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DipIMC > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is the paediatric weight calculation for 1-5yrs?

A

(2 x age in years) + 8

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2
Q

What is the paediatric weight calculation for 5-12 years?

A

(3 x age years) + 7

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3
Q

What are the paediatric weight calculations for different age categories?

A

< 1 year = (0.5 x age months) + 4
1-5years = (2 x age years) + 8
5-12 years = ( 3 x age years) + 7

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4
Q

What is Sandel Tape?

A

Length based way of calculating weight

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5
Q

How should an OP airway be inserted in paediatric patients?

A

Using tongue depressor and right way up

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6
Q

When does DAS recommend surgical airway in paeds?

A

SATs <80% and falling

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7
Q

What does DAS recommend for a surgical airway in under 1yrs?

A

ENT

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8
Q

What does DAS recommend in age 1-8 yrs as first line for surgical airway?

A

Percutaneous cannula unless ENT experience
- surgical if failed

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9
Q

When do DAS recommend surgical airways as first line?

A

> 8 years

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10
Q

Where should an IO be avoided in pre-school kids?

A

Humeral head as not ossified enough

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11
Q

When should ionotropes be started in paeds (according to ABC PHC)

A

After 40ml/kg fluids

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12
Q

Describes the parts of the FLACC pain scoring system in paeds

A

Face
Legs
Activity
Cry
Consolability

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13
Q

What is the FLACC score for paeds pain out of?

A

10

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14
Q

How are Wong-Baker faces used to assess paeds pain?

A

6 faces - score 0 to 10

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15
Q

When can Wong-Baker faces be used to assess pain?

A

> 3 years

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16
Q

Describe the visual analogue scale (VAS) for assessing paeds pain

A

10cm line with no pain on one end and worst pain imaginable on the other. Child marks where there pain is

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17
Q

What is the dose of adrenaline nebs for paeds stridor?

A

5ml of 1:1000

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18
Q

What are the doses of adrenaline in paeds anaphx?

A

> 12 years = 500mcg
6-12 years = 300mcg
6months-6 years = 150mcg
<6 months = 100-150mcg

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19
Q

When does NICE recommend febrile seizures be conveyed? (5)

A
  1. First seizure
  2. < 18 months old
  3. Complex seizure
  4. Diagnostic uncertainty
  5. Parental anxiety/unable to cope
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20
Q

What makes a febrile seizure complex? (4)

A
  1. > 15mins
  2. Focal
  3. More than 1 episode within 24 hours
  4. Incomplete recovery
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21
Q

What are 3 differences in the distribution of traumatic injury in paeds? (3)

A
  1. Younger ages less likely to have c-spine injury
  2. Complaint chest means can have little external evidence of injury but can have lung injury
  3. Liver/spleen more exposed therefore more prone to injury
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22
Q

Before CPR in paeds resus what should be done?

A

5 rescue breaths

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23
Q

What is less likely to be a cause of arrest in paeds?

A

Dysrhythmia

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24
Q

Under what age should the brachial pulse be used to check of a pulse?

A

< 1 yr

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25
Q

When should the ‘encircling technique’ be used for CPR?

A

< 1 year

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26
Q

What are the ventilation rates for paeds patients during resus? (5)

A

neonate = 30
< 1 year (infant) = 25
1-8 years = 20
8-12 years = 15
>12 = 10-12

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27
Q
A
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28
Q

What 3 things must be present to diagnose BRUE?

A
  1. < 1 year
  2. <1 mins
  3. Sudden return to baseline
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29
Q

What 4 signs/symptoms characterise a BRUE (need at least one of these)

A

1, Cyanosis/pallor
2. Absent/irreg breathing
3. Increased or decreased tone
4. Altered GCS

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30
Q

How much of a babies birth weight is expected to be lost by week one and when should they regain it?

A
  1. 10%
  2. Week 2
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31
Q

How should temperature be measured in babies <4 weeks?

A

Electronic axilla thermometer

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32
Q

How should temp be measured in children 4 weeks to 5 years?(3 options)

A
  1. Electronic axilla thermometer
  2. Chemical dot thermometer
  3. Infra-red tympanic thermometer
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33
Q

Under what age should babies have full septic work up?

