Paeds

Question 1

Discuss specific difference in assessment of pediatric cases

Answer 1

• Compensatory mechanisms in young patients tend to mask sings of severe illness until the illness is very advanced
• resever capacity is low
• absolute volumes (eg blood and tidal) are low
• small absolute changes results in large relative changes
• metabolic rate is high
• signs of deterioration are non specific

Question 2

Discuss respiratory exam in children

Answer 2

Tachypnoea remains an important sign child may have paradoxical response and depressed resp rate or apnoea
cyanosis is a late sign of resp distress – if present without resp distress consider heart disease

Question 3

Discuss difference in pediatric airway intervention

Answer 3

-upper airway obstruction more common
-obligate nasal breathes 3-5 months with increased airway resistance
-large occiput tends to flex neck which can cause obstruction – towel under child shoulder can help
large epiglottis

Question 4

Discuss assessing dehydration in children

Answer 4

Mild (<5%)

• oliguria
• dry mucous membranes

Moderate (10%)

• look unwell
• tachy
• reduced skin turgor
• cap refill>3

Severe:

• shock
• hypotension
• very poor peripheral perfusion
• acidosis

Extreme

• -severely ill
• -shocked
• -comatose

Question 5

Discuss inotropes use in children

Answer 5

Dopamine may be best initial agent
dobutamine may be preferable in the following states
- non hypotensive infants who are very dependent on increasing hyeart rate to increase CO
-low CO due to systemic or pulmonary vasoconstriction

Question 6

What is the commonest cause of acute renal failure in children

Answer 6

HUS

Question 7

Discuss use of steroids in menigitis

Answer 7

Should be given ideally 10-20 minutes prior to Abs

Should not be used in children in whom antibiotics have already been started as is unlikley to improve outcome

Question 8

Discuss Abs to be used

Answer 8

<1month use ampicillin and either cefotaxime or an aminoglycoside

> 1 month, vancomycin plus cefotaxime

Question 9

Discuss differential of menigigits

Answer 9

Viral encephalitits
viral menigitis
other causes of non traumatic coma
-a gcs >13, complex seizures or focal neurology should raise suspicion of a diagnosis other then menigitis such as space occupying lesion or cerebral odemea

Question 10

Discuss DKA in children

Answer 10

The greatest mortality and morbidity in the setting of DKA is from cerebral odema and NOT shock with cardiovascular collapse

While not fully understood it is thought to occur due to too rapid correction of hyperosmolar state that produces an osmotic dysequilibrium

Dont start insulin until 30-60 minutes after fluid

Targets

• reduce blood glucose 2-4 mmol/hour
• reduce osmolality by <5mosmol/l/hour