7/11/21 Flashcards
Difference in presentation between cystitis and pyelonephritis in paediatrics.
- UTI/Cystitis → dysuria, frequency, urgency and lower abdominal discomfort
- Pyelonephritis → systemic features such as fever, malaise, vomiting and loin tenderness
Paediatrics: Duration of ABx for cystitis vs pyelonephritis. When are IV ABx required?
- if seriously unwell or <3 months → admitted for IV ABx
- if cystitis → 3-7 day course of ABx
- if pyelonephritis → 7-10 day course of ABx
ABx for non-severe pyelonephritis, be specific. (paedaitrics)
- trimethoprim + sulfamethoxaole 4+20mg/kg up to 160+800mg orally BD for 10/7. If clinical response is rapid, stop therapy after 7 days
OR
1. trimethoprim 4mg/kg up to 150mg orally, 12 hourly for 10/7. If clinical response is rapid, stop therapy after 7 days
- Cefalexin 12.5mg/kg up to 500mg PO Q6H for 10/7. If clinical response is rapid, stop therapy after 7 days
Clinical Feature of Paediatric Vulvovaginitis (4 points)
- Itching in the vaginal area
- Discharge from the vagina
- Redness of the skin of the labia majora
- Dysuria
Causes of Paediatric Vulvovaginitis (4 points)
- Lining of the vagina can be quite thin and therefore easily irritated.
- Moisture and dampness around the vulva → worsened by tight clothing or being overweight
- Irritants → soap residue, bubble baths, antiseptics
- Threadworms can sometimes cause or worsen vulvovaginitis → children with threadworms often scratch at night
Management points for Paediatric Vulvovaginitis (4 points)
- Wear loose cotton underwear and avoid tight jeans
- Maintain healthy weight - diet and exercise
- Don’t use a lot of soap in the bath or shower → remove soap residue
- Avoid bubble baths and antibacterial products
- Vinegar Baths → add half cup of white vinegar to shallow bath and soak for 10-15 mins. Daily for a few days
- Soothing Creams → soft paraffin or nappy-rash cream → settles the soreness as well as protect the skin from moisture.
History taking of a Straddle Injury (paeds) (7 points)
- Mechanism of Injury
- Timing and Setting of Injury
- First Aid
- Inability to pass urine or faeces
- Other Injuries
- Witnesses
- Consider whether injury is consistent with history → ?NAI
Management of a straddle injury. Minor vs Non-Minor.
- Contact local forensic paediatric service if concerned re: NAI
- Review Tetanus Status
- If MINOR Injury → bleeding is more and child can void spontaneously
- Salt water baths
- Simple analgesia
- Reduction of strenuous activity for 24/24 - reduce risk of re-injury
- Topical anaesthetic cream or barrier cream → reduce local pain on micturition
- If NON-MINOR injury → ongoing bleeding, laceration borders not visualised, labia minora tear, unable to void, clinician concern
- similar management as minor injury
- consider urethral catheter if unable to void (for example in the context of a vulval haematoma)
- refer to local paediatric team or local gynaecology/surgical service
Post-Natal Check (8 points)
- Enquire about vaginal discharge (lochia) and whether ceased
- Ask about healing of the perineum if vaginal delivery
- Review abdomen (uterus should be impalpable) and Caesarean Wound if present
- Check for any urinary or bowel problems (incontinence)
- Check if breast-feeding and whether there are concerns
- Check if intercourse has resumed and whether there are problems or concerns
- Discuss contraception options
- Advise on post-natal exercises
- Adequate diet, rest and personal care, sleep, exercise
- Psychological Health - Edinburgh Post-Natal Depression Scale , social supports
- Consider Pelvic Examination - checking perineum and pelvic floor strengths
- Cervical Screening Test (if due)
- Review antenatal screening tests for follow-up action - rubella booster
- Other → smoking and alcohol
Clinical Features of Post Natal Depression (4 points)
- difficulty coping with baby
- guilty thoughts of being a bad mother
- excessive anxiety of well-being of the baby
- irritability toward family
Management of Post Natal Depression. Mild to Moderate vs Severe.
Mild-Moderate Depression → psychological therapies
Severe Depression → antidepressants with SSRIs to be considered as first line therapy
Clinical Features of NORMAL CRYING
- at 6-8 weeks of age → a baby cries 2-3 hours per 24 hours
- increases in early weeks of life and peaks at around 6-8 weeks and usually improved by 3-4 months of age
- usually worse in late afternoon or evening but can occur at any time
- infant may draw legs up as if in pain → but NO EVIDENCE that this is due to intestinal pathology
2 main non-pathological causes of normal crying
-
Excessive Tiredness → if infants total sleep duration over 24 hours falls more than an hour short of the average of their age
- Birth - 16 hours
- at 2-3 months - 15 hours
- at 6 weeks - tired after being away for more than 1.5 hours
- at 3 months - tired after being awake for more than 2 hours
- Hunger - more likely if poor weight gain
Points of Management of a crying baby (5 points)
- Engage in partnership with parents → acknowledge concerns, taking time to observe the baby-parent interactions and offer follow-up
- Explain normal crying and sleep patterns
- Use normal crying curve to explain the natural history of a crying infant
- Use a sleep/cry diary to explain the infant’s cry/sleep/feeding patterns
- Encourage parents to recognise signs of tiredness → frowning, clenched hands, jerking arms and legs, crying and grizzling
- Assist parents to help baby deal with discomfort and distress
- Establish pattern to feeding/settling/sleep
- Aim to settle the baby for daytime naps and night-time sleep in a predictable way → quiet play, move to the bedroom, wrap the baby, give the baby a brief cuddle, then settle in the cot while still awake
- Avoid excessive stimulation - noise, light, handling. Excessive quiet should be avoided - gentle music
- Darken the bedroom for daytime sleeps
- Baby massage/rocking/patting
- Provide patient information
- NO ROLE FOR MEDICATION including anti-reflux medication, anticholinergic medications, colic mixtures, simethicone, limited evidence for probiotics use.
Causes of Delirium (9 points)
- Infections → urosepsis, pneumonia and CNS infections
- Metabolic Disturbance → hypo/hyperglycaemia, hyponatraemia
- Medication Toxicity and Drugs and Alcohol Toxicity
- Organ Failure → kidney or liver failure, respiratory failure with hypoxia/hypercapnia
- Intracerebral Events → Stroke, Subdural Haematoma, Haemorrhage
- Cardiac Events → MI, arrhythmias, CCF
- Seizures and Post-Ictal States
- Withdrawal States → from EtOH or benzodiazepines
- Pain and Discomfort → urinary retention or constipation