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
