Paeds Flashcards
APGAR
Appearance - Colour - (Blue or pale/extremities blue/completely pink)
Pulse - HR - 0/1/2 (Below/above 100)
Grimace - Reflex - 0/1/2 (Grimace/Cough or sneeze)
Activity - Muscle tone - 0/1/2 (Limp/Some flexion/Active motion)
Respiration - Resp effort - 0/1/2 (Slow, irregular/good crying)
2 month/8 week vaccines
6 in 1, Rotavirus, Men B
3 month vaccines
6 in 1, Rotavirus, PCV
4 month vaccines
6 in 1, Men B
1 year vaccines
HiB/Men C, PCV, Men B, MMR
2-10 year vaccines
Flu annually
3 years 4 months vaccine
4 in 1 booster - DTaP/IPV, MMR
12-13 year vaccines
HPV
14 year vaccines
3 in 1 booster T/D/aP, Men ACWY
Normal urine output
> 2ml/kg/hr if <2yrs
>1ml/kg/hr if >2yrs
Fluid resus bolus
0.9% NaCl STAT
20ml/kg under 10 mins - children
10ml/kg under 10 mins - neonates
Fluid deficit
% deficit x weight x 10
Maintenance fluid
0.9% NaCl + 500ml 10% dextrose + 40mmol KCl
<10kg 100ml/kg/day (4/hr)
next 10-20kg 50ml/kg/day (2/hr)
>20kg 20ml/kg/day (1/hr)
DKA bolus
10ml/kg over 30 mins and subtract from fluid deficit
If shocked 20ml/kg and don’t subtract
Febrile convulsions
Mx - offer fluids and paracetamol
Next seizure - note when it starts, protect from injury but do not restrain, 5 min rule for ambulance and buccal midazolam (rpt at 10 mins)
NOT epilepsy
1 in 3 will have repeat febrile seizure
Safety net - non-blanching rash, reduced GCS, dehydration, fever >5 days
Sepsis Abx
Meningococcal - IM benpen in community, IV ceftriaxone in hospital
Neonates - IV benpen + gentamicin
Sepsis possible CNS infection or <1mth old
High risk: meropenem + amikacin + ampicillin
Moderate risk: cefotaxime + amikacin + ampicillin
T1DM
Body does not produce enough insulin - can lead to kidney damage, visual problems, skin ulcers
Mx: teach how to self-inject insulin into tummy/thigh before meals, teach how to finger prick - advise re continuous subcut insulin
High protien/low-fat diet, exercise
Regular GP review
If tired, dizzy, shaky, lips tingling, heart pounding - sugary energy drink - if not getting better 999
Epilepsy
Brain condition causing seizures - aetiology not known - lifelong, can get better over time
Ix: ECG, MRI/CT EEG (will only support diagnosis)
Mx: carbamazepine/lamotrigine, avoid sodium valproate in girls, go for levetiracetam
Buccal midazolam for future seizures
Advise avoiding swimming/bathing unsupervised
Care team, epilepsy society
West Syndrome
Infantile spasms
Mx: pred or vigabatrin (if due to tuberous sclerosis)
Refer to tertiary epilepsy specialist
Childhood absence seizures
Mx: ethosuximide (or valproate for boys)
Asthma (under 5)
Ix: clinical, spirometry (FEV1/FVC < 70%)
Asthma (under 5)
Ix: clinical, spirometry (FEV1/FVC < 70%), bronchodilator reversibility test, fractional exhaled nitric oxide, PFR, asthma control questionnaire
Mx:
- SABA reliever
- 8wk trial moderate dose ICS, stop then monitor - if resolved then remit:
within 4wks low dose
after 4wks moderate 8wk
- Consider LTRA to ICS maintenance therapy
- Specialist
Asthma (over 5)
Ix: clinical
Mx:
- SABA reliever
- Low dose ICS
- Consider adding LTRA and review in 4-8wks
- Stop LTRA, start LABA
- Change ICS and LABA to MART w/ low dose ICS and SABA
