Paeds Guidelines Flashcards
Bronchiolitis admission criteria
- Apnea
- Sats under 90% children 6 weeks or older
- Sats under 92% babies less than 6 weeks
- Inadequate fluid intake (under 50 or under 75% with RF) or signs dehydration
- Persisting severe resp distress
- ## social reasons
Bronchiolitis management
O2 if over 6 weeks and Sats below 90
O2 if under 6 weeks and Sats below 92
CPAP for impending Resp failure
Airway suctioning if signs of secretions and feeding difficulties
Airway suctioning if apneas even if no signs of secretions
NG feed if unable to feed
Nurse infants prone at 45 degrees head up
Define simple febrile seizure
Age 6m to 6y
Seizure with fever over 38
Isolated tonic clonic
Less than 15mins
Do not recur within 24h or within same febrile
Illness
Complete recovery within 1 hour
Febrile seizure advice
2.5% population will have febrile seizure
1/3 will have further future febrile seizure
Most recurrences with 1-2y of 1st febrile a seizure
Small increase in chance of developing epilepsy
Parental responsibility (who has it)
Mother (automatic)
Father of married to mother
Father if listed on birth certificate
Father if they were married when child born
Father if parental responsibility agreement with mother
Father if parental responsibility order from court
Bell’s palsy Dx criteria
No other neuro deficits
No sparing of upper forehead
Not under 2yo
Sudden onset, systemically well
No hearing loss, discharge, TM abnormality
No vesicles on face or ear
No history of tick bite
Treatment Bell’s palsy
Prednisolone 1mg/kg/day (max 60)
10 days (wean if over 40mg/day)
Artificial tears and eye ointment
Tape eyelids
Prognosis Bell’s palsy
Majority improve within 3 weeks
90% reviver within 2-3months
Rare cases symptoms don’t completely resolve
Westley croup score
Inspiratory stridor 0-2
Intercostal recession 0-2
Air entry 0-2
Level of consciousness 0 or 5
Cyanosis 0, 4/5
Moderate 3-6
Common non epileptic paroxysmal events
Breath holding
Reflex anoxic episode
Syncope
Night terror
gratification episode
Benign neonatal sleep myoclonus
Maintenance IV fluid calculation
Holliday segar formula
ml/kg/day
100 first 10kg
50 second 10kg
20 over 20kg
Max 2L per day
GORD information parents
Daily in 70% of 4month olds
5% have over 6 episodes a day
Starts between birth and 3months
Usually resolves by 6-12months
90% symptom free by 12 months
Faltering growth referral (Paeds)
Weight 0.4th centile
Fall through 2 centiles
Salter Harris classification
Physis # (growth plate)
S: straight across physis
A: above physis
L: lower than physis
T: through physis
R: rammed physis
Head injury child, CT in 1 hour
CT in 1 hour
- NIA
- seizure
- GCS<14 on ED assessment
- GCS <15 2 hour post injury
- skull or basal skull fracture
- tense fontanelle
- any neurology
- children under 1 bruise >5cm
Head injury child not for CT within 1h
Any of
- LOC over 5 min
- abnormal drowsiness
- 3 episodes vomiting
- dangerous mechanism
- amnesia
More than 1 = CT within 1 hour
Only 1 observe for 4 hours post HI
Further vomiting or episodes of drowsiness CT with 1 h
HSP Dx
Palpable purpura
Subcutaneous edema
80% arthritis
60% GI disturbance; pain, D+V
50% renal involvement
Other; genital, CNS, carditis, parotitis
HSP management
Bloods and urine dip
If normal GP follow up (weekly)
If abnormal nephrology follow up or admission
(Steroids if nephrotic/nephritis)
Hypoglycaemia Paeds Dx and management
BG<2.6
Obtain blood samples
Then correct hypoglycaemia
- 2ml/kg 10% Dex
Obtain next void of urine
Dx hypoglycaemia Paeds diabetic
BG<4 (in diabetic paed)
Treating hypoglycaemia awake vs not
Awake glucose (buccal)
Or
IV dex 2ml/kg
Repeat BG every 15min
Aim for BG over 4 (both diabetic and non)
ITP management
Based on symptom severity not count
Mild: bruises under 5cm
- refer to OP haematology
Mod: epistaxis longer than 20min
- Intermittent bleeding mucosa
- Stable; GI bleed, haematuria
