CSB349 Week 3 Paediatric
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Flashcards in this deck (38)

  • What are common aetiologies of paediatric seizures?

    • Febrile seizures
    • Epilepsy
    • Hypoxia and metabolic disturbances
    • CNS infections
    • Trauma
    • Structural abnormalities
    • Toxins and poisoning
    seizures aetiology paediatrics

  • What metabolic disturbances are listed as causes of seizures?

    • Hypoglycaemia
    • Hyponatraemia
    • Hypocalcaemia
    • Inborn errors of metabolism
    seizures metabolic paediatrics

  • List the clinical features of a generalised tonic-clonic seizure in children.

    • Tonic-clonic movements
    • Loss of consciousness
    • Postictal drowsiness
    seizures clinical generalised

  • What are the key features of focal seizures?

    • Unilateral motor activity
    • Altered awareness
    • Focal neurological signs
    seizures clinical focal

  • How do absence seizures present in children?

    • Brief episodes of staring
    • Often with eyelid fluttering
    • Lasting seconds
    seizures clinical absence

  • Describe myoclonic and atonic seizures succinctly.

    • Myoclonic: sudden muscle jerks without loss of consciousness
    • Atonic: sudden loss of muscle tone causing falls ('drop attacks')
    seizures clinical types

  • What is the primary focus of out-of-hospital paediatric seizure management?

    • Stabilisation, seizure control, and identifying underlying causes
    seizures management prehospital

  • What immediate actions are included in the primary survey for a child having a seizure?

    • Ensure airway patency
    • Provide high-flow oxygen if hypoxia suspected
    • Ensure place of safety
    • Monitor vital signs including glucose
    seizures primary resuscitation

  • Which anticonvulsant is recommended for intranasal/IV/IM use prehospital for seizures?

    • Midazolam
    seizures medication midazolam

  • When is levetiracetam suggested in prehospital seizure care?

    • Levetiracetam (IV/IO) is for CCP use only in status epilepticus
    seizures medication levetiracetam

  • What reversible causes should be considered during seizure control?

    • Hypoglycaemia
    • Environmental factors
    • Hypoxia
    • Fever
    seizures causes reversible

  • What are key components of postictal care for a child after a seizure?

    • Monitor and support airway, breathing, circulation
    • Provide reassurance to caregivers
    • Transport to hospital for first-time or prolonged seizures or suspected secondary causes
    seizures postictal management

  • What are the most common primary headache types in children?

    • Migraine (with or without aura)
    • Tension-type headache
    • Cluster headache (rare)
    headache primary paediatrics

  • What features commonly accompany paediatric migraine?

    • Nausea
    • Vomiting
    • Photophobia
    • Phonophobia
    headache migraine symptoms

  • How is a tension-type headache described in children?

    • Bilateral, pressing or tight sensation, typically without nausea or vomiting
    headache tension clinical

  • Name important secondary causes of paediatric headache.

    • Infections (meningitis, encephalitis, sinusitis, ear infections)
    • Head trauma
    • Raised intracranial pressure (tumours, hydrocephalus, IIH)
    • Hypertension
    • Toxic/metabolic causes
    headache secondary causes

  • List red flag features that suggest a secondary serious headache in a child.

    • Sudden onset ('thunderclap')
    • Fever, neck stiffness, altered consciousness
    • Morning headache with vomiting or progressive worsening
    • Headache with neurological deficits
    • Post-trauma headache
    • Triggered by exertion, coughing, or Valsalva
    headache redflags paediatrics

  • What are the paramedic management priorities for paediatric headache?

    • Primary assessment
    • Symptom management
    • Identify and treat underlying cause
    • Transport and referral
    headache management prehospital

  • What are common risk factors for acute ischaemic stroke in children?

    • Cardiac disorder
    • Infection
    • Head and neck trauma
    • Sickle cell disease
    • Vascular malformations
    • Genetic disorders
    • Autoimmune diseases
    stroke pediatrics riskfactors

  • Name clinical presentations of stroke in babies/neonates.

    • Seizures
    • Extreme sleepiness
    • Subtle developmental changes (eg. using one side less)
    stroke neonates presentation

  • List causes of perinatal stroke mentioned.

    • Pregnancy complications
    • Difficulties during birth
    • Infections
    • Blood clotting disorders in mother or baby
    • Heart problems
    stroke perinatal causes

  • What initial first aid step should be done for paediatric burns?

    • Stop the burning process and apply cool running water for \(20\) minutes
    burns firstaid pediatrics

  • Up to how long after a burn is cooling still beneficial?