- Increase ICS to moderate dose
- Specialist
Itchywheezysneezy.co.uk
Bronchiolitis/croup safety net
111
Less than half usual amount of feed in last 3
Dry nappy 12 hrs
38 persistently
Drowsy, irritable
999
Cyanosed
Lots of work of breathing
Pauses in breathing
Whooping Cough
Ix: NPA or swab
Mx: if <21 days of cough - macrolide
- <1 m - clarithromycin
- > 1 m or not pregnant - azithro/clarithromycin
- Pregnant - erythromycin
Do not use co-trimoxazole
Cystic Fibrosis
Ix: Guthrie
Sweat
Karyotyping
Mx: High fat diet Don't meet other CF kids antibiotic cover prophylactically Inhalers Creon ?steroids oral rhDNase
Cystic fibrosis trust
Measles
Mx: School exclusion for 4d after rash develops
MMR
Mumps
Ix: saliva swab
Mx: School exclusion for 5 days after onset
Rubella
Ix: Saliva swab
B19 testing if pregnant
Mx: 5d exclusion
Rheumatic fever
Ix: Jones Criteria, Throat Culture rapid antigen testing for GAS, Anto-streptolysin O titre
Mx: if unconfirmed - paracetamol
confirmed - benpen IM or penV - ?NSAIDs
If HF - furosemide/spironolactone or enalapril
AF - steroids, amoidarone/digoxin
If chorea - emergency valve surgery - carbamazepine (LFTs)
Long-term IM benpen monthly for 10 yrs or until age of 21 yrs
Regular check-ups
Infective Endocarditis
Ix: Follow up with cardiologist
Mx: abx for 6 weeks (started IV inpatient)
Penicillin-susceptible streptococcus - beta-lactam + gentamicin OR vanc
Penicillin-resistant streptococcus - beta-lactam + gentamicin OR vanc + gent
MSSA - beta-lactam/vancomycin/daptomycin/co-trimaxole + clindamycin
MRSA - vanco/dapto/co-trim + clindamycin
Penicillin-sensitive enterococci: beta-lactam/van + gent
Penicillin-resistant enterococci: ampicillin/vancomycin + gentamicin
HACEK: ceftriaxone + gent
Fungal: surgery + antifungal
Scarlet Fever
Ix: Clinical, consider throat swab GAS
Mx: penV / amoxicillin
School exclusion 24hrs post-abx start
Urticaria
Ix: Urticaria Activity Score (UAS7)
Mx: Antihistamines, prednisolone if severe
Antipruritic treatment (calamine lotion, topical menthol in aqueous cream), chlorphenamine at night
Montelukast, cyclosporin, omalizumab, mycophenolate mofetil
Eczema
Ix: Swabs if infected, CDLQI questionnaire
Mx: Emollients
Hydrocortisone 1% –> Betamethasone valerate 0.025% or clobetasone butyrate 0.05% –> betamethasone valerate 0.1%
Nappy Rash
Mx: High absorbency, leave nappies off, clean skin and change nappies every 3-4 hrs, change nappies ASAP after soiling or wetting, fragrance-free, alcohol-free, dry gently, avoid excessive bathing
Barrier preparation to protect the skin - Diprobase
Topical hydrocort up to 7 days
KDIGO/RIFLE/AKIN criteria for AKI
- Rise of serum creatinine of 26micromol/L or more within 48 hours
- 50%+ rise in creatinine in 7 days
- UO decreases to less than 0.5ml/kg/hr for more than 6hrs in adults, 8 in children
- 25% or greater fall in eGFR in children within 7 days
Iron-rich foods
dark green vegetables, iron-fortified bread, meat, aprcots, prunes, raisins
Hodgkin Lymphoma
Doxorubicin, bleomycin, vinblastine, dacarbazine
Septic arthritis
Ix: Synovial fluid joint aspiration
Mx: G+ fluclox + joint aspirate OR clindamycin OR vanc
G- ceftriaxone + joint aspirate OR ciprofloxacin