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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? (RCUK) (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

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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28
Q

How should temperature be measured in babies <4 weeks?

A

Electronic axilla thermometer

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29
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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30
Q

Under what age should babies have full septic work up?

A

3 months

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31
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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32
Q

What is an amber flag for paeds re: skin colour

A

Pallor reports by parents

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33
Q

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

A
  1. Pale
  2. Mottled
  3. Blue
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34
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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35
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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36
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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37
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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38
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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39
Q

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

A

Increased skin turgor

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40
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
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41
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
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42
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`
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43
Q

Describe the Westley croup score

A
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44
Q

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

A
  1. Less stridor
  2. Quicker onset
    3 More unwell
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45
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 or urinary ketones > ++
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46
Q

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

A
  1. sc insulin
  2. PO fluids
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47
Q

When should insulin be started in paeds DKA?

A

After at least 1 hour of fluids

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48
Q

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

A
  1. 48 hours
  2. Avoid cerebral oedema
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49
Q

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

A
  1. hypertonic saline (2.7% or 3% 2.5-5 ml/kg over 10-15 minutes)

or

  1. mannitol (20% 0.5-1 g/kg over 10-15 minutes)
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50
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)
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51
Q

Under what age should all limping children be investigated?

A

Under 3 years

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52
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
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53
Q

How is mild/moderate/severe DKA defined in paeds according to BSPED?

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
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54
Q

How much and what 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 30mins normal saline
  2. 10ml/kg bolus isotonic crystalloid (hartmanns/plasmolyte) or normal saline if not available, up to maximum of 40ml/kg (above this call PICU)
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55
Q

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

A

Miller if experience allows

56
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
57
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

58
Q

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

A

Atropine
20mcg/kg

59
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
60
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
61
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

62
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

63
Q

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

A
  1. FLACC - pre verbal
  2. Wong-Baker faces
64
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
65
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

66
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.

67
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)
68
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

69
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

70
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
71
Q

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

A
  1. High flow 02
  2. Oxygen driven salbutamol nebs
72
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
73
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
74
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
75
Q

What are the doses of prednisolone in paeds asthma?

A

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

76
Q

What are the dose of hydrocortisone in paeds asthma?

A

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

77
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

78
Q

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

79
Q

How does JRCALC define status?

A

Bilateral tonic-clonic seizure lasting > 5mins

80
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

81
Q

What does JRCALC recommend for second benzodiazepines in paeds seizures?

A

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

82
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

83
Q

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

A
  1. Still seizing
  2. Status
  3. Suspected meningitis
84
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
85
Q

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

A

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

86
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)

87
Q

What helps distinguish herpes simplex encephalitis?

A

Focal neurology or focal seizures

88
Q

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

A

Convey and consider blue light

89
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
90
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
91
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
92
Q

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

A

Bloody diarrhoea and haemolytic ureamic syndrome

93
Q

What criteria must be met to diagnose a BRUE? (5)

A
  1. Must be < 12 months old +
  2. Duration <1 minute (typically 20-30 seconds)
  3. Sudden onset, accompanied by a return to a baseline state
  4. Characterised by ≥1 of the following:
    - cyanosis or pallor
    - absent, decreased or irregular breathing
    - marked change in tone (hypertonia or hypotonia)
    - altered level of responsiveness
  5. Not explained by identifiable medical conditions
94
Q

What criteria make a BRUE low risk? (4)

A

No concerning features on hx and examination and

  1. age >60days
  2. Born >32 weeks gestation or if premature corrected gestational age > 45 weeks)
  3. No CPR from healthcare professional
  4. 1 episode only
95
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
96
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.
97
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
98
Q

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

A
  1. INH salbutamol via MDI
  2. Steroids
99
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%
100
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
101
Q

What are the 4 abnormalities associated with ToF?

A
  1. VDS
  2. Overriding aorta
  3. RV hypertrophy
  4. Pulmonary valve stenosis or pulmonary outflow tract obstruction
102
Q

When should an APGAR should be routinely done following birth and what is a normal range?

A

At 1 and 5 mins

7-10 is normal

103
Q

How is an APGAR score calculated and what is normal range

A

7-10 normal

104
Q

What is the fluid requirement calculation for DKA outlined by BSPED?

A

Hourly rate = ({Deficit – initial bolus} / 48hr) + Maintenance per hour

105
Q

How does BSPED work out the fluid deficit on DKA?

A
  1. Use blood gas:
    Mild-moderate = 5%
    Severe = 10%
  2. Minus the initial fluid bolus (10ml/kg) given in the non-shocked patient from this
  3. Any fluid bolus given in shocked patients is not subtracted
106
Q

What formula does BSPED state to use for calculating maintenance fluids in paeds DKA?

A

Holliday-Segar formula

  • 100 ml/kg/day for the first 10 kg of body weight
  • 50 ml/kg/day for the next 10 to 20 kg
  • 20 ml/kg/day for each additional kilogram above 20 kg
107
Q

What is the max weight used to calculate paeds DKA fluids (BSPED)?

A

75kg or 97th centile for age, whichever is lower

108
Q

What is the hourly fluid requirement for a 20 kg 6 year old boy who has a pH of 7, no signs of shock

109
Q

What is the hourly fluid requirement for a 60 kg 15 year old girl with a pH of 6.9 who was shocked at presentation has received 30ml/kg of 0.9% Saline for resuscitation.

