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.
ASD Triad and Management
Global Impairment of Language and Communication
Impairment of social relationships
Ritualistic and Compulsive behaviour
Most also have a decreased IQ, high functioning is rare
Management:
Specialist referral MDT approach with psychiatrist, paediatrician, LD specialist, OT, SALT and social services
Parent education and training
Psychosocial treatment for behaviour management
Support at school and aim to build on communication
Girl: Rett’s Syndrome
Boy: Fragile X
Migraine Management
Nasal Triptan for paediatrics. Consider metoclopramide or promethazine otherwise.
Rule out other causes. No COCP to be given if aura for example.
Inhaled Foreign Body Management
ABCDE
CXR to confirm diagnosis
Specialist help for removal of foreign body
Will likely require IV midazolam for sedation before removal attempt is made and anaesthesia and analgesia
Consider bronchodilators and Abx and steroids as necessary
NAI Management
ABCDE Approach Baselines Obs and Full Examination Require senior consultant in charge to come and do it with presence of a chaperone FBC, U+E, CRP, ESR, Bone Profile Skeletal Survey Admit child Social services Child Protection Team Normalise the situation, a child with an injury of this type, we like to do some extra checks because it is unusual
Constipation Management
Rule out sinister causes. Ribbon stools, no meconium passage, neurological signs, failure to thrive, distended abdomen
Management:
If impacted, movicol paediatric plan, specialist nurse for constipation referral. add senna if required.
Will also need maintenance of movicol as constipation can take a while to resolve and gradually reduce dose as it resolves.
Also lifestyle management, exercise, diet, water and reward charts, encourage toileting routine
Somatisation in Children Abdo Pain Management
Rule out separation anxiety or truancy and organic causes
Psycho-Social Approach: It is real, it is a physical manifestation of the worries a child may be having. Psychoeducation, deal with underlying issues, if there are family problems for example or there is bullying at school…etc…For the child, distraction and relaxation techniques, and avoid precipitating factors
Bronchiolitis Management
ABCDE Approach
It gets worse before it gets better, course is around 8 to 10 days
Caused by a viral infection
Will probably admit but will double check with seniors. If child is acutely unwell will admit.
Management is supportive with humidified oxygen and possibly an NG tube if feeding is poor
Failure to Thrive Management
ABCDE Approach
FBC, U+E, LFT, TFT, B12, Folate, Vit D, Bone Profile
Can be due to malnourishment, malabsorption or increased requirement
Think GORD, Food allergy, Coeliac
Limp Causes and Management
Septic Arthritis, DDH, Osteomyelitis, Fractures, Transient Synovitis, Perthe’s disease, Slipped upper femoral epiphysis, Neoplasms, JIA, Soft tissue injury, NAI
Management: ABCDE approach, bloods and abx as required, hip XR or USS/MRI
Some may require surgical management
Septic Arthritis/Osteomyelitist- Abx after taking a blood culture and synovial fluid aspirate
Transient Synovitis-Conservative
Perthe’s Disease- Aim to keep femoral head within acetabulum, use braces or casts as required. If young watchful waiting, if over 6 surgery.
DDH: Pavlik Harness, diagnosed using USS
Slipped Upper Femoral Epiphysis: Restrict movement as much as possible, surgical screw to fixate joint. Consider doing both as it can be bilateral.
18m old refuses to eat
Dietitian, health visitor, child psychologist, SALT for swallowing and introduction of food. Think of mechanical or neurological causes for lack of feeding.
Lifestyle management, try to make a regular approach. Build a routine.
6 year old shortest in class
Normal, Malnourishment, Malabsorption, Excessive Usage, Endocrine Cause, Precoccious puberty
Investigations: Growth, Growth velocity, Mid-parental height, GH Levels (IGF-1 surrogate), XR of non-dominant wrist, check for coeliac and allergies
Stiff child Causes
Cerebral Palsy
Metabolic Disorders
Neuromuscular Dystrophy
Cerebral Palsy Management
ABCDE approach
MDT Approach, specialist approach, SALT, OT, Social Worker, School support, Orthopaedic referral, Physio’s
Severe spasticity- Give baclofen
Down’s Syndrome
Higher risk of medical problems Heart disease Hirschsprung's disease Biliary Atresia Learning disability (IQ around 80) Physical abnormalities Cleft Lip Palate Prominent tongue (difficulty feeding) Developmental delay, milestones reached eventually Life expectancy is reduced, but people are living longer all the time
Biopsychosocial Approach
MDT approach, see specialists, will get support throughout, may need to go to special school, OT, social worker, SALT, paediatrician, genetic counselling,
CF Fibrosis
Mucociliary Clearance
Respiratory infections
Failure to thrive
Diabetes secondary to pancreatic destruction
No cure, shorter life expectancy, but is improving all the time
Will need physiotherapy regularly throughout. Will teach how to clear out lungs themselves. Regular enzyme supplements and antibiotics.
Blue baby
Infection Hypothermia Congenital Cyanotic Heart Disease Respiratory Conditions Meconium Aspiration
Do baseline obs
FBC, U+E, CRP, ESR, Blood cultures, Urine Culture, US Head, To determine if its respiratory or cardiac cause of blueness, measure pre and post ductal saturation. Nitrogen washout test.
3 day old fit
IVH Cerebral Palsy Neonatal infections Congenital syndromes Febrile convulsions Shaken baby syndrome
Febrile Seizures
Roseala Infantum
Common, affect 3% of children 6m-6yr and resolve by 5yrs.
Precipitated by rapidly rising temperature. Run in families It can reoccur but not always.
Manage at home if its less than 5 minutes. If its a typical or longer than 5, ambulance. If at home, put into the reocvery position, don’t put anything in their mouth.
Slightly increased risk of epilepsy compared to the general population.
