Management Flashcards
Intussusception
- Air enema:
Air introduced into colon via catheter under fluoroscopic control. Reduction of Intussusception demonstrated when small bowel fills with air. - Surgical reduction if air enema fails or with signs of peritonism. Laparotomy and manual reduction by pushing distal end of Intussusception, lower rate of relapse.
Necrotising enterocolitis
3wk old preterm infant presents with bile stained vomiting, fresh blood in the stool and a taut distended abdomen
Hypotensive, tachycardic, abdomen does not transilluminate
- Stop oral feeds
- Start abx: penicillin, gentamycin, metronidazole
- Urgent IV fluid resus and maintenance
Deterioration and abdomen transillumination: bowel perforation
Urgent resus and surgery - bowel resection
Respiratory Distress Syndrome
Recently delivered baby, severe respiratory distress.
Supportive to allow RDS to abate, usually 3-7 days
Ventilators: care re retinopathy of prematurity if
Transposition of the Great Arteries:
Cyanotic + metabolic acidosis
Stabilise ABC
Continuous prostaglandin E2 infusion
to maintain Ductus Arteriosus patency
Correct acidosis, maintain temperature, dextrose infusion
Tetralogy of Fallot
Episodes of cyanosis and distress with air hunger
ABC Supportive treatment Investigation: CXR, ECG, echo Blalock-Tausig shunt (scar behind scapula, joins subclavian to pulmonary artery) Final reconstructive surgery
Jaundice
Clinically evident -> transcutaneous bilirubin meter
High level -> serum bilirubin: plot on age dependent chart
Preterm = greater risk of sustaining damage
Correct dehydration/ poor milk intake
Phototherapy
Exchange transfusion
Hypoxic-Ischaemic Encephalopathy:
4 hour old neonate delivered after a prolonged second stage of labour with shoulder dystocia.
Cannot feed, has abnormal tone.
ABC: resuscitate and stabilise
Respiratory support
aEEG and treat any seizures that occur
Fluid restrict - transient renal impairment
Treat hypotension- volume and inotrope support
Monitor and treat hypoglycaemia and electrolyte imbalance
UTI
ABC: resuscitate and stabilise if req IV abx Oral abx once afebrile Renal USS post infection DMSA after 3 months: static radioisotope scan Prophylactic abx: trimethoprim
Vesicoureteric reflux
Long term prophylactic abx
Blood pressure check biyearly (renal scars can produce renin)
Urine culture in non specific illness
UTI -> investigations re scarring
Usually reflux resolves with age, if not surgical reimplantation
Mild dehydration:
Oral rehydration solution
If not tolerated orally attempt NG tube prior to IV fluids
Moderate dehydration: 5-10%
Signs of cellular dehydration
No signs of shock
- Oral rehydration trial 6 hrs 100ml/kg
2. IV 0.9% saline
Severe dehydration: >10%
Shock
IV 0.9% saline:
20ml/kg bolus
Correct fluid deficit: % dehydration x weight in kg
Maintenance: 100ml/kg first 10 kg, 50ml/kg second 10kg, 20ml/kg rest
Suspected bacterial meningitis:
High fever, impending shock, reduced consciousness
IV antibiotics: cefotaxime + ampicillin if
Confirmed bacterial meningitis
Consider antibiotics given organism cultured and it’s sensitivity
Prophylactic abx for all close contacts: oral rifampicin/ciprofloxacin
Report case to consultant in charge of communicable disease control
Asthma
Back to back salbutamol O2 driven nebs x3 one with added atrovent Admit -> HDU IV salbutamol IV aminophylline IV magnesium sulphate
