Paeds Flashcards
Dehydration Management
Mild/Moderate: Oral feeds encouraged along with oral rehydration solution (50ml/kg over 4 hours) + maintenance fluids Severe: IV Fluids 20ml/kg bolus of saline then bolus of 100ml/kg over 4 hours + maintenance
Maintenance Fluids Per 24 Hours
Fluid Bolus
100ml/kg for first 10 kg 50ml/kg for next 10kg 20ml/kg onwards
Bolus is 20ml/kg EXCEPT DKA and stuff like that
Cradle Cap
Seborrhoeic Dermatitis Manage with emollients, baby shampoo and oils. If severe, consider steroids
Candida Infection
Causes and complicates nappy rash. Spares flexures, satellite pustules, good hygiene with topical antifungals Disposable nappies, expose area to air when possible Barrier cream (zinc) and caster oil
Atopic Eczema
First year of life. On face and trunks. Management is via avoiding triggers, emollients or moisturising cream. Consider steroids as needed
Psoriasis
Emollients, coal, tar, steroid cream
Acne
Associated with puberty. Conservative management is avoid over cleaning, less makeup, don’t pop spots, healthy diet. Consider psychosocial factors.
Management is via topical retinoids, consider Abx + benzoyl peroxide.
If severe, consider oral Abx and oral retinoids.
If severe, may require specialist referral. Takes a while.
Meningococcal Sepsis Causes and Management
GEL in babies NHS in older ceftriaxone and Amoxicillin Consider Antivirals Dexamethasone if over 1m and H Influenzae suspected
ABCDE approach, sepsis screen, do urine dip, CXR and regularly monitor.
Complications include hearing loss, cerebral palsy, epilepsy, kidney problems and joint damage
Vaccination Contraindications
Acute febrile illness
Egg allergy- Influenza, Yellow fever
Previous anaphylaxis to vaccine
Immunocompromised
Guthrie Test
PKU CF Hypothyroidism MCADD Sickle Cell MSUD Homocystinuria IVA GA1
Resus Guidelines for Paeds
ABCDE
5 rescue breaths
15 compressions and 2 rescue breaths
Defibrillate if VF or pulseless VT
Paediatric Choking Algorithm
Encourage cough if possible
If not, 5 back blows and thrusts
Start CPR if unconscious
Anaphylaxis Management
ABCDE approach, lie down flat, legs raised. Give oxygen, get IV access and IM adrenaline (1:1000 or 0.3/0.5ml)
Drugs:
Adrenaline, Chlorphenamine, Hydrocortisone and Fluids
Prescribe epipen once stable and admit for monitoring for a biphasic relapse, give steroids and anti-histamines
Differentials include upper airway obstruction, hereditary angiodema and severe asthma exacerbation
Acute Asthma Management
ABCDE Nebulised Salbutamol Oral/IV Steroids Nebulised Ipratropium Also give magnesium sulphate Call for help
Asthma Management Long Term Over 5
Good spacer technique and all that SABA Inhaled Steroids LABA Leukotriene Receptor Antagonist or Theophylline Increase inhaled steroids Oral Steroids
Asthma Management Long Term Under 5
SABA Inhaled Steroids Leukotriene Receptor Antagonist Specialist Referral Good spacer technique.
DKA Management
ABCDE
Call for help
Fluids correction over 48 hours with potassium chloride
Once glucose drops to 15, add in insulin infusion and glucose
Regularly monitor blood glucose, urine output and neuro examination and bloods
Must balance cerebral oedema (fluids) and hypoglycaemia (insulin)
Long term: Give long acting insulin at night and short acting before each meal
Epilepsy/Seizure Management
ABCDE Call for help IV lorazepam, if not buccal midazolam or rectal diazepam Then after 10 minutes IV lorazepam IV Phenytoin infusion Get anaesthetics involved
ALWAYS rule out sepsis, meningitis, UTI
Enuresis Management
Organic Causes: Diabetes, Constipation, UTI
Lifestyle advice on fluid, diet and toileting training
Reward charts for positive behaviour such as going to the toilet before sleeping
Enuresis alarm if that doesn’t work
Desmopressin if not resolved or if child is over 7
15 year old wanting a TOP
Focused history Discuss options Assess capacity Advice to speak to family about it Refer for TOP Contraception Advice for longer term
MMR Counselling
Given at 12-13 months and 3-4 years. Weakened live vaccine
They may get a fever and a rash a few days after the vaccine which often self resolves
Studies have shown that it is effective and the risks of MMR vaccine are significantly lower than the devastating consequences of getting any of the MMR infections Can be fatal, affect pregnant women not immune to it Severe complications are so rare that data is not available on it because of how uncommon it is.
Contains weakened versions of the live virus to help body build immunity to it
No link to autism, no mercury in it
Measles: Coryza, Cough, Conjunctivitis, Koplik spots, then rash
Mumps: Fever and Parotitis, Pancreatitis, Orchitis
Rubella: Rash, fever, lymph nodes, coryza, arthropathy, can cause problems for women who are pregnant, Congenital rubella syndrome
Childhood Obesity
Rule out organic causes: Hypothyroidism, Cushings, GH deficiency, Prader-Willi
Age and gender specific charts to work out BMI
Exercise
Healthy diet
Dietician Referral
Consequences include: Bullying, OSA, Fractures risk, T2DM, HTN in the long run
ADHD Triad and Management
Attention Deficit
Hyperactivity
Impulsive Behaviour
Management: Methylphenidate is biologic. Psycho is support for family, parenting training and support, psychoeducation, school support,
Healthy diet, if specific food is found, keep a food diary
Before making a formal diagnosis, the family should be referred to CAHMS. Behaviour needs to be consistent at home and at school. Otherwise, consider conduct disorder, oppositional defiant disorder and maybe ASD
If giving drugs, monitor growth every 6 months.
