mx Flashcards
Management of croup
ABCD
Admit?
- If current or previous moderate/severe croup
- Under 6 months old
- Poor feeding.
- Oxygen
- Oral dexamethasone (or, if unavailable, prednisolone)
- If deteriorating further nebulised adrenaline (1:1000)
Management of molluscum contagiosum
Conservative:
- Resolves on its own approx. 18 months
- Avoid towel/clothes sharing
- Stay in school/nursery
- Squeezing spots but this shouldn’t be necessary
Surgical:
- Cryotherapy
Management of eczema
Tailored approach based on the severity of their eczema using a ‘stepped approach’
Mild eczema:
- Emollient (cream, lotion, bath/shower, ointment)
- Mild topical steroid (~1% hydrocortisone)
Moderate eczema:
- Emollient
- Moderate topical steroid (Betnovate, Eumovate)
- Topical calcineurin inhibitor (tacrolimus)
- Bandages and wet wraps
Severe eczema:
- Emollient
- Potent topical steroid (Betnovate, Beclametasone)
- Topical calcineurin inhibitor
- Bandages and wet wraps
- Phototherapy
- Systemic therapy (oral steroids or non-steroidal immunosuppresants)
Management of acne vulgaris
Conservative:
- Washing no more than twice a day
- Do not pick or scratch
- Fragrance free emollients if dry skin is an issue
- Avoid lots of make-up/buy some derm-friendly stuff
Mild acne:
- Benzoyl peroxide or topical retinoid
- azelaic acid if above doesn’t work
- Consider COC, e.g. Yasmin in female patients who want contraception
- Follow-up in 6-8 weeks
Moderate/severe acne:
- As above plus …
- topical (or oral if difficult to reach areas) antibiotics like tetracyclines
- Refer if risk/current scarring, psychological impact or endocrine pathology suspected
Management of scabies
Conservative:
- Avoid body contact until patient/partners treated
- Machine was clothes/towels/linen on first day of treatment
Medical:
- Permethrin (2nd-line malathion) applied whole body, twice 7 days apart. Allow to dry then wash about 12-24 hours later.
- All contacts (symptomatic or not) must simultaneously be treated.
- Hydrocortisone for itching
Management of ringworm/tinea
Conservative:
- wash affected skin daily including skin folds
- wash clothes/linen frequently
- Don’t share towels
- No need to exclude from school
Medical:
- topical miconazole/econazole/clotrimazole consult dermatologist before prescribing to under 16s though
- if inflamed –> hydrocortisone
Management of pyloric stenosis
ABCD
Conservative:
- Plot weight
- NBM
- Fluid resus with saline bolus
- NG drainage/aspirations
- IV fluids for deficit and maintenance
- Electrolyte/Acid-base monitoring regularly
Surgical:
- Once stable surgery review
- Pyloromyotomy is gold standard
Management of status epilepticus
Call for senior paediatric SpR/Consultant and on call anesthetist
A - ensure patency
B - high flow oxygen mask
C - Assess and gain IV or IO access. Get BM, U+Es, gases
If IV/IO access:
- Diazepam/Lorazepam/Midazolam and wait 5 minutes
- repeat step 1
- Phenytoin 18mg/kg over 20 mins
- Anaesthetist for RSI
If no IV/IO access:
- Buccal midazolam/rectal diazepam, wait 10 minutes.
- If access go to step 2 above otherwise Buccal midazolam/rectal diazepam, wait 10 minutes.
- If access go to step 3 above, otherwise Paraldehyde PR and try for access again.
- Anesthetist for RSI
Management after a febrile seizure?
ABCD
- Rule out underlying cause, e.g. meningitis, meningococcal disease, encephalitis
- Admit if:
- 1st febrile seizure or never been seen by a paediatrician for a febrile seizure
- Child is less than 18 months
- Seizure: longer than 15 minutes; focal features; seizure within same febrile illness or 24 hours; incomplete recovery by 24 hours
- Current/Recent antibiotic use
- Parents are anxious that they can’t cope
Management of ?viral encephalitis
ABCD + glucose
- Sepsis work-up:
- FBC
- Throat/rectal swabs
- Blood culture
- Urine (ideally suprapubic aspirate)
- LP
- CXR
(also send for PCR analysis) - Neuroimaging e.g. MRI
- Consider EEG
- Therapy as indicated by causative virus
Management of slipped upper femoral epiphysis
ABCD
- Don’t walk
- Painkillers
- Hip X-ray (widened growth plate, femoral neck anteriorly rotated, femoral epiphysis slipped down and back)
- Ortho referral for surgical pin fixation
Management of acute infective conjunctivitis (not neonatal)
ABCD
Conservative:
- Clean secretions with wet cotton wool
- Wash hands regularly, avoid sharing towels/pillows
- Advise condition usually resolves on its own
Medical:
- Ocular antibiotics usually makes little difference to outcome
- e.g. Chloramphenicol or fusidic acid (the latter in pregnant ladies)
Management of lower UTI
ABCD
If under 3 months –> admit
If 3months to 3 years –> low threshold for admission, otherwise as below
If more than 3 years…
Conservative:
- Obtain urine specimen for culture before antibiotics
- Encourage and monitor fluid intake
Medical:
- Fever or pain then give paracetamol
- Oral antibiotics for three days, e.g. trimethoprim, nitrofurantoin, cefalexin, amoxicillin
Follow-up:
- Review within 48 hours in person/telephone
- If responding but the organism is sensitive then switch antibiotics and send urine for test of cure analysis after Abx treatment
- If still unwell –> reassess
- If responded consider referral if recurrent UTIs
Management of constitutional delay?
Observe and monitor
If psychosocial adjustment (usually due to short stature) then consider:
- giving boys a weak androgen or testosterone for 3-6/12
- giving girls oestradiol for 3-6/12
Management of ADHD
Conservative:
- Manuals/DVDs/Leaflets for parents on positive parenting techniques
- Maintain a balanced diet and adequate exercise, consider a food-behaviour diary and see if any links. Consider dietitian input.
Pre-school children:
- parent/carer training/education
- drug treatment not recommended
Moderate ADHD:
- Parent/carer training/education
- Offer patient group therapy CBT/social skills, consider individual sessions for older patients
- Drug treatment not recommended
Severe ADHD:
- Drug treatment for severe ADHD
- Methylphenidate (Ritalin) … or if that fails then atonmoxetine
- Titrate over about 1 month until symptoms improve no further
- Consider modified release
- Provide clear instructions written/pictures on how to take drug.
