Paeds Flashcards
Sepsis 6.
3 in 3 out
Out
- blood cultures
- lactate
- urine output
In
- high flow O2
- fluids
- antibiotics
Fluid bolus vol in children?
10mls/kg. Over <10mins
Use normal saline 0.9% NaCl
Maintenance fluid vols in children?
First 10kg- 100mls/kg/day
Second 10kg- 50mls/kg/day
Over 20kg- 20mls/kg/day
Estimating child weight 1-10yo?
Weight (kg)= (Age + 4) x2
2 signs of meningism can be found on examination?
Brudzinski sign- hips and knees flex in response to neck flex ion
Kernig’s sign-resistance to knee extension when the hip is flexed
Most common causative organisms of meningococcal sepsis in children over 3 months?
Neisseria meningitidis- gram -ve diplococci
Haemophilus influenzae (type B)- gram -ve bacilli
Streptococcus pneumoniae- gram +ve cocci
Most common causative organism of meningococcal septicaemia in under 3 month olds?
Group B streptococcus- gram +ve cocci
Escherichia coli- gram negative rod
Listeria monocytogenes- gram +ve rod
Strep pneumoniae- gram +ve cocci
Signs and symptoms of meningococcal disease?
High temp
Vomiting
Headache
Drowsiness
Stiff neck
Photophobia
Non-blanching rash
In babies- bulging fontanelle
Meningitis- Household contact prophylaxis?
Ciprofloxacin single dose within 24 hours of diagnosis
Ensure up to date with vaccinations at later point
2nd line- rifampicin twice a day for 2 days
A gram -ve diplococci confirmed cause in ?meningitis. What organism most likely?
Neisseria meningitidis
Less than 3 months old with meningococcal septicaemia. What antibiotics? Why?
Cefotaxime or ceftriaxone AND amoxicillin or ampicillin
To cover for listeria monocytogenes which can cross the placenta and is resistant to cephalosporins
Other meningitis investigations?
Lumbar puncture. Send for biochem, cultures and PCR
Bacterial finding on LP?
Yellow/ turbid colour
⬆️⬆️⬆️ Neutrophils
〰or⬆️ Lymphocytes
⬆️⬆️⬆️ Protein
⬇️⬇️⬇️ Glucose
Viral findings on LP?
Clear fluid
〰or⬆️ Neutrophils
⬆️⬆️⬆️ Lymphocytes
〰or⬆️ Protein
〰 Glucose
TB findings on LP?
Yellow and viscous
〰or⬆️Neutrophils
⬆️⬆️⬆️ Lymphocytes
⬆️⬆️Protein
⬇️⬇️⬇️ Glucose
Ie combo of bacterial and viral. Looks like bacterial with potentially normal neutrophils
Fungal findings on LP?
Yellow and viscous colour
〰or⬆️Neutrophils
⬆️⬆️⬆️ Lymphocytes
〰or⬆️Protein
〰or⬇️Glucose
Tx is suspected meningitis in community?
IM Benzylpenicillin and transfer to hospital
1st line abx of meningitis in hospital?
IV 3rd gen cephalosporin e.g. cefotaxime or ceftriaxone.
Acyclovir if suspecting HSV
+/- dexamethsone, O2, fluids, ITU if comatose
LP contraindications?
Raised ICP: reduced consciousness, bradycardia & HTN, focal neurology, unequal/dilated pupils
Coagulation abnormalities- inc platelets <100
Local infection
Extensive or spreading purpura
Shock
Ongoing convulsions
Resp insufficiency- LP can cause resp arrest
3 initial investigations to confirm DKA?
BM- raised blood sugars?
ABG- acidotic?
Ketones- raised?
Key presenting features of DKA?
Confusion, vomiting, abdo pain
Thirsty, passing lot of urine
Thin/losing weight. Increased appetite
3 diagnostic features for DKA?
Acidosis- pH<7.3 OR bicarb <15mmolL
Ketonaemia >3mmolL
Hyperglycaemia- >11mmolL (can be normal in known diabetics)
High bloods sugars (>30mmolL) with little or no acidosis or ketones. Diagnosis?
Hyperosmolr hyperglycaemic state- requires different tx to DKA
DKA management?
ABC
Cannula & bloods
Fluid resus. 10ml/kg bolus
Ongoing fluids
Insulin- start 1-2hours after fluids. 0.05-0.1 units/kg/hr
Nursing obs hourly
Change fluids to 5%glucose+0.9% NaCl+20mmolKCl when glucose drops to 14mmolL
Initial mx of DKA?
Iv fluids then insulin
Ongoing fluid therapy? Vol and type?
Hourly rate:
[(Deficit - vol of unshackled bolus) / 48hrs ] /maintenance hourly
0.9% Saline + 20mmol K+ in every 500ml bag