A

3 months

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34
Q

If a child > 3 months with a fever only has green features but no source what should be done? (2)

A
  1. Urine sample
  2. Assess for signs of pneumonia
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35
Q

What is an amber flag for paeds re: skin colour

A

Pallor reports by parents

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36
Q

What are red flags for paeds re: skin colour? (3)

A
  1. Pale
  2. Mottled
  3. Blue
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37
Q

What are amber flags for paeds re: activity? (4)

A

1, Not responding normally to social cues
2. No smile
3. Only wakes on prolonged stimulation
4. Decreased acitivity

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38
Q

What are red flags for paeds re: activity (4)

A
  1. No response to social cues
  2. Appears ill to healthcare professional
  3. Does not wake or stay awake
  4. Weak/high pitched/continous cry
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39
Q

What are amber flags in paed fevers < 5yrs re: resp (4)

A
  1. Nasal flaring
  2. RR > 50 in 6-12 months
    RR > 40 > 12 months
  3. <95% SATs
  4. Crackles on chest
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40
Q

What are red flags in paeds re: resp (3)

A
  1. Grunting
  2. RR >60
  3. Mod-severe chest indrawing
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41
Q

What are amber flags in paeds fever < 5yrs re: CVS (4)

A
  1. HR
    >160bpm < 1year
    > 150bpm 1-2 years
    > 140bpm 2-5 years
  2. CRT > / 3 secs
  3. Poorer feeding
  4. Decreased UO
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42
Q

What are paeds red flags re: CVS? (1)

A

Increased skin turgor

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43
Q

What are the other paeds amber flags (5)

A
  1. 3-6 months and fever >39
  2. Fever 5 days or more
  3. Rigors
  4. Swelling of joint/limb
  5. NWB limb
44
Q

What are the other paeds red flags? (7)

A
  1. <3 months and fever >38
  2. Non blanching rash
  3. Bulging fontanelle
  4. Neck stiffness
  5. Status epilepticus
  6. Focal neurology
  7. Focal seizures
45
Q

What are the 5 parts of the Westley croup score?

A
  1. Stridor
  2. Retractions
  3. Air entry
  4. SATs <92%
  5. Reduced GCS`
46
Q

Describe the Westley croup score

A
47
Q

How will acute epiglotitis present differently to croup? (3)

A
  1. Less stridor
  2. Quicker onset
    3 More unwell
48
Q

What are the criteria for diagnosis of paeds DKA? (3)

A
  1. Gluc > 11 (can be normal)
  2. Acidosis - PH <7.3 of HCO3 <15
  3. Blood ketones > 3mmol/l
49
Q

What is the management of paed DKA who is alert, not vomiting and not dehydrated?

A
  1. sc insulin
  2. PO fluids
50
Q

When should insulin be started in paeds DKA?

A

After at least 1 hour of fluids

51
Q

Over what period should IV maintenance be calculated in paeds DKA and why?

A
  1. 48 hours
  2. Avoid cerebral oedema
52
Q

What should be given in paeds DKA in the case of cerebral oedema and at what dose?

A

20% mannitol 0.5-1.0g/kg over 15 mins

or

5ml/kg hypertonic saline

53
Q

What are 5 ‘red flags’ for patients presenting with eating disorders?

A
  1. HR < 40bpm
  2. syncope
  3. postural drop
  4. high levels of dysfunctional exercise
  5. possible daily episodes of purging behaviours)
54
Q

Under what age should all limping children be investigated?

A

Under 3 years

55
Q

What are the criteria for conservative management of a limping child? (4)

A
  1. 3–9 years
  2. Afebrile
  3. Mobile
  4. Symptoms for less than 72 hours, or more than 72 hours and improving
56
Q

How is mild/moderate/severe DKA defined in paeds?

A
  1. Mild = PH 7.2-7.29 or HCO3 < 15
  2. Moderate = 7.1-7.19 or HC03 < 10
  3. Severe = PH < 7.1 or HC03 < 5
57
Q

How much fluid should be given in paeds DKA initially and over what time according to BSPED:
1. No shock
2. Shock

A
  1. 10ml/kg over 1 hour
  2. 10ml/kg bolus up to maximum of 40ml/kg (above this call PICU)
58
Q

What is the paeds maintenance fluids calculations?

A
  1. 4ml/kg for first 10kg
  2. 2ml/kg for second 10kg
  3. 1ml/kg thereafter (max 80kg)
59
Q

Below 6 months of age what type of laryngoscope could be considered?

A

Miller if experience allows

60
Q

What should be done in a paeds RSI to try and reduce the dead space? (3)

A
  1. Compress catheter mount
  2. Paeds filter
  3. Paeds ventilator circuit if TV <250ml
61
Q

What is more important to ensure we have done post RSI in children compared to adults?

A

OG tube to decrease gastric volume and increase ventilation

62
Q

What additional drug should be drawn up during a paeds RSI and at what dose?

