Childhood Illness Flashcards
AIRWAY
What is epiglottis?
- Bacterial infection = causes inflammation of epiglottis
- Hib vaccine
Signs & symptoms
- Stridor
- low SpO2
- high fever
- Peripherally shut down - inflammatory process, cardiovascular compromised
- Tachycardia
- Tachyphnoea
- TRIPODING
- DROOLING
Treatment
- High flow O2
- DO NOT AGITATE
- Needs ENT & senior anaesthetist
BJM
AIRWAY
What is tonsillitis?
Acute infection of parenchyma of the palatine tonsils
Signs & Symptoms
- Pain on swallowing
- fever >38 C
- Tonsillar exudate
Treatment
- Paracetamol
- Fluids
- Rest
BJM
AIRWAY
What is anaphylaxis?
- Type 1 allergic response = histamine release = oedema of mucus membranes
Treatment
- 1 in 1,000 IM into large muscle
- IV access
- Hydrocortisonse
- Chlorphenamine
- Fluids
BJM & JRCALC
AIRWAY
What is CROUP?
The underlying pathology is inflammation of the pharynx, larynx, trachea or bronchi.
6months - 6 years
Signs & Symptoms
- Sudden onset of seal-like Barry cough
- Stridor
- Resp distress
- Voice hoarseness
Treatment
- Dexamethasone (corticosteroids)
- Nebulised adrenaline
- O2
- Humidifier
BJM or RCEM Learning
What is the Westly Croup Score?
Children with croup can be divided into four levels of severity:
- Mild (croup score 0-2)
- Moderate (croup score 3-5)
- Severe (croup score 6-11) and
- Impending respiratory failure (croup score 12-17)
RCEM Learning
AIRWAY
What is an URTI?
- viral infection
Signs & Symptoms
- Runny / blocked nose
- Ear ache - often pull ear (eustation tube)
- Sore throat
Treatment
- Fluids
- Rest
- Ibuprofen / paracetamol
- Ice cream - cooling on throat
BMJ
AIRWAY
Foreign body - treatment
- effective cough?
- No - up to 5 back slaps
- No - up to 5 abdominal thrusts
Inhaled FB
- Anterior & posterior chest x-ray (CXR)
- Lateral neck for soft tissues if FB suggestive to be in neck, irrespective of whether FB is radio opaque or not
Hazardous
- CXR
Foreign body in nose
- unilateral offensive discharge strongly suggestive of long standing FB
- parental ‘magic kiss’
DON’T MISS….
- Foreign body in upper eye lid
- Non accidental injuries
AIRWAY
Identifying teething
3-5 months
Signs & symptoms
- Drooling
- Fever
- Not sleeping
- Crying
- Crysal symptoms
- Can get rash around mouth = can lead to impetigo (yellow)
- red & sore gum
- rubbing they’re ear
- chewing on things
Treatment
- Paracetamol / ibuprofen
NHS
BREATHING
Bronchiolitis
Acute viral infection of the lower respiratory tract
Signs & Symptoms
- Cough
- Wheeze
- Laboured breathing
- Tachypnoea
- Retractions, grunting & nasal flaring
- oedema
- Tugging & intercostal recession (lungs far more compliant, more elastic = recession) - children have a smaller tidal volume
BREATHING
Asthma
> 5 y/o
Signs & symptoms
- wheezing episode triggers
- increased WOB
- features of atopic disease
Treatment
- salbutamol - beta 2 agonist
- oxygen
- dexamethasone (steriod)
- ibratropium
- adrenaline
BMJ
BREATHING
Lower Respiratory Tract Infections / pneumonia
Secondary infections e.g. from bronchiolitis
Signs & Symptoms
- Productive cough (thick & green)
- Tachycardia
- Fever
- Pneumonia = exudate on lungs (decreased air sounds, bronchial breathing), dull percussion
Treatment
- Oxygen
- Fluids
- Hospital - if suspect pneumonia in under 5 need to go in, may be another cause
BMJ
CIRCULATION
Gastroenteritis
Causes;
- Infection e.g. bacterial
- Autoimmunue disorders e.g. chrones
- Metabolic e.g. DKA
Signs & Symptoms
- Dehydration e.g. vomiting = lose potassium, can cause arrthymias
- Decreased urine output
- Sunken fontella
- Dry mucus membranes
- cold extremities
- Altered responsiveness e.g. irritable, lethargic
- deteriorating
- diarrhoea causes loss of sodium
NICE CKS
CIRCULATION
Causes of dehydration?
- Not swallowing e.g. infection - URTI
- Neglect
- N&V
- Insensible loss e.g. sweat
- Haemorrhagic
- Distributive e.g. Sepsis or Anaphylaxis - AKI
- Renal failure
CIRCULATION
What are the signs & symptoms of shock and dehydration?
Clinical Dehydration
- Deteriorating *
- Altered responsiveness *
- Decreased urine output
- skin colour unchanged
- warm extremities
- sunken eyes
- Dry mucous membranes
- Tachycardia
- Tachypnoea
- reduced skin turgor
Clinical shock
- decreased LOC
- Pale or mottled skin
- Cold extremities
- Tachycardia
- Tachypnoea
- Weak peripheral pulses
- Prolonged CapRefil
- Hypotension
- = red flag symptoms - risk of progression to shock
NICE
CIRCULATION
Treatment pathways for dehydration - red flags?
