7/6 Flashcards
Run through how you would approach a NAI OSCE
Before we begin anything today I want to stress the importance of being honest during this conversation. My priority as I’m sure yours is too is to keep … as safe as possible. Now the health visitor has raised some concerns around the brusing … has. But before we get onto this I just want to ascertain a few quick questions about … development.
BFGD+V
How was the pregnancy with .. And the birth okay?
Were they breastfeed and any problems with terms of feeding and growth
Any concerns with development
Up to date with vaccinations
Okay to come on to the bruising I want you to tell me in your own words what has been causing this bruising
Who - who else was in the house, who witnessed it, where were you at the time
What - what exactly happened
Where - where is this taken place
When - when exactly did this happen
First time this has happened?
FH of bruising or bleeding disorders
Who typically stays in the house
Any regular visitors
Who is in care of the care of .. - how much do they see each person
What’s your support network like?
- Partner - how do they cope? Mental health struggles? When you say fustrated what do you mean? Are they ever voilent towards you or the kids?
Is their drinking or drugs in the home?
Manage
Immediate/witnessed abuse = 999
- Investigate for organic causes and help monitor and look after them
MUST EXPLAIN TO PT that initating the protocal - which is mandatory for all children who present with the pattern of bruising … has.
Suspicious - CANNOT LEAVE - if they try phone 999
Contact SNP
Social worker
Nurse advisor on child abuse
Paediatrican on-call really clearly and why you are concerned - inaccuracies in the story are really important to catch out coverup
Stridor vs wheeze
Stridor on inspiration
Wheeze on expiration
What kind of bleeding disorders could cause bruising in a child?
Von Willebrands disease
Leukemia
If male = haemophilia
ITP
What is the BFGD+V?
Birth
- How and where born?
- Any difficulties with pregnancy/birth?
- Any problems immediately post birth
Diet
- what’s diet like?
<12mnths - breast or bottle?
6-12mnth - weaning ok?
Growth
- ask for red book
- any concerns regarding growth
Development
- any concerns regarding development
Vaccinations
- all up to date with vaccinations
When should each of the following developmental milestones have occured?
- social smile
- hold head up
- localises to sound
- sit
- stranger danger
- walks
- first words
- 2 word phrases
- 3 word sentences
- pincer grip
- 6 wks
- 3 month
- 6 months
- 9 months
- 9month
- 15 months
- 12-18month
- 2 years
- 3 years
9-12 months
Name signs of paed resp distress
Subcostal and intercostal recession
Abdominal breathing
Head bobbing - bad
Tracheal tug
Nasal flaring
Cyanosis
Raised RR
Use of accessory muscles
Think of it by working down from head to nose to chest
Croup vs broncholitis OSCE
Croup = oedema of the larynx caused by parainfluenza
Bronchiolitis = oedema of the bronchioles caused by RSV - if adult would be fine as lungs are bigger due to the childs size
Hx
BOTH
- increased WOB
- low grade fever
- corozyal sx
CROUP ONLY = barking cough, stridor and hoarse voice
Ask about periods of not breathing
Then rest is normal hx
Invx
Signs of resp distress as done already
Manage
- Croup - single dose of oral dex regardless of severity
= admit if severe = neb steroids (if can’t do oral), neb adrenaline and O2
Bronchiloitis
- self resolving and reassure parents should be good by 7-10 days - worst at 3-4 days BUT MAKE SURE TO SAFETY NET
- admit if <3mnths/pre-exisiting health inc.prem/reduced milk intake
= supportive management, fluids + oxygen + nasal suction
What are high risk babies given for bronchiolitis
Monthly vaccine of palivizumab
DDx of croup/bronchiloitis
V
I - tonsilittis, epiglottitis, pnemonia
N
D
I - foreign body inhalation
C
A - asthma, laryngomalacia
What does ibruprofen put pts with chicken pox at increased risk of ?
Necrotising fascitis
What should be tried prior to fusidic acid in impetigo if pt well and not at high risk of complications?
Hydrogen peroxide cream
Why are osmotic laxatives prescribed over stimulant laxatives in children?
How is child constipation managed
Stimulant - only short-term use
Children will likely have to be on it for a long time hence osmotic
Conservative
Adequate fluid and fibre
Medical
Movicol paediatric - increasing dosage as req.
If not causing poo in 2 weeks -> stimulant laxative e.g. senna
Child with penicillin allergy with scarlet fever?
Azithromycin
Answer the following regarding paid BLS
- how fast?
- how deep?
100-120bpm
1/3rd of the chest depth
Covering lower 1/2 of the sternum
Answer the following regarding adult ALS