A

Atropine
20mcg/kg

63
Q

What does JRCALC recommend for a bolus in paeds shock caused by:
1. Trauma
2. Medical
3. Heart failure/renal failure

A
  1. 5ml/kg
  2. 10ml/kg
  3. 5ml/kg
64
Q

What does JRCALC say about follow up fluid bolus in paeds in:
1. Trauma
2. Medical

A
  1. Give 5ml/kg aliquots until ‘significantly improved’
  2. Can give one further 10ml/kg bolus only
65
Q

What does JRCALC recommend for paeds DKA fluid bolus in:
1. Shocked patients
2. Non-shocked patients

A

1.10ml/kg over 15 mins
2. 10ml/kg over 30 mins

66
Q

What does JRCACL state re: further fluid bolus in paeds DKA?

A

May need further 5ml/kg bolus but only after discussion with senior clinician

67
Q

What method of assessing paeds pain does JRCALC mention? (2)

A
  1. FLACC - pre verbal
  2. Wong-Baker faces
68
Q

What does the Serious Crime Act 2015 place a duty on healthcare workers to report? (5)

A
  1. Serious domestic abuse (serious not defined)
  2. FGM
  3. Child sexual exploitation/abuse
  4. Gang related activity
  5. Cybercrime
69
Q

What does JRCALC state should happen with non-mobile babies and injury/

A

Needs assessment from clinician and d/w on call paediatrician or conveyence

70
Q

What defines a moderate asthma exacerbation?

A

PEFR more than 50–75% best or predicted (50% paeds) and normal speech, with no features of acute severe or life-threatening asthma.

71
Q

What defines acute severe asthma exacerbation in paeds? (7)

A
  1. PEFR 33–50% best or predicted (less than 50% best or predicted in children)
  2. SATS <92%
  3. Respiratory rate of :
    > 12 years = > 25/min
    5-12 years = > 30/min
    2-5 years = > 40/min
  4. HR of:
    > 12 years = > >110
    5-12 years = > 125
    2-5 years = > 140
  5. Inability to complete sentences in one breath
  6. Accessory muscle use
  7. Inability to feed (infants)
72
Q

What are the HRs that define acute severe asthma in:
> 12 years =
5-12 years =
2-5 years =

A

> 12 years = > >110
5-12 years = > 125
2-5 years = > 140

73
Q

What are the RRs that define acute severe asthma in:
> 12 years
5-12 years
2-5 years

A

> 12 years = > 25/min
5-12 years = > 30/min
2-5 years = > 40/min

74
Q

What defines life threatening asthma in paeds? (10)

A
  1. SATS <92% +
  2. PEFR less than 33% best or predicted,
  3. Altered consciousness
  4. Exhaustion
  5. Confusion
  6. Cardiac arrhythmia
  7. Hypotension
  8. Cyanosis
  9. Poor respiratory effort
  10. Silent chest
75
Q

How should moderate asthma be managed in paeds according to JRCALC?

A
  1. High flow 02
  2. Oxygen driven salbutamol nebs
76
Q

How should acute severe asthma be managed in paeds according to JRCALC?

A
  1. Add ipratropium nebs if poor response to salbutamol
  2. Back to back nebs
  3. Steroids
77
Q

How should life threatening asthma in paeds be managed according to JRCALC?

A
  1. Add magenisum
  2. IM adrenaline if continues to deteriorate
  3. Consider PTX
78
Q

What is the dose of:
1. Salbutamol
2. Ipratropium

Nebs in paeds

A
  1. 5mg > 5 years
    2.5mg 2- 5 years
  2. > 12 = 500mcg
    2-12 = 250mcg
79
Q

What are the doses of prednisolone in paeds asthma?

A

> 5 years = 30–40 mg
2-5 years = 20mg
< 2 years = 10mg

80
Q

What are the dose of hydrocortisone in paeds asthma?

A

> 5 years = 100mg
2-5 years = 50mg

81
Q

What are the doses of IM adrenaline in paeds?

A

> 12 years = 500mcg
6-12 years = 300mcg
6months to 6 years = 150mcg
<6months = 100-150mcg

82
Q

What percentage of children only have one febrile convulsion and how many go on to develop epilepsy?

A
  1. 66%
  2. 5%
83
Q

How does JRCALC define status?

A

Bilateral tonic-clonic seizure lasting > 5mins

84
Q

When does JRCALC recommend giving a dose of benzodiazepine in paeds seizures?

A

After 5 mins or if child has had 3 or more focal/GTC seizures in 1 hour

Usually rectal diazepam or bucacal midazolam

85
Q

What does JRCALC recommend for second benzodiazepines in paeds seizures?

A

Further dose at 10 mins after 1st dose given + ideally IV

86
Q

What does JRCALC state about a third dose of benzodiazepines in paeds seizure?

