Child Health Management Flashcards
Management of mild acute wheeze
10 puffs MDI salbutamol
Mild acute wheeze that is improving
Wean MDI dosing and observe
Goal to get 4 hours between each 10 puffs
Management of moderate acute wheeze
10 puffs MDI salbutamol x3 over 1 hour
Oral prednisolone
Management of severe/life threatening acute wheeze
Nebulised salbutamol and ipratropium (combi neb) 3 times over 1 hour
Oral prednisolone
Severe/life threatening acute wheeze that is not improving with treatment
Continuous nebulised salbutamol IV hydrocortisone if can't take oral steroid Consider CXR IV aminophylline Discussion with intensive care
What is mild croup?
Clinical signs present when upset or active but not at rest
Management of mild croup
Single dose of oral dexamethasone
Home with advice sheet
What is moderate croup?
Clinical signs present at rest
Management of moderate croup
Oral dexamethasone single dose
Observation until symptoms not present at rest
Discharge with advice sheet
If worsening, nebulised adrenaline
What is severe croup?
Severe respiratory distress
Cyanosis
Exhaustion
Management of severe croup
Nebulised adrenaline
Oral/IV dexamethasone
Facemask oxygen
Senior help/intensive care review
When would you admit a baby with bronchiolitis?
If feeding less than half normal volume
If they are dehydrated (e.g. fewer wet nappies)
Will be worse on day 3-4, so if bad on day 1
Are they at greater risk e.g. premature?
What would help you decide whether a child with diarrhoea should be admitted?
If they are clinically dehydrated or shocked
What fluid would you give to a dehydrated child oral and IV?
Oral - dioralyte with a bit of sugar
IV - 0.9% saline with 5% dextrose
What should a diarrhoea with blood be treated as?
Medical emergency (could be haemolytic uraemic syndrome)
Management pathway of GORD in babies
Conservative measures e.g. positioning
Thickened feed e.g. gaviscon
PPI or ranitidine
Domperidone (empty stomach faster)
What guidance would you use for children who are feverish to determine how best to treat them?
NICE feverish illness in children traffic light guidance
When would you do a jaundice screen and what does it consist of?
Baby still jaundiced at 14 days or 21 days if premature Conjugated/unconjugated bilirubin Coombs' test (direct antiglobulin test) TFTs FBC and blood film Urine culture and sugars U&Es, LFTs
What would you add to control the asthma of a child which is not controlled by SABA and low dose ICS?
Leukotriene receptor antagonist (montelukast)