    • Cooling is beneficial up to 3 hours after injury
    burns firstaid timing

  • What analgesia consideration is recommended for infants under 12 months with burns while preparing definitive analgesia?

    • Sucrose for children under 12 months
    burns analgesia infants

  • What is the 'A' step in the ABCDE approach for major burns?

    • Airway: assess for inhalation injury, consider early intubation, maintain spinal precautions
    burns abcde airway

  • What does the 'B' step require in major burn management?

    • Breathing: give high-flow 100% oxygen, assess breathing and circumferential chest burns, assess for cyanide poisoning
    burns abcde breathing

  • What are key circulation actions in ABCDE for major burns?

    • Assess bleeding, HR/BP/neck veins/capillary refill, 2 large-bore IVCs or early IO, fluid replacement
    burns abcde circulation

  • What does the 'D' step include for burn patients?

    • Disability: check blood glucose, assess level of consciousness, address and treat pain
    burns abcde disability

  • What are the 'E' step actions in burn assessment?

    • Exposure: expose and examine head-to-toe, keep warm and cover to minimise heat loss
    burns abcde exposure

  • What are the four types of child abuse listed?

    • Physical abuse
    • Sexual abuse
    • Emotional abuse
    • Neglect
    childabuse types

  • What does the TEN-4-FACESp rule flag as concerning bruising?

    • TEN: Torso, Ears, Neck
    • 4: any bruising in infants ≤4 months
    • FACES: Frenulum, Angle of jaw, Cheeks, Eyelids, Subconjunctivae
    • p: patterned bruising
    childabuse bruising ten4facesp

  • What immediate actions should paramedics take when managing suspected non-accidental injury?

    • Manage injuries per protocols, provide emotional support, assess privately where possible
    childabuse paramedic management

  • If consent for transport is refused in suspected child abuse, what must paramedics do?

    • Report suspected abuse through mandatory reporting pathways appropriate to jurisdiction and abuse type
    childabuse reporting legal

  • List cardiovascular signs of severe paediatric sepsis/septic shock.

    • Tachycardia
    • Bradycardia (especially in infants)
    • Prolonged capillary refill time
    • Decreased peripheral pulses
    • Hypotension (late sign)
    sepsis pediatrics signs

  • What are prehospital management principles for paediatric severe sepsis?

    • Early recognition and rapid transport
    • Oxygen administration
    • Fluid resuscitation
    • Consider antipyretics and prehospital antibiotics
    • Always assess for meningococcal septicaemia
    sepsis prehospital management

  • When managing paediatric resuscitation, should antipyretics be considered?

    Yes — consider using antipyretics during resuscitation.

    resuscitation antipyretics paediatrics

  • Are prehospital antibiotics recommended in paediatric resuscitation?

    Consider prehospital antibiotics depending on local clinical guidelines.

    resuscitation antibiotics prehospital

  • What specific severe infection must always be assessed for during paediatric resuscitation?

    Always assess for meningococcal septicaemia.

    resuscitation meningococcal sepsis
Study Notes

Paediatric Emergency Summary

Brief, high-yield guidance for common paediatric emergencies: seizures, headache, stroke, burns, child abuse, and severe sepsis.

Seizures

Aetiology (common causes)

  • Febrile seizures—most frequent in young children; often viral-associated.
  • Epilepsy and recurrent seizure disorders.
  • Hypoxia and metabolic disturbances (hypoglycaemia, hyponatraemia, hypocalcaemia, inborn errors).
  • CNS infections (meningitis, encephalitis, brain abscess).
  • Trauma, structural brain abnormalities, toxins/poisoning.

Clinical features (key seizure types)

  • Generalised (tonic-clonic): Bilateral convulsions, loss of consciousness, postictal drowsiness.
  • Focal: Unilateral motor phenomena, altered awareness, focal neuro signs.
  • Absence: Very brief staring episodes, eyelid fluttering, seconds long.
  • Myoclonic: Sudden brief jerks without major LOC.
  • Atonic: Sudden loss of tone → falls ("drop attacks").
  • Postictal state: Confusion, drowsiness, transient deficits.

Paramedic management — priorities

  1. Primary survey & resuscitation: Airway patency, high-flow oxygen if hypoxic, safe environment, monitor vitals and blood glucose.
  2. Immediate actions: Protect from injury (do not restrain limbs), clear airway secretions, lateral position if breathing and no spinal concern.
  3. Seizure control: Identify reversible causes (glucose, temperature, hypoxia). First-line benzodiazepine: midazolam (IN/IV/IM). Consider levetiracetam IV/IO in status epilepticus (CCP only). Give a second benzodiazepine dose if seizure persists beyond \(10\) minutes.
  4. Identify/manage causes: Check and correct blood glucose, treat fever/infection, assess for trauma or toxins.
  5. Postictal care & disposition: Support ABCs, reassure caregivers, transport for first-time, prolonged, or suspected secondary cause.