110
Q

What type of fluid should be used in paeds DKA maintenance (BSPED)?

A

Normal saline +/- potassium

111
Q

What do the BSPED guidelines states re: oral fluids in patients having IV fluids in DKA? (3)

A
  1. Do not give oral fluids to a child or young person who is receiving intravenous fluids for DKA until ketosis is resolving and there is no nausea of vomiting.
  2. A nasogastric tube may be necessary in the case of gastric paresis.
  3. If oral fluids are given before the 48hr rehydration period is completed, the IV infusion needs to be reduced to take account of the oral intake.
112
Q

What does BSPED state about K+ in DKA requirement fluid?

A
  1. All fluids except for initial bolus should have 40mmol KCl in 1L
  2. If K+ is high only give if one of the following:
    - once passed urine
    - hx of recently passing urine
    - drops <5.5 following initial bolus
  3. If low (<3.0) consider delaying insulin until >3.0 and placing CVP to give increased dose K+
113
Q

What dose of insulin does BSPED recommend commencing and when?

A

After 1-2 hours fluid

  • 0.05units/kg/hr
  • 0.1units/kg/hr only in severe DKA or adolescents
114
Q

What does BSPED recommend doing with
1. Long acting insulin
2. Insulin pump

If on fixed rate infusion for DKA?

A
  1. May continue
  2. Stop pump
115
Q

When does BSPED recommend switching fluid to 5 % dextrose ?

A

Glucose < 14

116
Q

What is the peak age for bronchiolitis?

A

3-6 months

117
Q

What is first line for suspected bacterial meningitis and what should be used if severe allergy?

A
  1. Ceftriaxone or benpen (if no cef)
  2. Chloramphenicol (although advised not to give abx if severe pen allergy OOH)
118
Q

When should dexamethasone be used to treat meningitis?

A
  1. If over 3/12 and strong suspected give with first dose abx

No routinely given in meningococcal disease

119
Q

Which ionotropes (2) should be used pre-hospital in paeds sepsis, at what dose according to resus council?

Which should be avoided and why?

A

Adrenaline 0.05-0.3mcg/kg / min and/or

Noradrenaline via central line 0.05mcg/kg/hr

Dopamine causes vasodilation as well as ionotropy and should be avoided in sepsis

120
Q

What is the dose of buccal midazolam for seizures? (RCUK)

A

0.3-0.5 mg/kg

121
Q

What do resus council status algorithm state for second line agents and which one has the best evidence?

A
  • Levetiracetam 30–60 mg kg-1 (over 5 min, max 3 g)
    OR
  • Phenytoin 20 mg kg-1 by slow IV infusion
    over 20 min with ECG monitoring
    OR
  • Phenobarbital 20 mg kg-1 by IV infusion over 5 min

All have been shown to be equally effective if several trials

122
Q

After what period of time does likelihood or seizure termination decrease and what consequence does this have to the status algorithm

A

After 5 mins which is when resus council define status

Means first dose benzo should only be given after 5 mins.

123
Q

When giving phenytoin IV, what must be considerd?

A

If given as bolus will lead to bradycardia/hypotension +/- asystole

124
Q

What induction agents are mentioned by resus council for third line status tx?

A

There is no evidence for the ideal third line agent:
1. thiopentone,
2. propofol
3. ketamine
4. midazolam

all appropriate

125
Q

How does RCUK define warm and cold shock?

A

Warm = high cardiac output, low SVR

Cold = low CO high SVR

126
Q

What are the parts of paeds development milestones? (4)

A
  1. Gross motor
  2. Vision and fine motor
  3. Hearing/speech and language
  4. Social and emotional
127
Q

What are the normal paeds milestones for a:
3 month old
6 month old
9 month old

128
Q

What are the normal paeds milestones for a:
1 year old
18 month old
2 year old

129
Q

What is the dose of IN fentanyl in paeds?

A

First dose 1.5mcg/kg
Subsequent doses 0.75-1.5 mcg/kg titrated to affect

130
Q

What temperature should be targeted post ROSC in paeds?

A

36.0-37.2 degrees C

131
Q

In a low risk BRUE pre-hospital, what should be done?

A

Convey to local ED - discharge on scene discouraged

132
Q

What ages can the following be used?
1. Electronic axillary thermometer
2. Axllary Tempa.Dot
3. Tympanic thermometer
4. Rectal thermometer

A
  1. Any age
  2. > 4 weeks
  3. > 4 weeks
  4. Not in children, especially < 5 yrs
133
Q

What is the paeds dose of keppra?

A

40mg/kg with a max 3g

134
Q

What should be used to perform a thoracostomy:
1. < 5yrs
2. 5-12 yys
3. > 12 yrs

A
  1. Mosquito forceps
  2. Artery forceps
  3. Spencer wells
135
Q

What size chest drain should be placed in paeds trauma?

A

Size (Fr) = 4 x ETT size

136
Q

How far should an chest drain be placed into paeds trauma patient?

A

4cm i.e. make sure last hole is 4cm into thorax

137
Q

What defines a massive haemothorax in paeds?

A

20ml/kg initially

or 3-4 x ml/kg/hr thereafter

FIMC (17 decks)

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