Breath Holding Attacks
Common and benign. Children do go out of it
Happens when they breathe out without breathing back in. If they get scared or if they get hurt. Part of the normal physiology of the body.
No medication necessary, would consider checking for anaemia.
Blue spells or reflex anoxic seizure. Both benign.
8 year old daughter headaches and missing school
Tension headache Migraine with/without aura SOL Dehydration Sinusitis Hypertension Benign Intracranial Hypertension
Somatisation disorder Hypochondriac Conversion disorder Truancy Separation Anxiety
6m old screaming with pain and drawing up their legs, has not opened bowels, looks pale.
Constipation Intussuception Mesenteric Adentitis Bowel Obstruction Hirschsprung Disease Congenital Malformations Gastroenteritis Hernia's and Testicular torsion in boys Infantile Colic UTI, Meningitis, Sepsis
Baseline Obs (Dehydration)
Examination
Bloods-FBC, U+E, LFT, CRP, ESR
Imaging- USS
Infantile Colic
Conservative management. Affects many babies, and often goes away on its own. Wrap up baby and comfort the baby.
Baby vomits all the time. 6m old
GORD Overfeeding Biliary Atresia (Kasai procedure) Pyloric Stenosis Posseting Intussuception TOF Laryngomalacia Aspiration
If it’s GORD
Conservative: Positioning the baby. Fix cot so it’s slightly upright Smaller and more frequent feeds, burping the baby. Thicker milk if bottle feeding can be tried.
Medicial: Alginates and consider Omeprazole
Abdominal Pain with Dark Urine
DKA UTI Urinary Calculus Vesicoureteric Reflux T1/2DM IEM WIlm's Tumour
HUS
Anaemia, Thrombocytopenia and Haematuria
E. Coli 0157
FBC, UE, LFT, CRP, ESR, Lactate Dehydrogenase, Clotting
Neonatal Jaundice
Infection-Sepsis, Meningitis, UTI G6PDD, Hereditary Spherocytosis, Autoimmune Haemolytic Anaemia, Haemolytic Disease of the Newborn, ABO Incompatibility Trauma Biliary Atresia Hepatic Outflow Obstruction
After first day
Breast Milk and Physiological
Neonatal Hepatitis
Ask about activity, stool, urine, etc…. ABCDE approach. Bloods, urine dip, etc…all of that stuff. Unconjugated bilirubin is worse.
For high levels, phototherapy or exchange transfusion
UTI Management
If young, child needs to be admitted and regularly monitored. If older, give antibiotics.
Upper UTI, co-amoxiclav for like 10 days
Lower UTI, trimethoprim for 3 days with safety netting
As always, ABCDE approach first
Child with IBD Management
Induce remission
Consider steroids, enteral feeding,
Maintaining remission includes Azathioprine and mercaptopurine
Biopsychosocial support. Counselling, specialist referral bioeducation
Chickenpox in Child and Pregnant Mother Management and Complications
Take a full history, ask about previous chickenpox exposure If not sure, then check for varicella IgG antibodies. If negative, then give IVIG. If she gets chickenpox, then give aciclovir.
Complications include fetal varicella syndrome, risk is highest in early pregnancy, like 1% but not a risk worht taking. Can lead to foetal abnormalities including microcephaly, eye defects, limb hypoplasia, learning disabilities. It can be fatal.
Antibiotics do not work!
Ricket’s Diagnosis and Management
History includes bowed legs, knock knees, failure to grow in a child, Often due to vitamin D deficiency
So management is calcium with vitamin D
Bloods show low calcium, low phosphate, low vitamin D, raised PTH
XR problems seen most at the growth plates in kids.
Pyloric Stenosis Diagnosis and Management
Presents as projectile vomiting, non-bilious, constipation, dehydration too.
Hypochloraemic, hypokalaemic metabolic alkalosis
May feel a mass on examination and USS can confirm
Management is specialist referral, will require surgical management. Ramstedt’s Pyloromoytomy
Strangulated Hernia Diagnosis and Management
ABCDE approach
Oxygen, fluids, analgesia as required
More common in premature babies
Management is surgical, normally don’t need a mesh as the body will grow stronger over time in a baby
Abdominal Pain in a Child Causes and Management
Causes Mesenteric Adenitis Constipation Appendicitis Peritonitis UTI Somatisation DKA HSP Sickle Cell
Fever in a Child Causes and Management
URTI LRTI Meningitis Encephalitis UTI Septic Arthritis Otitis Media Gastroenteritis PUO (HIV, TB)
Management
ABCDE approach, oxygen, fluids, check blood glucose, do full head to toe examination. Get baseline observations
Measure lactate, get blood cultures, get urine output and urine dip
Give oxygen, fluids and antibiotics
Plus supportive oxygen and regular monitoring
Seizures/Fits/Faints in a Child Causes and Management
Causes include Encephalitis, Febrile Convulsions, Vasovagal syncope, reflex anoxic seizure, breath holding attacks, west syndrome, meningitis, trauma, head injury, hypoglycaemia
Management
ABCDE approach. Put child in recovery position and call ambulance. Bring child into hospital. Do full septic screen along with baselines obs and examination. Get urine dip too.
IV lorazepam/buccal midazolam/rectal diazepam first attempt if still fitting
Call for help, establish IV access now
If still fitting, IV lorazepam
If still fitting, Phenytoin infusion and call ITU ASAP
Treat underlying cause. Tonic clonic seizure is less worrying, if the seizure is partial or complex, then do EEG or MRI
Safety netting, parents should communicate with school so that they are aware, kid should not be doing activities such as swimming alone.
Developmental Delay Causes and Management
Causes include understimulation, neglect, iron deficiency, cerebral palsy, ASD, congenital syndromes, kernicterus
Management is specialist referral to assess.
