Paediatric Emergencies - Encephalitis, Sepsis, Collapse and Burns

Question 1

What is encephalitis?

Answer 1

Inflammation of the brain parenchyma due to a virus

Question 2

What are the main causes of encephalitis?

Answer 2

Direct viral infection of the brain - mostly herpes simplex

Post infectious - autoimmune process following virus elsewhere in the body

Bacterial, fungal, parasitic

Question 3

What is the main trio of symptoms seen in encephalitis?

Answer 3

Altered Mental State
Fever
Headache

Question 4

What other symptoms would you see in encephalitis?

Answer 4

Meningitis symptoms
Seizures
Flu-like symptoms
RICP symptoms
Focal neurological signs

Question 5

How is encephalitis diagnosed?

Answer 5

Lab diagnosis based on CSF

Lymphocytosis
Normal glucose ratio
Normal/high protein
Virology PCR

Question 6

What other scans can you do for encephalitis and under what circumstances?

Answer 6

CT - Raised ICP
MRI - show demyelination and oedematous change
HIV test
Swabs or stool/urine sample
EEG - behavioural changes

Question 7

What is needed to diagnose sepsis?

Answer 7

Suspected Infection

2/3
Temp >38.5 <36
WCC high or low
Tachypnoea
Tachycardia

Question 8

When would you screen for sepsis?

Answer 8

Child score PEWS >3

Parental/clinical suspicion

Question 9

What are the red flags for sepsis in children?

Answer 9

Change in mental state/behaviour
Doesn't wake if roused/stay awake
Looks very ill
SpO2 < 90% / new need for O2
Tachycardia (5y >130, 5-7y >120, 8-11y >115)
Tachypnoea (5y >28, 6-7y >26, 8-11y >24)
Anuria for 18h
Mottled, ashen or blue skin
Non blanching rash

Question 10

What is sepsis 6?

Answer 10

1 Give high flow O2 until sats >94%
2 Gain IV access - blood cultures, blood gas, FBC, U&E, CRP, crag
3 Give Antibiotics
4 Give fluids - 20ml/kg (max 500ml) over 5-10 mins
5 Review by ST4 or above. If Lactate >4 review by consultant
6 If normal physiological parameters aren’t restored after 2 hours, consider adrenaline infusion

Question 11

What are the main categories of causes for collapse?

Answer 11

Postural
Cardiac
Neurological
Neurally mediated
Other

Question 12

What postural causes can lead to collapse?

Answer 12

Drugs

Hypovolaemia - blood loss or dehydration

Question 13

What are some cardiac causes that lead to collapse?

Answer 13

Arrhythmia
HOCM - hypertrophic cardiomyopathy
Aortic Stenosis

Question 14

What neurological causes could lead to collapse?

Answer 14

Seizure

Head Injury

Question 15

What neurally mediated causes lead to collapse?

Answer 15

Vasovagal syncope
Situational syncope - micturition
Carotid Sinus hypersensitivity

Question 16

What other things can cause a child to collapse?

Answer 16

Breath holding spells
Anaemia
Hypoglycaemia

Question 17

What is the most common cause of burns in children?

Answer 17

Scalding from hot liquids

Question 18

What other causes are there for burns?

Answer 18

Fire
Chemical
Electrical
Cold
Inhalation

Question 19

How deep do electrical burns tend to be?

Answer 19

Full thickness

Question 20

How deep do scalds tend to be?

Answer 20

Deep but partial thickness

Question 21

What should be estimated when assessing burns?

Answer 21

Extent
Depth
Distribution

Question 22

How would a superficial burn appear?

Answer 22

Red
No blistering
Affect only epithelial layer

Question 23

How would a partial thickness burn appear?

Answer 23

Pink or mottled
Blisters
Some dermal damage

Question 24

How would a full thickness burn appear?

Answer 24

Painless
White or charred
Full dermal and nerve damage

Question 25

Roughly what percentage of surface area does each part of the body make up in a child?

Answer 25

9% = head (reduce with age - 18% when <1y)
18% each torso and back
18% each leg
9% each arm
1% gonads

Question 26

What investigations should be carried out for burns?

Answer 26

ABG
Carboxyhaemoglobin
Blood count
U&E - inc. creatinine
Group and save
Serum albumin

Question 27

How deep must a burn penetrate to affect cap refill time?

Answer 27

Prolonged if deeper dermis

No cap refill if full thickness

Question 28

What first aid is recommended for burns?

Answer 28

Run under cold water for 5 minutes

Question 29

When would you admit a child to the burns centre?

Answer 29

Over 5% full thickness
Over 10% partial thickness
Difficult area involved - face, hands, feet, perineum or genitalia
Inhalational injury
Chemical or circumferential burn

Question 30

How are burns managed?

Answer 30

Analgesia
IV Fluids
Wound care

Question 31

When do you give IV Fluids for a burn?

Answer 31

> 10% in infants

>15% in children

Question 32

How much fluid should be given for burns?

Answer 32

20ml/kg (shock)

Normal fluid req plus parklands formula

Question 33

What is parklands formula?

Answer 33

% burn x weight x 4

Half amount given within 8 hours

Question 34

What should you aim to keep urine output above in a burns patient?

Answer 34

1ml/kg/hr

Question 35

What other things can you consider giving a burns patient?

Answer 35

Humidified 100% O2
Tetanus jab

CONSIDER SAFEGUARDING

Question 36

What is important to consider with facial burns?

Answer 36

Airway involvement

Scarring

Question 37

What is important to consider with hand burns?

Answer 37

Contractures

Functional loss

Question 38

What is important to consider with genitalia burns?

Answer 38

Difficult to nurse

Risk of infection

Question 39

What would make you worry a burn is non accidental?

Answer 39

Glove and sock distribution - immersion injury
Delay in presentation
Buttocks or perineum burns
Other social concerns with family