- consider treatment
Severe epistaxis requiring packing
- continuous mucosal bleed
- stable bleed; >20g Hb drop
- Prednisolone + admit
Life threatening
- Intracranial bleed
- unstable bleed; hypotension, shock
- transfuse, IV methyl pred, IVIG, TXA, consider plt transfusion
Contra indications to transcutaneous bilirubinometer
Under 35 weeks gestational age
Already had photo therapy
Already had transfusion
Under 24h old
Over 14 days old
Jaundiced infant management
Transcutaneous bilirubinometer
Reading over 250
Consider sepsis , poor feeding, weight loss
If under 14 days; start phototherapy
Formal bloods; fBC, bilirubin conj and unconj, direct Coombs
?plasma exchange
Kawasaki disease management
ECG
Bloods
Echocardiogram
IVIG
Aspirin
+- Steroids
Limp investigations
XR; #, perthes, SUFE, osteomyelitis, Ca
US
- effusion; transient synovitis or septic joint
- developmental dysplasia of hip
Bloods
Limp red flags
Unwell
Fever over 38
Severe pain
Poor response to analgesia
Non weight bearing
Erythema or swelling
Pain worse at night
Multiple attendances
Social concerns
Back pain
Neuro signs
Developmental regression
Abnormal bloods
Limp differential diagnoses
Common
- transient synovitis, #, soft tissue injury
Less common;
- septic joint, osteomyelitis, perthes, SUFE, JIA, NAI, myosotis, osteochondrosis
Rare
- malignancy, discitis, spondylolysis
Non MSK
- malignancy, UTI, lymphadenitis, abdominal mass, appendicitis, constipation
Osteochondroses
Derangement if Norma bone growth
Severs disease
- heel pain
Freiburg disease
- 2,3,4th metatarsal heads
Kohler disease
- navicular
Osgood schlatters
- tibial tuberosity
Sinding Larsen johansson
- inferior pole patella
Management hydrocele
Most resolve by 2yo
Refer to Surg after 2yo
If hernia suspected refer surgeons immediately
Undescended testis
Can descend spontaneously upto 3m
Refer if over 3m
Early surgery proffered under 1yo
Phimosis management
Many boys unable to retract until age 10
Some will persist to puberty
Should be retractile by 16
Conservative management;
Attempt to retract daily for 1 year and topical steroids for 6w
Circumcission if
- BXO
- physiological phimosis over 10 and failed conservative management but still symptomatic
- recurrent balanitis
Non blanching rash management
Unwell
- treat as meningococcal
Spots over 2mm
- ?HSP or treat as sepsis
Mechanical explanation
- SVC (above nipple), NAI?
Rash spreading? Lymphadenopathy
Consider bloods; ITP, leukaemia
Milk problems in paeds
Cows milk allergy (IgE)
- Sx within 1 h, anaphylaxis type Sx
Non IgE milk allergy
- diarrhoea +- mucus or blood or GORD
- eczema not responding to Tx
Lactose intolerance
- diarrhoea, flatulance, AP
Cows milk issue management
RAST test (IgE cows milk protein)
Exclusion 6-8 weeks
Extensively hydrolysed formula milk
Cows milk allergy prognosis
75% tolerant by 2 years old
85% by 3yo
Lactose intolerance Dx
Unusual before age of 2
Clinical suspicion and 2 week exclusion trial
If Sx persists consider coeliac screen and total IgA
Can attempt re-challenge with lactose
Orbital cellulitis Sx
Proptosis
Globe displacement
Limited eye movement
Double vision
Reduced acuity
Otitis media and antibiotics
Systemically unwell but do not require admission
High risk complications
Symptomatic for over 4 days
Younger than 2yo and bilateral
Perforation or discharge in ear canal
Sx usually improve within 3 days
JIA Dx
Arthritis in any number of joints
Fever of at least 2 weeks
Daily fever for at least 3 days
Accompanied by;
- evanexcent rash; macular salmon pink
- lymphadenopathy
- enlarged liver or spleen
- serositis
Complicated seizure Dx
Prolonged >15min
Focal features
Recurrent seizures
SVT Tx
Unstable
- sync DC shock
- 1J/kg -> 2J/Kg, amiodarone
Stable
- vagal; carotid massage, diving reflex
- adekosine 100mcg/kg, 200, 300
UTI and urine dip by age
<3m dipstick unreliable -> MC&S
3-6m: leu or nitrate -> Tx and MC+S
