Paediatrics - Child at risk and community services

Question 1

What is initial burn management?

Answer 1

• Follow ABCs
• Identify and treat associated injuries (explosions)
• Remove patient from source, protect rescuer, drop roll over
• Initial cooling with cold (not ice) water, cover with sterile dressing, leave blisters intact
• Brushing off any metal or powder, copious irrigation for chemical burns

Question 2

How to estimate the percent total body surface area of burns in children?

Answer 2

Question 3

How to classify burns severity?

Answer 3

Question 4

How to classify burn depth based on histology, appearance, sensation, healing?

Answer 4

Question 5

What are the 3 most common child injuries requiring medical treatment?

Answer 5

Falls injury
Sports related injury
Bicycle related injury (no helmet, child at home by theirselves)

Question 6

What are the common home accidents in children?

Answer 6

MPF and 3S

Mechanical objects: infant cushions, adult beds (trapped between wall and bed) strangulations by window blinds, or strollers (slip into leg opening)
Poisoning
Falls (window safety)

Small object (foods swallowing)
Sharp objects
Scald (burns)

Question 7

What are the recommendations for childrens in car and seatbelts?

Answer 7

– 1 year of age or under or weighing less than 20 pounds: a rear facing infant seat.
– Between 1 - 4 years old and 20 - 40 pounds: a forward facing child safety seat.
– Between 4 - 6 years old or 40 - 60 pounds: a booster seat with a lap and shoulder belt.
– 6 years old or 60 pounds and greater: a seatbelt.

Question 8

What are the common presentations of substance abuse?

Answer 8

Physical: person hygiene worsens, odor, weight loss/gain, eye small/large, black eyes
Social: family dispute, loss of interest in previous hobbies
Mood: depressed, easily agitated, withdrawal
Finance
School: memory loss, attention span shortened, late
Speech: incoherent, inappropriate laughter, always going toilet

Question 9

What are the common types of drugs abused by reported drug abusers by age group?

Answer 9

But in older ages most common is heroin

Question 10

1. What is the 3 most common types of drugs abused?
2. 3 most popular types in young drug abusers aged under 21?

Answer 10

1. Heroin, methamphetamine (ice) and cocaine
2. Cannabis, cocaine and ketamine (K)

Question 11

What are the limitations of each drug testing?

Answer 11

Urine: needs to be observed to avoid adulteration, false positives
Hair: cannot detect very recent use
Saliva: short detection window
Sweat: more expensive and requires specialist lab services for analysis

Question 12

What are the drug detection times for different drugs?

Answer 12

Question 13

Adolescent drug abuser, what is its use?
Who to consult if cannot identify substance?

Answer 13

K仔
Sent to lab for identification
ekG of HA: toxicology
PWH drugs and poisons information bureau hotline

Low cost, affordable price, can be used with other substances e.g. ecstasy

Question 14

What are the urological complications of ketamine?

Answer 14

Dysuria, frequency, urgency, urge incontinence, and painful haematuria
Reduced functional capacity of urinary bladder to 30-100ml: may require augmentation enterocystoplasty
Detrusor overactivity with urinary leakage
Cystitis glandularis
Bilateral hydronephrosis
Papillary necrosis
Renal failure: secondary to ureteric stricture requiring per-cutaneous nephrotomy

Question 15

What are the hepatobiliary system physical complications and lab results of ketamine abuse?

Answer 15

• Dilated common bile ducts mimicking choledochal cysts
• Recurrent colicky epigastric pain, especially after ketamine abuse
• Elevated ALT and ALP with normal bilirubin
• USG and CT showed uniform, with fusiform dilation of common hepatic and bile duct (CBD) without gross obstructive lesion.

Others: rhinitis and sinusitis as there is a habit using nasal decongestant inhaling tube among abusers

Question 16

How does an adolescent abuse ice?

Answer 16

Question 17

Where can you refer an adolescent abusing ketamine and ice?

Answer 17

• Compulsory detoxification
• Voluntary residential detoxification and rehabilitation
• Methadone clinic treatment program
• Substance abuse clinics under HA (QMH, PYNEH, KH, PWH)
• Substance abuse counselling center

Question 18

What is drug management during pregnancy?

Answer 18

Heroin: repaced by methadone
Methamphetamine and ketamine: stop immediately

Question 19

What are the benefits of using methadone during pregnancy?

Answer 19

It reduces fluctuations in maternal serum opioid levels, so it protects a fetus from repeated withdrawal episodes
Comprehensive methadone maintenance treatment that includes prenatal care reduces taht risk of obstretical and fetal complications, in utero growth retardation and neonatal morbidity and mortality

Question 20

When may methadone users be allowed to breastfeed?

Answer 20

Not HIV positive
Not abusing substances
Do not have a disease or infection in which breast feeding is contraindicated

Question 21

What are the complications in childhood (infancy: 0-15 months, toddlerhood (15-36 months), preschool years (3-5 years) with a methadone user as a mom?

Answer 21

Question 22

What is weight growth chart for newborn girl?

Answer 22

Question 23

What are the sensitive periods in early brain development?

Answer 23

Question 24

What is the effect of maternal depression on children?

Answer 24

Question 25

Child born 2.8kg, 2 months later was 2.74kg, what adversities may have been faced?

Answer 25

Maternal mental health issues, child neglect, malnutrition, poverty, poor parenting

Question 26

What is the relation in the interaction between genetics and experience and development of depression?

Answer 26

Polymorphism in the promotor region of the serotonin transporter (5-HT T) gene was found to moderate the influence of stressful life events on depression