Kids Flashcards
DKA Initial Management
Admit to HDU/ITU if necessary
call senior
ABCDE
Airway - if pt drowsy, call anaesthetics and secure airway
B- give O2
C- Begin with IV 0.9% Saline with 40mmol KCl (bolus for resus + deficit + maintenance) + IV insulin
D- assess GCS. Once glucose <14mmol/L, add 5% dextrose infusion
E- Monitoring:
Continuous ECG monitoring for hypoK
Frequent obs measurements + capillary glucose + fluid balance
Refer to diabetes clinic once patient is stable
DKA Examinations Ix
Examination: fluid assessment Bedside: Obs Urinary glucose and ketones ECG Capillary blood glucose and ketones Bloods: VBG to assess acidosis Can take more thorough blood tests when cannulating (blood glucose, U and Es, FBC, creatinine, results may show AKI with raised urea and creatinine due to fluid depletion secondary to osmotic diuresis)
MDT members for cerebral palsy
Main Members: paediatrician, nurse, physiotherapist, occupational therapist, speech and language therapist, dietetics, psychology
cerebral palsy Rx
- it is a lifelong condition that affects movement and coordination of the child
- it is often caused by an insult to the brain before, during or after the birth of the child
- Referral to developmental paediatrician
-Physiotherapy – encourage movement, improve strength and stop muscles from losing range of motion
-Speech therapy – improve language abilities
-Occupation therapy – identify everyday tasks that may be difficult and help make these tasks more accessible
-Medication
• Stiffness – baclofen, diazepam
• Sleeping – melatonin, sleep hygiene advice
• Constipation – laxatives
• Drooling – anticholinergics
Asthma Rx for children between 5-16
Asthma is caused by swelling (inflammation) of the breathing tubes that carry air in and out of the lungs. This makes the tubes highly sensitive, so they temporarily narrow.
It may happen randomly or after exposure to a trigger.
Give 10 puffs pf salbutamol every 30-60 seconds if unwell now Ladder: 1. SABA 2. SABA + Paediatric low dose ICS 3. Above + LTRA 4. Step 2 + LABA (stop LTRA) Other: - ensure they have peak flow meter - check inhaler technique - asthma action plan
An Asthma Action Plan is a written worksheet that shows you the steps to take to keep your asthma from getting worse. It also provides guidance on when to call your healthcare provider or when to go to the emergency room. An asthma action plan is an important tool to share with caregivers of children with asthma, including daycare providers, schools and aftercare programs.
what is the SpO2 cutoff between moderate asthma attack vs severe and life threatening attack in children?
>92% = moderate <92% severe or life threatening What differentiates severe and life threatening in children between 2-5 yrs are red flags suggestive of life threatening: - silent chest - agitation - altered consciousness - poor resp effort - cyanosis
in children >5 yrs we can use PEF. In general anything <50% PEF is suggestive of severe attack and <33% = life threatening
mild- severe asthma exacerbation what do you give for each severity?
Mild: salbutamol inhaler (via spacer, 1 puff every 30-60 secs until 10 puffs maximum) + 3 days prednisolone PO (given to all children with asthma exacerbation regardless of severity) + oxygen
Moderate:
above + admit + ipratropium bromide (muscarinic antagonist)
Severe:
same as moderate but give everything nebulised (other than steroids where you still give PO pred) and consider giving MgSO4 (nebulised). Consider 2nd line treatments like IV salbutamol, IV aminophylline or IV magnesium sulphate
Autism counselling/Rx
- explain autism is a spectrum so difficult to predict extent of impact on the child’s life
- characterised by triad of impaired social interaction (cannot appreciate other’s feelings), language impairment (monotonous voice, taking what people say literally), ritualistic behaviours (throw tantrums when routines are broken)
- DO YOU FEEL LIKE THIS IS SOMETHING THAT HAS BEEN HAPPENING WITH YOUR CHILD
Management Management in PRIMARY CARE:
- refer for an autism assessment. This is done by a specialist team who have expertise in autism. They will observe how your child behaves and interacts with other people and also will speak to people who are close to the child (friends, family, school) and produce a report to tell you whether your child has autism or not.
