolism in paeds |
symptoms that worsen or emerge in a normally self-limited illness, recurrent vomiting despite multiple formula changes, symptoms when an switches to formula, symptoms that start with a new food, family history of metabolic disease, history of unexplained neonatal death, or history of consanguinity. |
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exam findings of paed with errors of inborn metabolism |
organomegaly, abnormal tone, abnormal mental status, neutropenia, thrombocytopenia, hyperpnea, dysrhythmia, liver failure, cataracts, abnormal hair, and unusual rashes. |
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nmemonic for inborn errors of metabolism |
THE MISFITS T-Trauma (non-accidental and accidental) H-Heart disease / hypovolemia / hypoxia E-Endocrine (congenital adrenal hyperplasia, thyrotoxicosis) M-Metabolic (electrolyte imbalance) I-Inborn errors of metabolism: Metabolic emergencies S-Sepsis (meningitis, pneumonia, urinary tract infection) F-Formula mishaps (under- or over-dilution) I-Intestinal catastrophes (volvulus, intussusception, or necrotizing enterocolitis) T-Toxins= S-Seizures
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blood tests for inborn errors of metabolism |
VBG electrolytes full blood count a renal function a urine dipstick, an ammonia level, Cortisol levels Growth hormone levels Insulin levels ketones, lactate liver function In the setting of a sick neonate, an ECG, chest X-ray, four limb oxygen saturations, blood pressures, blood cultures, and a lumbar puncture |
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Treat suspected inborn errors of metabolism |
IVfluids 10% dextrose and 0.25% saline at 1.5 x maintenance fluid infusion Stop feeds as stops the metabolic process |
