Paedatric Surgery Flashcards
How can you calculate a child’s average weight from their age?
2 x (4 + age)
How do you calculate a child’s blood volume norm?
80mls/kg
How do you calculate a child’s urine output norm?
0.5-1ml/kg/hr (little less as you age)
How do you measure insensible loss norms of a child?
20ml/kg/day
How do you work out systolic BP norms for a child?
80 + (2 x age)
What are the vital signs of a <1yo and how do these age with age?
RR 30-40
HR 110-160
BP 70-90
BP increases with age and HR and RR decrease
What is the concept of pain barriers?
The hurdles to a child receiving analgesia
E.g. telling mum/teacher they are sore, going to GP, going to hospital etc.
Don’t delay giving analgesia to kids - makes them easier to examine
What is the WHO pain ladder for children?
Paracetamol - 20mg/kg 4-6hrly
Ibuprofen - 10mg/kg 8hrly
Weak opioid
Strong opioid
What age is codeine licensed for?
> 12
What are the issues with codeine?
20% people don’t have the enzyme that coverts it into morphine (which supplies pain relief)
A small handful of people have too many enzymes –> respiratory depression & death
What are the two types of fluid manage?
Resuscitation - acute fluid depletion
Maintenance
What do you give as resuscitation fluids?
0.9% NaCl saline 20ml/kg bolus
What do you give as maintenance fluids?
0.9% NaCl 0.5% dextrose, 0.15%KCl
4ml/kg for first 10kg, 2ml/kg for next 10kg, 1ml/kg after that
What are the sentinel signs?
Reduced feeding (too tired to fed = v. unwell)
Green bilious vomit (bowel obstruction)
Colour - grey baby
Tone - floppy baby
Temperature - low temp more useful for diagnosing sepsis
What things do you want to clarify in your history of abdominal pain?
Colic vs constant pain Vomiting (?green) = sicker Diarrhoea Loss of appetite = sicker Movement - pain going over speed bumps? more likely to be peritonitis Menstrual pain
What is colic pain more likely to be?
Dysfunctional gut
What is constant pain more likely to be?
Peritoneal irritation/peritonitis
What kind of menstrual pain can you get?
Mittleshmzer and dysmenorrhoea
What are you looking for in examination of a child with abdominal pain?
General appearance
Guarding
Temperature
What is guarding?
Involuntary contraction of abdominal muscles
What investigations should you do in abdominal pain?
Urine dipstick
FBC if diagnostic uncertainty
Electrolytes if v sick/dehydrated
X-ray rarely
What is murphy’s triad?
Classical symptoms of appendicitis: fever, pain (McBurney’s point), vomiting
Where is McBurney’s point?
2/3rds along the line from the umbilicus to ASIS on the right side
What are the clues that would make you think appendicitis?
Periumbilical pain, followed by localised pain in McBurney’s point
Moderate temp <40, vomiting, looks unwell
Unusual <4y
