Paediatrics Flashcards
Seizure (Epilepsy)
Definition of Epilepsy: Common condition that affects the brain and causes seizures
Seizures = Bursts of electrical activity in the brain that temporarily affects how it works.
Sometimes we don’t know why this happens, but can be due to funny heart rhythms, infection, dehydration, alcohol
Test are NORMAL
- Something we would be worried about is epilepsy, condition where you have multiple seizures. This needs to be seen by specialist doctor and need regular medications
- Advise on:
- Warning signs (faintness, change in vision, flashing lights/aura)
- Avoid driving for 6m
- Avoid dangerous situations
- If another seizure, go to A&E
- REFER to First fit clinic (neurologist)
MDT:
- Paediatrician, neurologist, epilepsy nurse, school nurse, GP
- Main goals:
- Ensure diagnosis is correct
- Control seizures
- Minimize drug side effects
- Ensure any learning/behavioural difficulties are addressed
- Help child live a normal life with full participation in activities at home/school
Anaphylactic shock
Anaphylaxis is a severe and potentially life-threatening reaction to a trigger such as an allergy. Type 1 hypersensitivty - IgE mediated
85% due to food allergy
Medical emergency - ABCDE
- A - Obstruction, stridor, intubate if necessary
- B - if not breathing, IM ADRENALINE STAT IN THE THIGH+ Start CPR - (5 rescue -> 15:2)
- Repeat IM adrenaline every 5 mins
- Remove trigger if possible
- Give high-flow oxygen
- Give IV fluids (crystalloid 20ml/kg)
- Give IV chlorphenamine + hydrocortisone
Needs to be referred to ALLERGY CLINIC where further tests may be required to determine exact allergens
When to discharge:
- Good response to 1 dose of adrenaline + completely resolved = 2hrs
- 2 doses of adrenaline OR previous biphasic = min. 6hrs
- >2 doses OR severe asthma = min. 12hrs
Future Mx
- Educate on symptoms
- Refer to allergy clinic
-
EPIPEN training, advice - take everywhere, including school trips, give one to school etc
- Need a doctors note for epipen if flying
- Call ambulance immediately if Sx develop
- Food diary/avoid suspected trigger
- Contact school - keeping epipen in school all the time, make sure someone is trained there
- Leaflet
- Nutritionist help if they will struggle with diet
Chickenpox
Definition: Common, mostly affects children. Usually gets better by itself without needing to see the GP
Complications: NSAIDs have increased risk of necrotising fascitiis
Management:
- Calamine lotion
- Keep cool, keep nails short
- Plenty of fluids
- Most infective 1-2 days before rash
- Infectious until all lesions are dry and crusted over (5 days after onset of rash)
- AVOID CONTACT WITH:
- Immunocompromised
- Pregnant women
- Infants <4wks
- ≤ 20 weeks gestation is not immune to varicella she should be given varicella-zoster immunoglobulin (VZIG) as soon as possible
- RCOG and Greenbook guidelines suggest VZIG is effective up to 10 days post exposure
- if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure
Septic arthritis
Septic arthritis = Infectious arthritis of SYNOVIAL JOINT
Osteomyelitis = Infection of BONE (usually metaphyses)
Most common organism = STAPH AUREUS
KOCHER CRITERIA (Fever >38.5, non-weightbearing, Raised WCC + ESR)
Complications: Joint degeneration/Permanent damage to joint
Management:
- Joint aspirate to determine cause + Aspirate to dryness
- IV Flucox first 2 wks, then 4 wks oral Abx
- Gram positive = Vancomycin
- Gram negative = Ceftriaxone
- Washout of joint/ surgical drainage may be needed
Neonatal jaundice
- Transcutaneous BR (>35wks GA, Jaundice at >24hrs old)
- Serum BR (Jaundice at <24hrs)
Start with Transcutaneous BR, if >250 do serum
Assess risk of Kernicterus
- Serum BR >340 (>37wks GA)
- Rapidly rising BR >8.5 per hour
Features of Kernicterus = HYPOtonia, Poor feeding, extreme lethargy, high-pitched cry
Measure Serum BR every 6hrs if started on Tx
Investigations for underlying cause
- Haematocrit
- ABO Blood group of mother and baby
- DAT test (Coombs)
- If the mother is Rh-negative, find out whether the mother received prophylactic anti-D immunoglobulin during pregnancy
- FBC and blood film (e.g. looking for hereditary spherocytosis)
- Blood G6PD levels (consider ethnic origin)
- Microbiological cultures of blood, urine and/or CSF (if suspected infection)
- TSH
- LFTs
- Bilirubin (split)
Counselling
- Continue breastfeeding
- Stay in after stopping phototherapy to check for rebound hyperbilirubinaemia
- Leaflet
Overweight / Diet
- MUST EXCLUDE organic causes
- Cushings (striae, thick neck skin, acanthosis, easy bruising, acne)
- Hypothyroid (Cold intolerance, constipation, low mood, low appetite)
- GH deficiency (short stature)
-
Congenital
- Prader-Willi - fat + floppy + hungry
- Down’s
- PCOS (girls)
- DIET
- EXERCISE
- MOOD
- How does he feel about weight gain?
- ?Bullying at school -> Stress eating
- Would you like to lose weight? Have you tried? Was it successful?
Very overweight children tend to grow up to be very overweight adults, which can lead to health problems such as T2DM, heart disease and certain cancers.
Research shows children who achieve a healthy weight tend to be fitter, healthier, better able to learn, and are more self-confident. They’re also less likely to have low self-esteem and be bullied
Mx:
- Be a good role model (mum + dad)
- Encourage 1 hour activity a day
- Keep meals to child-sized portions
- Eat healthy meals, drinks and snacks
- less screen time and more sleep
- Star-chart/ set goals to encourage exercise
- May refer to local weight management programme for children (MORE-LIFE.CO.UK)
Routine weight + height measurement programme = 4-5yo + 10-11
RFs for obese = Females, asians, organic causes
BMI >98th centile = HTN, DM, psychosocial, dyslipidaemia, exacerbation of asthma
Complications of obesity = SUFE, CVD (HTN, stroke), GI (GORD, NAFLD), resp (sleep apnoea, worsening asthma)
