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WorksheetsPediatric Critical care - Egurukul Feb
Total questions: 14
Worksheet time: 10mins
A 8 yr old girl, known case of asthma, presents to the ER with acute exacerbation, she is insignificant distress with subcostal, intercostal retractions and room air sats is 88 % . on auscultation there is no wheeze and air entry is diminished.
She is drowsy and her ABG shows
PH- 7.1, PC02 – 58, PO2- 70 , HCO3- 18 , Lactate – 4.0
Which of the features is most concerning?
Subcostal Retractions, and room air sats – 88%
No wheeze with diminished air entry, lactate – 4.0
Room air sats- 88 %, co2- 58
No wheeze with reduced air entry, co2 – 58, and altered sensorium.
A 6 yr old boy, wt 20 kg, come to the ER in status asthmaticus. He has just received back to back nebulisations and Methylprednisolone outside. His RR is 45, with retractions. His room air sats is 85%. He is not able to talk even single words. Choose from below appropriate drugs and dosage for the next line of Mx.
Magnesium sulphate 1000 mg , subcutaneous adrenaline diluted 1:10000 : 2 ml
Nebulization with budesonide ,
Dexa 8 mg
Magnesium sulphate 100 mg , subcutaneous adrenaline undiluted 0.2 mg
Magnesium sulphate 1000 mg , subcutaneous adrenaline undiluted 0.2 mg
A 2 yr child is in the ER with status asthmaticus. The baby had significant distress on arrival, received back to back nebulisations followed by hourly salbutamol nebs , steroids and one dose of SC adrenaline. Currently the child is comfortable with RR- 30 ,HR-160 and room air sats- 94%, wheeze still present on auscultation .
Her ABG shows PH-7.35 , PCO2- 30 , HCO3-20 ,Lactate – 6.0
What is the next line of management and why
2 nd dose of subcutaneous adrenaline as still wheeze is present
High lactate with tachycardia is a sign of shock hence give 20 ml / kg volume bolus
High HR and lactates in an improving child suggests b agonist overdose , reduce the frequency of nebulisations , no further dose of subcutaneous adrenaline
Child has improved , so ignore the HR and high lactate
1. What is the most common cause of status epilepticus in Indian set-up?
Metabolic
Genetic
Neuro-infections
Trauma
For termination of seizures, midazolam can be given through the following routes except:
Intramuscular
Subcutaneous
Intranasal
Buccal
The maximum dose of intravenous diazepam as bolus for seizure control is
10 mg
7 mg
5 mg
2 mg
What is the target while a child is on thiopentone infusion for status epilepticus?
Burst suppression pattern on EEG
Flat EEG
Sleep spindles pattern on EEG
Brush pattern on EEG
When infants are confronted with the need to increase work of breathing because of underlying pulmonary disease, a certain percentage of them will fatigue and ultimately develop apnea. Which of the following is a contributing factor?
Functional residual capacity is much greater than closing capacity in infants
The small tidal volume in infants
The highly compliant chest wall
The CO2 response curve of infants is shifted to the right
Patient with severe type Guillen Barrie syndrome develop which type of respiratory failure ???
Type-1
Hypoxic respiratory failure
Type-2 Hypercapnic respiratory failure
Type-3 Perioperative Respiratory failure
Type-4 Respiratory failure (Shock)
Mixed type respiratory failure
Four old girl baby a known case of asthma presents to the pediatric ER with acute
exacerbation with mild respiratory distress, room air sats -93%, and significant wheeze.
Which of the following options can be considered except?
O2 by nasal prongs to maintain sats above 94%
MDI inhaler salbutamol with spacer
Addition of ipratropium
O 2 by NRM to target oxygen saturation of 100 percent as sick child
Which of the following beta blocker is less likely to cause CNS symptoms at toxic dose?
Propranolol
Carvedilol
Metoprolol
Atenolol
3 yr child came with c/o ingestion of 5 tablets of alprazolam 3 hours before arrival.
O/E child drowsy, HR – 68/mt, RR- 12/mt, SpO2-96%, BP – 67/43 mm Hg
Antidote of choice in this scenario?
Naloxone
Flumazenil
Fomepizole
Fluoxetine
she had playfully ingested around 15 ml of “ALL OUT” mosquito repellent liquid at 7 am & brought to ER at 6 pm.
O/E: Child alert, tachypneic, nasal flaring & mild intercostal retractions +, SpO2 – 91%, Chest - occasional Rt basal creps+.
What is the next line of management?
Put NG tube and give gastric lavage
Start on O2 & consider CXR
Start iv Dexona
Start Iv Ceftriaxone
1.5 yr child brought with h/o ingestion of Paracetamol syrup 60 ml (10 kg weight, strength 250mg/5 ml) 24 hours back.
Now presented with irritability & abdominal tenderness
O/E child alert, irritable, icterus +, HR- 102/mt, RR – 28/mt, SpO2- 97%, BP – 98/60
P/A – Tender hepatomegaly +
Which of the following is true about management of this child?
Send & wait for LFT, Blood Paracetamol level and Plot level against time on Rumack Mathew nomogram and decide about NAC
Send LFT & blood paracetamol level, Start NAC loading f/b infusion & decide further course of action based on LFT & paracetamol level
NAC wont be useful after 24 hours
Blood paracetamol concentration is not reliable after 24 hours of ingestion
