Paediatrics Flashcards
Risk factors for intussuception
Previous intussusception Meckels diverticulum HSP Lymphoma Recent bowel surgery Recent rotavirus vaccine Male 2m - 2yrs
Intussusception history & exam
Episodic distress (pain, pallor, drowsy, vomiting, diarrhoea)
RUQ mass, abdominal distension, guarding, hyperactive bowel sounds
Intussusception XR & US findings
XR: soft tissue mass RUQ, lack of air in RLQ, crescent lucency bowel gas, SBO, pneumoperitoneum
US: Target sign, pseudokidney
Intussusception treatment
Enema if less than 24 hours
Nasogastric tube
Antibiotics
Fluids
Relative ketamine CI
Less than 6 months Tongue laceration Significant cardiac disease Glaucoma Porphyria Psychosis Procedure >20mins Known difficult airway
Paediatric Ataxia
Cerebellar ataxia (normal LOC, nystagmus, recent viral illness)
Drugs: phenytoin, benzo, opioids
Post infectious demyelination encephalmyelitis
Basilar Migraine (headache, vertigo)
GBS (opthalmoplegia of vertical gaze)
Tumour
Trauma
One pill kill
CCB TCA Opioids Propranolol Theophylline Venlafaxine Baclofen Clozapine Carbamazepine
AOM red flags & complications
Unilateral Indigenous Cochlear implant TM rupture Systemically unwell
Mastoiditis CN VII palsy Cholesteatoma Intracranial infection Sinus thrombosis Malignant otitis media
BRUE definition
Marked change in breathing, tone, colour or LOC Complete return to baseline state No medical explanation <1 minute <1 year old
Low risk of BRUE
>2 months old <1 minute Not premmy (>32/40; corrected >45/40) No CPR required First episode
Criteria for Kawasaki Disease
Complete & Incomplete
Fever >5/7 + 4 of:
- bilateral non-purulent conjunctivitis
- cervical LN >1.5cm
- polymorphous rash
- lip and oral hyperaemia
- painful hyperaemic hands & feet
Fever 5/7 + 2 criteria or Fever 7/7 without another explanation and 3: - anaemia - plts 450+ - albumin <30 - raised ALT - WBC >15 - WBC in urine or +ve ECHO
Kawasaki differential & investigations
GAS, scarlet fever, rheumatic fever, TSS, SJS, adenovirus
ECHO, raised CRP/ESR, raised LFT, ASOT, FBE (platelets raised at 2 weeks)
Note: common findings arthritis, aseptic meningitis, sterile pyuria
Kawaski management
IVIG 2g/kg
Aspirin 5mg/kg at least 6 weeks or until ECHO normal
Prednisolone 2mg/kg if high risk
(Shock, <1yr, Asian, cardiac or liver dx)
Kawasaki Complications
Coronary artery aneurysm Peripheral limb ischaemia Valve regurgitation Pericardial effusion Aseptic meningitis Myocarditis
Criteria for septic arthritis & bugs
Kocher criteria/
- NWB
- Temp >38.5
- ESR >40
- WBC >12
1: 3%
2: 40%
3: 93% (OT)
4: 99% (OT)
Bugs: S.Aureus, GAS, GBS, Haem influenza
Salmonella in sickle cell
Risk of recurrent febrile convulsion
<1 year Family hx febrile convulsion Repeated previous seizures Focal seizure Brief duration between fever and onset
Simple vs complex febrile convulsion
Simple: Generalised <10 mins Complete recovery 1hr No recurrence within same illness
Risk factors in febrile convulsion to progress to epilepsy
Family hx of epilepsy
Neurodevelopmental problem
Prolonged or focal seizure
Febrile status
Risk from 1% up to 10%
Causes paediatric scrotal swelling
Torsion Incarcerated hernia Torted appendage (gradual, tender upper pole, blue dot) Hydrocoele (painless, transilluminate) Variceole (painless, bag of worms) Tumour Idiopathic scrotal oedema Orchitis
Rapid Nasogastric Rehydration
25ml/kg/hr for 4 hours
Reasons to give slower NG hydration
<6 months
Significant abdominal pain
Co-morbidities
Replace deficit over 6 hours then maintenance
Maintenance IV fluids
4ml/kg/hr for first 10kg
2ml/kg/hr for next 10kg
1ml/kg/hr for remaining kg
5% dextrose and 0.45% saline
Difference in calculation burn BSA in kids
Head 9% (F&B)
Arms 4.5% (F&B)
Legs 7% (F&B)
Bum 2.5% x 2
Poor prognosis in kids with drowning
Immersion time 5mins Rectal temp <30 degrees Time to effective ALS 10 minutes CPR in progress when arrive to ED GCS <5 ABG pH <7.1 on arrival No respiratory effort within 40 mins
Phases of drowning
Immersion
Breath hold
Laryngospasm
Aspiration
Discharge drowning
8 hours post drowning No symptoms Normal Resp exam Normal vitals No social safety concerns (Social work should be involved)
Conns & Modell Drowning Score
2 hours post drowning
A: Alert
B: Drowsy
C: Unresponsive
Gartland criteria
Supracondylar fracture
1: undisplaced. Above elbow backslab and GP 3 weeks
2: angulated but posterior cortex intact. Above elbow 3/52 and # clinic
3: displaced posteriorly - surgery
Post tonsillectomy bleed management
Sit up Volume resuscitate TXA 15mg/kg DDAVP 0.3mcg/kg Suction Metoclopramide Direct pressure (co-phenylcaine, txa, adrenaline soaked gauze) IV Abx Gargle H2O2 Suck ice
Pertussis
- when give Abx
- complications
- what Abx
- when not infectious
Abx: within 2 weeks of cough or admitted to hospital
Apnoea, cyanosis, pneumonia
Azithro 10mg/kg PO & clarithro 7.5mg/kg BD
or Bactrim 4-20mg/kg BD
Back to school after 5 days tx or 3 weeks cough
Causes neonatal jaundice
<24hrs pathological
Term TCB should be <250
Increased lysis:
- ABO/Rh incompatibility
- RBC defect (G6PD)
- sepsis
Reduced conjugation:
- Criglar-Nijar
- Biliary atresia
- Hepatitis
- Hypothyroidism
- Hypopituitarism
- Bowel obstruction
Physiological:
- breast milk
- dehydration (first few days BF babies)
- haematoma breakdown
Red flags limp
>7 days Nocturnal pain Change to urinary/bowel function Systemic symptoms Unable to weight-bear Severe localised joint pain
Red Flags Limp exam (3)
Muscle wasting
Fever
Petechia or ecchymosis
Paediatric Syncope
Vasovagal Arrhythmogenic (WPW, QTc, Brugada) Structural cardiac (HOCM, AS, CHD) Reflex Anoxic Episodes Metabolic: hypoglycaemia, hyponatraemia Neurogenic: Vertigo, migraine, micturation
Normal paediatric variation
sinus tachycardia/arrhythmia RSR pattern V1 (RBBB but say this) Dominant R wave in V1 TWI V3 & V2 TWI III