Special considerations

  • Febrile seizures: Supportive care, temperature control, parental reassurance; most are benign.
  • Known epilepsy: Follow seizure action plan if available.

Headache (Paediatric)

Classification

  • Primary: Migraine (± aura, often with nausea/photophobia), tension-type (bilateral, pressing), cluster (rare in children).
  • Secondary: Infections (meningitis, sinusitis), head trauma, raised intracranial pressure (tumour, hydrocephalus), hypertension, toxins/metabolic causes.

Red flags (urgent evaluation)

  • Sudden severe onset ("thunderclap") — suspect subarachnoid haemorrhage.
  • Fever, neck stiffness, altered consciousness — consider meningitis/encephalitis.
  • Morning headache with vomiting or progressive worsening — suspect raised ICP.
  • Focal neurological deficits, post-trauma headache, exertion/cough-triggered headaches.

Paramedic approach

  • Rapid primary assessment and analgesia as appropriate.
  • Treat identifiable causes (fever, trauma) and consider urgent transport for red flags.
  • Provide clear handover regarding red-flag features.

Childhood Stroke

Risk factors

  • Cardiac disease, infection, head/neck trauma, sickle cell disease, vascular malformations, genetic or autoimmune disorders.

Clinical presentation

  • Neonates/infants: seizures, excessive sleepiness, subtle developmental changes (e.g., preferential use of one side).
  • Older children: acute focal deficits, altered consciousness, seizures.

Causes

  • Perinatal events (birth complications, maternal/baby clotting disorders), congenital heart disease, thrombophilia, arteriopathies.

Paramedic focus

  • Recognise subtle signs, rapid transport, clear neurology-focused handover, consider stroke pathways where available.

Paediatric Burns

Child-specific considerations

  • Thinner skin, smaller airways, lower blood volume, poor thermoregulation; burns cause high distress.

First aid (critical)

  • Stop the burning process and remove heat source.
  • Cool with running water for \(20\) minutes; cooling is beneficial up to \(3\) hours after injury.
  • Early, effective analgesia is essential; sucrose for infants \(<12\) months while awaiting analgesia.

ABCDE for major burns

  • A (Airway): Assess for inhalation injury, consider early intubation, maintain spinal precautions.
  • B (Breathing): Give \(100\%\) oxygen if indicated; assess for circumferential chest burns and cyanide risk.
  • C (Circulation): Control bleeding, monitor HR/BP/neck veins/CRT, establish \(2\) large-bore IVs or early IO, begin fluid resuscitation per protocol.
  • D (Disability): Check blood glucose, level of consciousness, treat pain.
  • E (Exposure): Fully examine, prevent heat loss, cover burns after cooling.

Child Abuse (Overview)

Types

  • Physical, sexual, emotional abuse, and neglect.

Clinical indicators

  • Skin injuries (bruises, abrasions, lacerations) are the most common site; pattern and context matter.

TEN-\(4\)-FACESp bruising rule (concerning features)

  • TEN: Torso, Ears, Neck.
  • \(4\): Any bruising in infants aged \(\le 4\) months.
  • FACES: Frenulum, Angle of jaw, Cheeks, Eyelids, Subconjunctivae.
  • p: Patterned bruising (e.g., objects, handprints).

Paramedic management principles

  • Provide immediate medical care and emotional support; examine privately where possible.
  • Assess safety and urgency: risk of serious harm or death, ongoing danger, self-harm risk.
  • Transport to hospital and give a clear, factual handover of concerns.
  • If consent is refused, follow mandatory reporting pathways per local jurisdiction and document carefully.

Severe Sepsis / Septic Shock (Paediatric)

Key cardiovascular signs

  • Tachycardia; in infants bradycardia can be concerning.
  • Prolonged capillary refill time, weak peripheral pulses.
  • Hypotension is a late sign in children and not used alone to diagnose.

Prehospital management

  • Early recognition and rapid transport are vital.
  • Give oxygen and start fluid resuscitation per local paediatric guidance.
  • Consider antipyretics and prehospital antibiotics when protocols allow.
  • Always assess for meningococcal sepsis and escalate care urgently.

Practical tips & reminders

  • Always check bedside glucose early in any altered child.
  • Protect airway and treat hypoxia first; many interventions depend on stable ABCs.
  • Use seizure action plans and prior history when available.
  • Document precisely: timing, duration, observations, treatments given, and caregiver reports.