Paeds Flashcards
Acute Asthma Attack
History
HPC - timeframe, cough, wheeze
PMH - previous attacks, developmental, allergies
Social history - exacerbations
Acute Asthma Attack
Differentials
Foreign body
PE
Pneumothorax
Pneumonia
Acute asthma attack
Impending resp failure
Exhaustion no speaking colour hypoxia despite oxygen Silent chest Tachy Drowsiness
Acute Asthma Attack
Exacerbation scale
Moderate - over 92 sats, absence of severe symptoms.
Severe - <92sats, no tealking, HR >130, RR>50, accessory muscles
Life threatening - <92 sats PLUS colour, conscious, agitaiton, resp effort, silent chest
Acute Asthma Attack
Moderate Treatment
B2 agonist 2-10 puffs VIA SPACER plus facemask
reassess afer 15 mins
Responding - 1-4hrls salbutamol
Give prednisolone sluble orally
Not responding - repeate B2 agonist, prednisolone, admit
Acute Asthma Attack
Severe - Treatment
nebulised B2 agonist 2.5mg (5 if over 5) salbutamol/terbutaline 5mg (10 if over 5)
02 via face mask
Soluable prednisolone 20mg or IV hydrocortisone
not responding - ipatropium bromide 0.25mg
- bolus IV salbutamol
X-ray, bloods
Acute Asthma Attack
Discharge
continue B2 agonist 4 hrls predniolone daily for 4days @20mg PROVIDE WRITTEN ASTHMA PLAN REVIEW REGULAR TREATMENT Arrange GP follow up check inhaler technique
Acute Asthma Attack
Management summary
ABC obstruction hf oxygen start regular inhaled beta agonist via nebuliser cardiac monioring- why? oral pred/IV hydrocortisone Blood gases and cx ray
Acute Asthma attack
Discharge quesitions
How often does he miss his regular drugs?
• Is there parental supervision?
• What device does he use? Children rarely use
• Consider changing to a combined steroid/long-acting β-agonist inhaler.
• Ask about smoking – him and his family. Adults should be encouraged to
stop smoking or to smoke outside.
• Educate about allergen avoidance, e.g. daily vacuuming to reduce house
dust mites. Consider measuring total IgE and specific allergen IgE (RAST)
if the history suggests allergies.
• All asthmatics should have a written home management plan.
• Provide an asthma symptom diary and arrange hospital follow-up until
control improves. Most children can and should be managed in primary
care. Primary care and hospital-based asthma specialist nurses are very
helpful.
ADHD (3 pillars)
Inattention
hyperativity
Impulsiveness
ADHD further quesitons
Chronology of symptoms How evolved across 3 pilars School behaviour Family and socail history bedtime routine mothers concern/agenda
Differentials of ADHD
Learning difficulty from hearing impariement
Psychosocial involvement in developement
Antisocial behaviour disorder
Thyrotoxicosis
ADHD management
behaviour modifying - structured environment - reinforcement - self control educational - classrom help
Drug treatment -ritalin
Ritalin side effects
growth
hypertension
requie a drug holiday once a year
Anaphylaxis
Differentials
Acute Exacerbation of asthma
Anaphylaxis Tests
Blood gas and bloods
Anaphylaxis
Management
CONSTNAT OBS
ABC
Breathing oxygen and neb salbutamol
IM adrenaline 10ug/kg
Circulaton - 20ml/kg of 0.9% saline as in shock
repeat every 5 mins if no improvement
Anaphylaxis tx once stabe
IV hydrocortisone
IV chlorpheniramine
Skin prick
serum IgE
RAST tests
All done a wek after last steroid given
Anaphylxis discharge
Conservaitve- food avoidance
Medical - oral anthistmaines
- IM adrenaline pen
- how to use
MDT - paediatrician for allergen
dietician
educate - family and school
Appendicitis (differnetials)
-Gastro Appendicitis Obstruction Mesenteric adenitis Gastroenteritis Crohns Hepatitis
DKA
Psychological
Urinary - UTI
Gynae - Ovulation pain ovarian cyst ectopic PID
Testicular torsion for male
Appendicitis Ivx
FBC inflammatory markers LFTS Dip urine Imagine Pregnancy Tesyt
Appendicits management
Medical
- Fluids and Abx
Surgical
Admission for surgicla opinon
- N.B.M
Appendectomy.
Causes of acute abdo pain
Surgical
Medical
Extra abdominal
Surgical Causes of acute abdo pain
Appendicitis intestinal obstruction Inguinal hernia Peritonitis Inflamed Meckel deverticulum Pancreatitis Trauma
Medical Causes of acute abdo pain
Gastroenteritis Urinary - UTI - Acute pyelonephritis - hydronephrosis - renal calculus
henlock Schon purpura DKA Sickel Clell Hep IBD Constipation Psych Gynae Lead posionin porphyria
Extra abdominal Causes of acute abdo pain
URTI
Lower lobe pneumonia
Torsion of the testis
Hip and Spine
Asthma
Atopic associated with
IgE
Asthma presentaiton
SOB, cough and wheeze
Worse at night/early morning Triggered Interva; family histroy resonds to therapy
Asthma questions
onset and associated symptoms
foreign body inhalation
previous history of wheeze
Atopy
Asthma differentials
Inhaled foreign body
Viral LRTI
Bacterial LRTI
Pneumothorax
Asthma management
B2 agonist with spacer
2-10 puffs
Consider soluable prednisolone
Two types of wheeze
- Transient early wheezing
2. Persistent and recurrent wheezing
- Persistent and recurrent wheezing
Atopic asthma (IgE assoc.)- common inhalant allergens. Assoc with
eczema, food allergy and hayfever.
o Non atopic asthma
Transient early wheezing
small airways being become narrow and
obstructed due to inflammation after viral infection. Gives condition it episodic
nature. Decreased lung function from birth due to premature or maternal
smoking
Asthma Aetiology
- Bronchial inflammation
Oedema, excessive mucus production and cell infiltration - Bronchial hyperresponsiveness
- Airway narrowing
REVERSIBLE airflow obstruction - Symptoms e.g. Wheeze, cough, breathlessness and chest tightness
Asthma risk factors
Genetic
Atopy (associated conditions)
Environmental triggers
House mite, pollens, pets, cold air, anxiety
Asthma investigations
CXR to rule out differentials
Peak flow diary
PEFR - before and after treatment
Types of inhaler
pMDI- younger age
o Dry powder- +4 years
o Metered dose inhaler - +6 years
o Nebuliser- emergency only
ASD differentials
Learning difficulty Psychiatric depression Anxiety disorder OCD Dyslexia ADHD
ASD diagnosed on
speech and language disorder
social interaction
ritualistic and repetitive behaviour
ASD management
Conservative
- Psychosocial play - attetion, engagement, communication
lie skills - coping strategies, lesure and emplyment facilities
interventions for othe disorders
AIMS
- Reduce ritualistic behavious
- Develop language
- Develop social skills
Medical - help sleeping
MDT approach
