Paeds ILA 1 - infection, inflammation Flashcards
Meningitis bugs.
a) Gram negative diplococcic
b) Gram-positive, non spore-forming, motile, facultatively anaerobic, rod-shaped bacterium
c) Gram-positive coccus with a tendency to form chains, beta-haemolytic, catalase-negative, and facultative anaerobe.
d) Gram-negative, coccobacillary, facultatively anaerobic pathogenic bacterium
e) Gram-negative, facultative anaerobic, rod-shaped, coliform bacterium
a) Meningococcus (n. meningitidis)
b) Listeria monocytogenes
c) Group B strep (s. agalactiae)
d) Hib
e) E. coli
LP indications.
a) Diagnosis
b) Treatment
a) suspected meningitis, MS, suspected IC bleed/SAH not diagnosed on CT/MRI, CNS vasculitis
b) Intrathecal chemotherapy, benign intracranial hypertension and normal-pressure (communicating) hydrocephalus
LP contraindications.
a) Signs of …? (give 6)
b) 5 other
a) Raised ICP: •Reduced GCS (< 9 or a drop of 3 or more). •Bradycardia and hypertension (Cushing reflex). •Focal neurological signs. •Abnormal posture or posturing. •Unequal, dilated or poorly responsive pupils. •Papilloedema. •Abnormal ‘doll’s eye’ movements.
•A tense, bulging fontanelle.
b) •Shock. •Extensive or spreading purpura. •Convulsions until stabilised. •Coagulation abnormalities (e.g. on ACs, thrombocytopenia) •Superficial infection at the LP site. •Respiratory insufficiency
LP complications.
a) 1 very common
b) 3 rarer and more severe
a) •Post-LP headache.
b) •Infection.
•Bleeding (approximately 2%).
•Cerebral herniation (rare but potentially fatal).
What is a septic screen and what does it involve?
a) Infants under 1 month
b) Infants 1-3 months
c) Children over 3 months - if red, if amber, if green
a) FUCC LP: FBC, Urine microscopy, CRP, Culture, Lumbar puncture
b) FUCC + LP if unwell/red flag features
c) - If red - FUCC + LP + CXR + Blood gas (clinical picture dictates).
- If amber - FUCC + LP (if < 1 yr) + CXR (if Fever >39, raised WCC)
- If green - urine test only
Jon, a previously fit and well one year old child develops fevers, a high-pitched cry and lethargy over
an eight hour period. Jon becomes hypotensive with a delayed capillary refill time, and develops tachycardia and a purpuric rash.
a) Immediate management
b) Cause of purpura from meningococcus
b) Meningococcus releases endotoxin, which causes disseminated intravascular coagulation (DIC)
Paediatric sepsis
a) Suspect if 2 or more of what 4 criteria (PATT)
b) Lower threshold for Sepsis in what patients?
a) Peripheries cool or mottled/CRT prolonged,
Altered mental state,
Temperature >38 or <36,
Tachycardia
b) Infants < 3/12, Immunosuppressed, Recent surgery, Indwelling devices / lines, Complex neurodisability, High index of clinical suspicion (tachypnoea, rash, leg pain, biphasic illness, poor feeding), Significant parental concern
Meningococcal disease: complications
a) Early complications
b) Of fulminant meningococcaemia
c) Late complications
a) seizures, raised intracranial pressure, cerebral venous thrombosis, and hydrocephalus
b) DIC, adrenal failure (Waterhouse-Friedrichsen syndrome)
c) communicating hydrocephalus (walking difficulty, cognitive impairment, incontinence), deafness (1-10% cases), psychosocial problems, neurological and developmental problems
Neonatal sepsis/proven GBS
- Rx?
14 days Benzylpen/Gent
Neonatal meningitis (empirical/listeria proven)
Gent + Amox
Paeds sepsis: management (ABCDE)
- Call for Help
- Primary Assessment
A (irway)
B (reathing) – high flow oxygen (10l/min)
C (irculation) – Rx hypovolaemia, hypoperfusion i.e. IV/IO access, push fluid bolus (saline/albumin), antibiotics
D (isability) (AVPU) Pupillary Reaction
E (nvironment) – body temperature, glucose, urine output - Reassess
May require inotropes, intubation, catheterization, possible haemodialysis and correction of electrolyte imbalance
Meningitis chemoprophylaxis.
a) Within…?
b) To who?
c) Drugs and course (different in pregnancy)
a) Chemoprophylaxis should be given within 24h, to:
b) - Household contacts such as family members, close intimate friends
- Intimate contacts such as boyfriends/girlfriends.
- Individuals who have had transient close contact with a case e.g. during intubation
c) Rifampicin – x2 days b.d./ Ciprofloxacin – 1 dose
Ceftriaxone – single IM dose in pregnant females
Kawasaki disease.
a) ESR is…?
b) Platelet levels are…?
c) Other features on FBC
d) Clinical features (CRASH and Burn)
e) Investigations
f) Management
a) Markedly raised (e.g. 135)
b) Markedly raised (e.g. 800)
c) Anaemia, leukocytosis
d) Conjunctivitis (bilateral, non-purulent),
Rash (polymorphic),
Adenopathy (lymphadenopathy: cervical, >1.5 cm),
Strawberry tongue (/other oral changes, eg cracked lips),
Hands and feet (swelling, desquamation)
Burn (fever 5 days or more)
- need 4 of crash features (also coronary artery aneurysm)
e) - Bloods: FBC, ESR
- ECHO
f) Aspirin - SEs: Reye’s syndrome, bleeding
IVIG - SEs: anaphylaxis, bleeding, haemolytic anaemia
A patient with suspected meningococcal sepsis is stabilised and transferred to the local PICU for ongoing management.
What measures may be used to stabilise and manage this patient? (ABC)
Airway and Breathing management – intubation, and ventilation
Circulation – fluid boluses / fluid management
IV/IO access - empirical broad-spectrum ABx (e.g. IV ceftriaxone)
Close contact
- 2 types
- Those who have had prolonged close contact with the case in a household type setting during the seven days before onset of illness.
- Examples of such contacts would be those living and/or sleeping in the same household (including extended household), pupils in the same dormitory, boy/girlfriends, or university students sharing a kitchen in a hall of residence.
2.Those who have had transient close contact with a case only if they have been directly exposed to large particle droplets/secretions from the respiratory tract of a case around the time of admission to hospital
