Paeds 2B Flashcards
Which investigations would you request in a patient having an asthma attack?
Obs (HR and RR are particularly important)
PEFR
SaO2
VBG/ABG
Examine for signs of increased respiratory effort
Outline the management of an acute asthma attack.
Supplemental oxygen
Nebulised SABA
If ineffective, add nebulised ipratropium bromide
+ mgso4 in life threatening cases
Monitor PEFR and SaO2
NOTE: if mild-to-moderate, SABA can be given through a large volume spacer
Which medication should a patient be given to take home after an acute asthma attack?
Oral prednisolone (3-7 days)
When should a patient with an asthma attack treated in hospital be followed-up?
Within 2 working days of discharge
How is foreign body inhalation treated in a conscious patient?
ABCDE
Encourage coughing
Back blows
Heimlich manoeuvre (NOT in very young children)
Remove object (rigid/flexible bronchoscopy)
How is foreign body inhalation treated in an unconscious patient?
ABCDE
Secure the airway
Remove the foreign body (rigid/flexible bronchoscopy)
Which patients with whooping cough should be admitted?
< 6 months
Significant breathing difficulties
Outline the pharmacological treatment of whooping cough.
< 21 days after onset of cough: macrolide (clarithromycin/azithromycin)
NOTE: use erythromycin in pregnant women
How is pneumonia in children treated?
1st line: amoxicillin 7-14 days
2nd line: add macrolide
ALL children with a clinical diagnosis of pneumonia should be treated with antibiotics
What are some treatment approaches for bronchiectasis?
Airway clearance techniques (physiotherapy)
Inhaled bronchodilator
Inhaled hypertonic saline (helps with coughing things out and airway clearance. Unsure exact mechanism)
Antibiotic prophylaxis (e.g. azithromycin)
What are the aspects of managing the respiratory issues in cystic fibrosis?
Pulmonary monitoring (every 2 months in children, every 3 months in adults)
Airway clearance techniques (physiotherapy)
Mucoactive agents
What is the first-line mucoactive agent for cystic fibrosis?
rhDNAse
2nd line: add hypertonic saline
Alternative: mannitol dry powder inhalation
What are the management approaches to the infection risk associated with cystic fibrosis?
Continuous prophylactic antibiotics (flucloxacillin and macrolides)
Prompt and vigorous IV therapy for infections
End-stage disease: bilateral lung transplantation
What are the management approaches to the nutritional problems in CF?
CREON enzyme replacement
High calorie diet
Fat-soluble vitamin supplements
What are the main domains of management in cystic fibrosis?
Pulmonary management (regular chest physiotherapy, mucolytics)
Infection management
Nutritional management (high calorie and high fat, vitamin supplementation, enzymes)
Psychological management
What is a treatment option for severe sleep disordered breathing in a child?
Adenotonsillectomy
What is some general conservative advice given to parents of an infant with a nappy rash?
Use high absorbency nappy
Leave nappy off as much as possible to help the skin dry
Clean the skin/change the nappy every 3-4 hours and ASAP after soiling/wetting
Bath the child gently
Use barrier protection (e.g. sudocrem)
How should an inflamed nappy rash that is causing discomfort be treated?
Hydrocortisone 1% cream OD (max 7 days)
How should a nappy rash caused by candida be treated?
Do NOT use barrier protection
Prescribe topical imidazole (e.g clotrimazole)
How should a nappy rash caused by bacterial infection be treated?
Oral flucloxacillin for 7 days
What is the first-line treatment of seborrhoeic dermatitis?
Regular washing of the scalp with baby oils and baby shampoo (gently brush to remove the scales)
What treatments for seborrhoeic dermatitis could be used if conservative measures fail?
Topical imidazole cream eg clotrimazole)
Hydrocortisone cream
What advice would you give a patient regarding emollient use for eczema?
Use in large amounts and often
Apply on the whole body
Use as a soap substitute
What advice would you give regarding how to apply topical steroids for eczema?
Use once or twice daily and only apply to areas of active eczema
Give an example of a mild, moderate and potent topical steroid used for eczema.
Mild - hydrocortisone 1%
Moderate - betamethasone valerate 0.025% or clobetasone butyrate 0.05%
Potent - betamethasone valerate 0.1%
