Paediatrics - Investigations and treatment Flashcards
Febrile convulsions
Investigation
Treatment
Clinical diagnosis
Tx
- Admit to paediatrics department
- (If outside hospital call an ambulance if seizure lasts more than 5 mins) –> give rectal diazepam or buccal midazolam
Pneumonia in children
Investigation
Treatment
Investigation
LARGELY CLINICAL
Investigations only for
- Failure to respond to treatment
- Complicated pneumonia
- Hospitalised children
X-ray, FBC, CRP, PCR - investigations (CONTINUE HERE)
Tx
First line - Amoxicillin
Second line - Amoxicillin + macrolides (clarithromycin)
Croup (laryngotracheobronchitis)
Investigations
Treatment
Largely clinical diagnosis - WESTLEY SCORING TOOL
Mild - occasional barking cough, no stridor, child is happy to eat and play, no sternal retraction
Moderate - Frequent barking cough, stridor at rest, very little distress and can be distracted by environment, slight sternal retraction
Severe - Frequent barking cough, Prominent stridor, significant agitation and distress, significant sternal wall retraction
If chest x-ray is done
(Antero-posterior neck view)
- Steeple sign (subglottic tracheal narrowing)
Tx
Guidelines for admission
- Moderate/severe croup
- <3 months of age
- Uncertainty about diagnosis
- Single oral dexamethasone (0.15mg/kg)
(prednisolone alternative)
Emergency
- Nebulised adrenaline - reduces swelling and oedema.
Asthma in children
Investigations
Acute and chronic treatment
Investigations
- Spirometry –> FEV1/FVC <0.8
- Peak expiratory flow
(In children old enough - bronchodilator reversibility)
Moderate - SPO2 >92%
Severe
- SPO2 <92%
- PEF 33-50%
- HR >125
- RR >30
Life threatening
- SPO2 <92%
- PEF <33%
- Silent chest
- Agitation
- Cyanosis
- Altered consciousness
Tx
Mild to moderate
SABA via spacer - Salbutamol (up to 10 doses via spacer) asap
Severe/life threatening
- Oxygen driven nebuliser
- Prednisolone (for 3 days)
Chronic
- Twice daily Paediatric low dose ICS (budesonide) with a SABA (salbutamol)
- If doesn’t work –> add LTRA (8-12 weeks)
- If doesn’t work –> switch to twice daily paediatric low dose ICS and LABA(salmeterol) combination inhaler + SABA
- If dosen’t work –> Increase dose of combination inhaler
If symptoms resolved then can stop and review after 3 months.
Bronchiolitis
Investigations
Treatment
Investigations
- Immunofluorescence of nasopharyngeal secretions - may show RSV
(Chest x-ray –> hyperinflation)
Tx
Supportive
- Treat hypoxia - Humidified oxygen (high flow nasal cannula therapy OR headbox)
- AND dehydration (NG feeding if child cannot take fluids/food by mouth)
Cystic fibrosis
Investigations
Treatment
GS - Sweat test (pilocarpine iontophoresis)- measuring the amount of chloride in the sweat (more chloride than usual) >60mmol/L
(Genetic testing)
Tx
MDT approach
- Chest physiotherapy, high calorie diet
- Pancreatic enzyme supplements taken with meals
- Vitamin ADEK supplements - fat soluble - for patients with pancreatic insufficiency
Orkambi- Lumacaftor/Ivacaftor –> used for treatment in homozygous delta F508 mutation
Acute epiglottis
Investigations
Treatment
Investigation
- Lateral neck radiograph - showing “Thumb sign” (done by senior/airway trained staff)
Tx
(KEEP PATIENT IN UPRIGHT POSITION AND DONT EXAMINE THE THROAT IF acute epiglottis suspected) - due to risk of laryngeal obstruction
- Airway support (senior involvement)
- Endotracheal intubation to protect airway
- Oxygen
- IV antibiotics
Otitis Externa
Investigations
Treatment
Clinical diagnosis
(in severe cases - ear culture for identifying the causative organism)
Tx
- Topical antibiotics/combined topical antibiotic with steroid
(Ciprofloxacin or ciprofloxacin/dexamethasone)
Removal of canal debris
2nd line - Oral Flucloxacillin
For fungal (in recurrent otitis externa) – Candida infection treated with Acetic acid
Acute otitis media
Investigations
Treatment
Investigations
1) Otoscopy - possible findings include:
- Bulging tympanic membrane (loss of light reflex)
- Perforation with purulent otorrhea
- Erythema of the tympanic membrane
Tx
- Usually self limiting
1st line - ANALGESIA - paracetamol/ibuprofen
If symptoms worsen or don’t improve after 3 days (4th day onwards)
- Start AMOXICILLIN
(penicillin allergy then - clarithromycin)
(Antibiotics should be prescribed immediately if
- Symptoms last more than 3 days
- Systemically unwell
- Immunocompromised
- Otitis media with PERFORATION.
Orbital/peri-orbital cellulitis
Investigations
Treatment
Investigations
- Ophthalmological assessment - decreased vision, afferent pupillary defect, proptosis, oedema, erythema
- FBC - elevated WBC, raised inflammatory markers
- Blood culture and microbiological swab to determine organism
For orbital cellulitis - CT with contrast (shows inflammation of orbital tissues, sinusitis)
Treatment
Orbital cellulitis –> IMMEDIATE ADMISSION
Broad spectrum IV antibiotics
- Co-amoxiclav/Flucloxacillin
(Penicillin allergy - clindamycin)
Squint/Strabismus
Investigations
Treatment
Investigations
- Cover test - ask child to focus on an object and cover one eye if there is refixation, strabismus is present. (refixation is in the opposite direction of the tropia e.g. eye moves inward in exotropia)
- Hirschberg test (corneal light reflex test)
–> Light should be in the same position in both eyes.
Tx
- Refer to ophthalmology
For amblyopia –> Occlusion of the normal eye with an eyepatch
For VA –> correct with spectacles or contact lenses
Definitive for strabismus –> Extraocular muscle surgery
Atrial septal defects
Investigations
Treatment
Investigations
- TOE, Echocardiogram –> Visualisation of the defect, right ventricular hypertrophy
- ECG - RBBB (marrow)
- Chest x-ray
Tx
Observation
Surgical closure of the defect
Ventricular septal defects
Investigations
Treatment
Investigations
- TOE- shows defect
- ECG
- Chest x-ray - cardiomegaly
Tx
Small VSDs usually close spontaneously –> Just monitor
Surgical closure of defect
- Ace inhibitor for heart failure
Tetralogy of fallot
Investigations
Treatment
Investigations
- Chest x-ray –> Boot shaped heart
- ECG –> Right ventricular hypertrophy (RBBB)
- TOE
Tx
Surgical repair
For cyanotic spells - Propanolol (relieves infundibular spasm - which blocks blood flow to the pulmonary circulation)
Transposition of the great arteries
Investigations
Treatment
Investigations
- Chest x-ray –> egg on side appearance
Tx
First line - Prostaglandin E1 given to keep the ductus arteriosus open
Surgical treatment - definitive
