PAEDS - important stuff Flashcards
IV fluid bolus calculation in the paediatric population
administered over 10 minutes at 10mL/kg
e.g. if child is 18kg, 10x18 = 180ml bolus over 10 minutes
green flags - paediatric assessment
a) colour (skin/lips/tongue)
b) activity
c) resp
d) circulation and hydration
e) other
a) normal colour
b) responds normally to social cues, content/smiles, stays awake or awakens quickly, strong normal cry/not crying
c) n/a
d) normal skin and eyes, moist mucous membranes
e) none of the amber/red symptoms or signs
amber flags - paediatric assessment
a) colour (skin/lips/tongue)
b) activity
c) resp
d) circulation and hydration
e) other
a) pallor reported by parent/carer
b) not responding normally to social cues
no smile
wakes only with prolonged stimulation
decreased activity
c) nasal flaring
tachypnoea (RR >50 in 6-12 months, >40 in >12m)
O2 sats 95% in air
chest crackles
d) tachycardia (>160 <12 months, >150 12-24 months, >140 2-5 years)
CRT >3 seconds
dry mucous membranes
poor feeding
reduced urine output
e) age 3-6 months and temp >39
fever for >5 days
rigors
swelling of limb/joint
non-weight bearing limb/using an extremity
red flags - paediatric assessment
a) colour (skin/lips/tongue)
b) activity
c) resp
d) circulation and hydration
e) other
a) pale/mottled/ashen/blue
b) no response to social cues
appears ill to healthcare professional
doesnt wake/if roused doesnt stay awake
weak, high pitched, or continuous cry
c) grunting
tachypnoea: RR>60
moderate or severe chest indrawing
d) reduced skin turgor
e) age <3 months and temp >38
non-blanching rash
bulging fontanelle
neck stiffness
status epilepticus
focal neuro signs/seizures
tachypnoea amber sign - > how many breaths per minute if
a) 6-12 months old
b) >12 months old
a) >50 breaths a minute
b) > 40 breaths a minute
tachypnoea red sign - > how many breaths per minute
> 60 breaths per minute in any age
tachycardia amber sign - how many beats per minute in…
a) <12 months
b) 12-24 months
c) 2-5 years
a) >160 beats per min
b) >150 beats per min
c) >140 beats per min
child imms schedule - when is the 6-1 vaccine given and what is included?
at 2, 3 and 4 months
diptheria, tetatnus, whooping cough, polio, Hib and Hep B
child imms schedule - when is Men B given?
2 months, 4 months, 12-13 months
child imms schedule - what is given at 12-13 months? (4)
- Hib/Men C
- MMR
- PCR
- Men B
child imms schedule - what is given at 3-4 years?
4-in-1 pre-school booster - diptheria, tetanus, whooping cough, polio
MMR
child imms schedule - what is given at 12-13 years?
HPV vaccine
child imms schedule - what is given between 13-18 years?
3-1 teen booster - tetanus, dibtheria, polio
Men ACWY
child BLS - chest compressions:breaths ratio?
15 compressions: 2 rescue breaths
child BLS - how many cm should the chest be pressed down in infants and children?
infants - 4cm
children - 5cm
children under what age should not receive corticosteroids when tx bacterial meningitis?
<3m
APGAR scoring - when should it be calculated when assessing a newborn baby?
at 1 and 5 minutes (at 10 if still <7)
APGAR scoring - after assessing at 1 and 5 minutes, when should it be reassessed if the score is still low?
at 10 minutes
APGAR scoring - what is the maximum score? what score indicates a…
a) v low score
b) moderate low
c) baby is in good state
maximum = 10
a) 0-3
b) 4-6
c) 7-10
what are the categories assessed in an APGAR score? (5)
- pulse
- resp effort
- colour
- muscle tone
- reflex irritability
indications of a score 2 (highest score)
a) pulse
b) resp
c) colour
d) muscle tone
e) reflex irritability
a) >100
b) strong, crying
c) pink
d) active movement
e) cries on stimulations/sneezes, coughs
indications of a score 1 (medium score)
a) pulse
b) resp
c) colour
d) muscle tone
e) reflex irritability
a) <100
b) weak, irregular
c) body pink, extremities blue
d) limb flexion
e) grimace
indications of a score 0 (highest score)
a) pulse
b) resp
c) colour
d) muscle tone
e) reflex irritability
a) absent
b) nil
c) blue all over
d) flaccid
e) nil
asthma management pathway in children aged 5-12
- SABA (salbutamol)
- SABA + low-dose inhaled ICS (<200mcg budesonide)
- SABA + ICS + LTRA (montelukast)
- switch LTRA for a LABA (e.g. salmeterol)
- switch the LABA and ICS for a low-dose combo maintenance and reliever therapy (MART)
- SABA + moderate ICS dose MART
- seek advice from asthma specialist and CONSIDER EITHER…
- increase ICS dose to high
- trial new drug e.g. theophylline
low, moderate and high doses of ICS in the treatment of asthma in children
BUDESONIDE
low = <=200mcg
mod = 200-400mcg
high = >400mcg
asthma treatment pathway in children <5
- SABA
- trial mod dose ICS for 8 weeks, if works then put on low dose ICS
- add LTRA (montelukast)
- stop LTRA and refer to paediatric asthma specialist
neonatal murmur- continuous machinery murmur
patent ductus arteriosus
neonatal murmur- harsh systolic ejection murmur over pulmonic and left sternal area, often with systolic thrill
tetralogy of fallot
neonatal murmur- pansystolic murmur in lower left sternum
ventricular septal defect
neonatal murmur- split double (split, fixed 2nd heart sound) + ejection systolic murmur
atrial septal defect
neonatal murmur- harsh ejection click radiating to carotid vessels
aortic valve stenosis
technique for chest compression in infants (<1)
two-thumb encircling technique
initial tx for DKA if child is N&V, clinically dehydrated
IV fluids (0.9% NaCl 10ml/kg)
+
subcut insulin (0.1units/kg/hr)
at what point should a child be referred if they are not yet…
a) smiling
b) sitting unsupported
c) walking unsupported
d) able to say 2-6 words
a) 10 weeks
b) 12 months
c) 18 months
d) 18 months
developmental red flags (6)
- not holding object by 5m
- not sitting unsupported by 12m
- not standing/walking independently by 18m
- not running by 2.5 years
- no words by 18 months
- no interest in others by 18 months
loud single S2, prominent right ventricular impulse, weak femoral pulses
transposition of great vessels