Emergency transfer if:
- Features of shock
- Features suggestive of alternative life-threatening diagnosis e.g. non-blanching rash
Face-to-face assessment if:
- episode of bloody diarrhoea
- signs of dehydration
- Risk factors increasing risk of dehydration:
- < 1y/o
- low birthweight
- stoped breast feeding while ill
- 6+ diarrhoea stools in 24h
- 3+ vomiting in 24 h
Treatment
- 20 mls fluid per kilo
JRCALC
NICE
CIRCULATION
What signs would make you suspect hypernatraemic dehydration?
- Jittery movements
- Increased muscle tone
- hyperreflexia
- Convulsions
- Drowsiness or coma
NICE
DISABILITY
Seizures
Causes of seizures?
- Infection e.g. meningitis
- Space occupying lesion e.g. tumour
- Metabolic/endocrine e.g. hypoglycemia
Signs & Symptoms
- Increased tone
- Colonus (foot)
- Nystagmus
Treatment
- Diazepam x2 doses
JRCALC
NICE
DISABILITY
Febrile Convulsions
Treatment
- treat as normal seizure
- 1st febrile needs to go hospital
- don’t reduce temp to much
- fluids & cool clothing
- don’t do active cooling, will cause shivering & increase temp
Hospital assessment needed if:
- 1st seizes
- <18 months
- ?regarding cause
- any neurological deficit
- Decreased LOC before seizure
- Child recently taken antibiotics - may mask sign of central nervous system infection
- suspected meningitis
- another suspected serious infection cause of fever e.g. pneumonia or sepsis
NICE
DISABILITY
Hypoglycaemia
What causes it?
- Septic child
- Type 1 DM and unwell
Signs & Symptoms
- unconscious
- Abnormal behaviour
- Sweaty and pale
Treatment
- Oral food
- Buccal glycogel
- IV glucose
- DON’T GIVE GLYCOGEN - have too small a storage
NICE
DISABILITY
Limping child causes?
DON’T MISS…
- Mallgnancy - consider in presence of non-articular bone pain, night sweats, weight loss, fever, fatigue and pallor
- Non-articular causes
- MSK
- Acute appendicitis
- Testicular torsion
- NAI
Minor Injury and Minor illness at a glance.
Identifying risk of serious illness…
AMBER FLAGS
Colour (skin, lips, tongue)
- Pallor
Activity
- Not responding normally to social cues
- no smile
- wakes only with prolonged stimulation
- decreased activity
Respiratory
- Nasal flaring
- Tachypnoea
- RR >50 (6-12 months)
- RR >40 (>12 months)
- SpO2 <95% on air
- Crackles in chest
Circulation and hydration
- Tachycardia
- > 160bpm (<12 months)
- > 150bpm (12-24 months)
- > 140bmp (2-5 years)
- CRT 3+
- Dry mucous membranes
- Poor feeding in infants
- reduced urine output
Other
- Age 3-6 months, temp >39 C
- Fevers 5 days+
- Rigours
- Swelling of limb or joint
- Non-weight bearing limb/not using an extremity
Minor Injury and Minor illness at a glance.
Identifying risk of serious illness…
RED FLAGS
Colour (skin, lips, tongue)
- Pallor/mottled/ashen/blue
Activity
- No response to social cues
- Appears ill to HCP
- Does not awake, or if does doesn’t stay awake
- weak, high pitched or continuous cry
Respiratory
- Grunting
- Tachypnoea
- RR >60
- Moderate or severe chest indrawing
Circulation and hydration
- Reduced skin turgor
Other
- Age <3 months, temp >38 C
- Non-blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurological signs
- Focal seizures
Neonates with sepsis may present with hypothermia rather than fever.
Minor Injury and Minor illness at a glance.
RASHES
Chicken Pox
- Rash everywhere
- 1-3 day prodome fever and respiratory symptoms
- Vesicles (small raised cavities containing fluid)
Minor Injury and Minor illness at a glance.
RASHES
Rubella
Rash starts on face. pruritic
red, spotty rash, blanching macules (small flat areas of change in skin colour) and papules (elevated lesions)
NICE
RASHES
Roseola
Rash starts on neck, pink. non-pruritic
- high fever, cough, respiratory symptoms
complications - febrile convulsions
NICE
RASHES
Measles
Rash starts on face. non-pruritic. closer together
3 Cs
- Cough
- Coryza
- Conjunctivitis
NICE
RASHES
5th Disease
Slapped cheeks, may appear on extensor surfaces. usually not pruritic
flu like illness
Minor Injury and Minor illness at a glance.
RASHES
Impetigo
Common around nose, mouth, hands and forearms
- Bullous (large blisters) and non-bullous (crusted)
- Bullae (fluid filled lesions0
RASHES
Eczema
Crusts when infected
Minor Injury and Minor illness at a glance.