A

If 10 mins post second dose of benzodiazepine and hospital still over 15mins away then seek clinical advice as to giving 3rd dose - MUST be IV/IO

87
Q

What does JRCALC define as time critical seizure transfers? (3)

A
  1. Still seizing
  2. Status
  3. Suspected meningitis
88
Q

What does JRCALC state needs conveying in terms of paeds seizures? (6)

A
  1. Children 2 or less
  2. First febrile seizure
  3. Children needing more than 1 dose benzo
  4. Children not fully recovered
  5. Status or still convulsing
  6. Suspected meningococcal disease
89
Q

What is the dose of PR diazepam in paeds? (2)

A

5 or older = 10mg
< 5 year = 5mg

90
Q

What is the approx dose of IV diazepam in paeds seizures according
To JRCALC

A

> 10yrs = 10mg

Below that approx 1mg/yr age (not exactly)

91
Q

What is the dose of buccal midazolam in paeds seizures according to JRLALC? (5)

A

> 10 yrs = 10mg
5-10 years = 7.5mg
1-5 yrs = 5mg
<1 yr = 2.5mg
1month = 1.25mg

92
Q

What helps distinguish herpes simplex encephalitis?

A

Focal neurology or focal seizures

93
Q

What does JRCALC state should be done with children featuring red traffic light features?

A

Convey and consider blue light

94
Q

What does JRCALC state should be done with children featuring amber traffic light features in fever <5 years?

A
  • can be considered for alternative pathway
  • multiple amber features must be considered for hospital
95
Q

If not conveying an child with amber traffic light signs or green but no source for fever, what does JRCALC state must be done? (3)

A
  1. Must be discussed with GP or paeds and follow up arranged
  2. Direct handover important to doctor (may not be possible)
  3. Arrangements must be made by ambulance staff, can’t just say to see GP
96
Q

What are the red flags that JRCALC mandate conveying kids with fevers? (9)

A
  • febrile <1/12
  • under 3/12 with no obvious source
  • under 3 years without cause if a urine can’t be arranged by GP
  • Any child with fever but not localising signs who have received abx in last 48 hours (partially treated meningitis)
  • immunosuppressed children inc. steroids
  • Those with signs of serious medical illness
  • doubt over might be ill
  • any psychosocial factors meaning may not be cared for well enough at home
  • those with medical protocol stating they must be conveyed
97
Q

What does E.coli 0157 lead to in paeds gastroenteritis? (2)

A

Bloody diarrhoea and haemolytic ureamic syndrome

98
Q

What criteria must be met to diagnose a BRUE? (3)

A

Need all of:

  1. Episode <1min (usually 20-30s)
  2. Not explained by identifiable medical condition
  3. Characterised by one or more of:
    - central cyanosis or pallor
    - absent, decreased or irregular breathing
    - marked change in tone
    - altered consciousness level
99
Q

What criteria make a BRUE low risk? (4)

A

No concerning features on hx and examination and

  1. age >60days and <1 year
  2. > 32 weeks gestation
  3. No CPR from healthcare professional
  4. First event
100
Q

In a low risk BRUE what can be considered?

A
  1. Discharge home
  2. ECG
  3. Period of observation in ED
  4. NPA +/- pertussis
  5. Education of parents around BRUE, low risk = no increased risk of SIDS
  6. CPR training
101
Q

When should patients being admitted with bronchiolitis according to NICE? (4)

A
  1. Apnoea (observed or reported)
  2. Persistent SATS:
    <90% if 6 weeks or older
    <92% if <6 weeks or any underlying health condition
  3. Inadequate oral fluid intake (50% to 75% of usual volume)
  4. Persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute.
102
Q

When does NICE recommend considering hospital with bronchiolitis? (5)

A
  1. RR >60
  2. Decreased oral intake (<50%)
  3. Clinical dehydrated
  4. Persistent SATS <92%
  5. Have lower threshold if < 3/12 or premature or any pre-existing medical issues
103
Q

What does NICE/BTS recommend for treatment of mild-moderate asthma? (2)

A
  1. INH salbutamol via MDI
  2. Steroids
104
Q

What does NICE/BTS recommend for children with acute severe asthma (3)

A
  1. Oxygen driven salbutamol nebs
  2. Ipratropium is poor response to initial salbutamol
  3. Neb magnesium to every neb in first hour if short hx of acute severe asthma and SATs <92%
105
Q

In children with poor response to first line treatment for acute severe / life threatening asthma what does NICE/BTS recommend as first line IV and subsequently? (4)

A
  1. IV magnesium first line
  2. Bolus IV salbutamol
  3. IV salbutamol infusion with specialist input
  4. Consider aminophylline

DipIMC (14 decks)

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