- Will also refer you to paeds who will manage this case
- an autism diagnosis can be helpful for identifying child’s needs eg educational, it also allows child to receive the necessary support in school. Parents and carers will also be supported too + eligible for financial benefits
Secondary Care management:
- MDT approach
- Psychological interventions to reduce ritualistic behaviours (behavioural modification approaches)
- Speech and language therapy (with a focus on social skills)
- Educational assessment and plan (assess for learning disability. May require EHC plan which is a legal document that describes a child’s special education, health and care needs)
- involve SENCO (special educational needs staff) in school
GERD Rx
· General: avoid overfeeding
· If Breastfeeding: offer breastfeeding assessment → alginate therapy
· If Formula: review feeding history (overfeeding) → try smaller, more frequent feeds → if doesn’t work try thickeners (gaviscon) → alginate therapy
· Position–> sit the baby upright after feed
Eczema Rx
emollients –> steroids –> calcineurin inhibitors (only if refractory to steroids)
• Prescribe generous amounts of emollients and recommend frequent and liberal use
• Consider prescribing a mild or moderate steroid (mild: hydrocortisone 1%, moderate: betamethasone 0.025%)
o Steroid should be used on the inflamed areas until the redness and itching subsides (usually until 48 hours after the flare has been controlled)
o Advise that they should be used sparingly.
o Explain that steroids are topical not systemic so dont worry too much
o Only a short course required – it is better to use 1-2 weeks short course to clear up eczema than to let child suffer for months.
• Consider non-sedating antihistamine (e.g. cetirizine, loratadine) if itching is severe (probably not necessary in this case)
ADVICE
o Explain the symptoms and signs of infected eczema and eczema herpeticum
o In many children, eczema improves with time
o Children may develop asthma, hay fever and allergies
o Avoid triggers (e.g. types of clothes, detergents, soaps)
o Avoid scratching if possible (keep nails short, use mittens)
o Use soap substitutes
o Website: itchywheezysneezy.co.uk
SAFETY NET:
- viral infections: eczema herpeticum. Sometimes the eczema can form blisters if infected by virus and this can burst, leaving an open sore. go to A and E immediately if you notice this.
Eczema Ix
- Examination: dry, flaky, excoriated skin on the trunk, child otherwise looks well
- No other investigations needed
- Diagnosis: moderate eczema
- Differential Diagnosis: cows’ milk protein allergy, viral exanthem, seborrheic dermatitis, contact dermatitis
Cow’s milk protein allergy Rx
- it is very common and many children grow out of it
Management if formula-fed:
- extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with mild-moderate symptoms (made from cow’s milk, but proteins broken down into smaller pieces)
- amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF
- around 10% of infants are also intolerant to soya milk
Management if breastfed:
- continue breastfeeding
- eliminate cow’s milk protein from maternal diet. Consider prescribing calcium supplements for breastfeeding mothers whose babies have, or are suspected to have, CMPI, to prevent deficiency whilst they exclude dairy from their diet
- use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months
Follow up:
- review in 6-012 months and consider re-introducing cow’s milk protein allergy using a MILK LADDER
- advise regularly monitoring growth
SAFETY NET:
- anaphylaxis: if any point child develops swollen lips, grunting, laboured breathing from feeds then bring him to A and E
explain cerebral palsy
an injury that happens to the brain, the injury doesn’t get worst but you don’t know from the beginning how this condition is going to manifest affects movements (motor)
Croup Rx
• Explain diagnosis (common infection of the airways caused by parainfluenza virus)
Rx:
- everyone regardless of severity: dexamethasone oral 1 dose (–> nebulised budesonide OR IM dexamethasone –> nebulised adrenaline)
- mild: no admission, safety net
- moderate croup: admit + oxygen
- severe: A-E, admit, oxygen, nebulised adrenaline (a1 mediated vasoconstriction –> decreased mucosal oedema in airways)
• Explain that it gets better over 48 hours and steroids have been given to help that
• If it gets worse, come back
• If the child becomes blue or very pale for more than a few seconds, unusually sleepy or unresponsive or serious breathing difficulties call an ambulance
• Paracetamol or ibuprofen if distressed
• Advise good fluid intake
• Advise regularly checking on the child at night (cough is worse)
good to keep them away from school for now as it is contagious and they can return once their fever settles and they feel better
Croup Ix
mostly clinical diagnosis, blood test rarely needed.
Bedside:
- Obs
- Top to toe examination, focusing on the respiratory system
