Paeds management Flashcards
Down syndrome MDT
paediatrician
specialist nurse
PT + OT
SALT
SENCO
Down syndrome monitoring
echo
FBC + blood film
TFTs
hearing screening
GBS Rx
IV benpen + gentamicin
HDN Rx
resus
phototherapy
consider exchange transfusion
immune haemolytic -> IVIG
HDN follow up
4-6 weeks: late anaemia
hearing screen
hep B Rx
monovalent hep B vaccine <24hrs of birth
6-in-1 vaccine at usual times
HBIG if:
mum HbSag positive
acute hep B during pregnancy
DNA > 1x10^6 in any sample
acute: supportive care
HIE
supportive
ventilation
inotropic support
nutrition
seizure management
therapeutic hypothermia
mec aspiration
term + no Hx of GBS -> observe
RFs/labs suggestive of infection -> IV ampicillin + gentamicin
oxygen + NIV
surfactant + inotropes
NEC
TPN
NG tube
broad-spec abx
IV fluids
perforation/failure to respond -> surgery
asymptomatic neonatal hypoglycaemia
blood glucose
encourage feeding
supplemented feeding
symptomatic neonatal hypoglycaemia or pre-feed < 2mmol/L
2ml/kg 10% glucose IV bolus
3.6mL/lg/hr 10% glucose infusion
aim 3-4mmol/L
IV delay -> buccal glucose/IM glucagon
neonatal hypoglycaemia <1mmol/L
buccal glucose as interim while arranging IV glucose
persistent neonatal hypoglycaemia
refer to endo
neonatal jaundice Ix
transcutaneous
serum bilirubin
TSH, LFTs, split bilirubin
neonatal jaundice Rx
plot on graph
phototherapy
exchange transfusion
treat underlying cause
check for rebound jaundice
neonatal jaundice resource
NHS choices factsheet
breastfeeding network
bliss (premature/sick babies)
pneumothorax
small -> observe + 100% oxygen
immediate risk of resp failure -> needle drainage
tension/ventilated/preterm -> chest drain
RDS
resuscitation
intubation + ventilation
CPAP
supplementary oxygen (aim 91-95%)
endotracheal surfactant
fluids
broad spec IV abx
CXR
TTN
observe + supportive care
nasal cannula (aim >90%)
RR >60 -> NG/TPN
persists for >4-6hrs -> amp + gent
atrial septal defect
observe
closure at ~2 years
transcatheter/open heart surgery
indications for atrial septal defect closure
R heart enlargement
symptomatic pulmonary overcirculation
significant L - R shunting
congenital cyanotic heart disease initial Rx
A/B:
intubate
consider hyperoxia test
supplemental O2
C:
2 IV cannulae
consider UVC/UAC
prostaglandin E1 infusion
10ml/kg crystalloid bolus
adrenaline for resistant hypotension
D:
check blood glucose regularly
CoA
Prostaglandin E1
supportive
surgical repair
heart failure
reduce preload: diuretics
reduce after load: ACEi, alprostadil
enhance contractility: inotropes
nutrition
routine physical activity
PDA
IV indomethacin
prostacyclin synthesise inhibitor
premature/VLBW -> ibuprofen
surgical ligation
percutaneous catheter device closure
rheumatic fever
NSAIDs
anti-strep abx (pen V, benpen, amox)
heart failure -> diuretics + ACEi +/- pred
SVT
1st: vagal manoeuvres
2nd: adenosine
3rd: DC cardioversion
unstable -> DC cardioversion
ToF initial Rx
prostaglandin E1 infusion
Blalock-Taussig shunt between subclavian and pulmonary artery
ToF definitive Rx
surgical repair from 4 months onwards
hyper cyanotic spells
knee to chest position
supplementary O2
morphine (decrease respiratory drive)
IV fluids
beta blockers (relax RV, improve flow to pulmonary vessels)
phenylephrine (increase PVR)
sodium bicarb (met acidosis)
TGA initial Rx
supportive
prostaglandin E1 infusion
balloon atrial septostomy (foramen ovale to create large ASD)
TGA definitive Rx
arterial switch in first 2 weeks of life
VSD
observe
consider prophylactic amoxicillin
large VSD
surgical correction (transvenous catheter/open)
diuretics
high calorie diet
acute otitis media
paracetamol/ibuprofen
decongestants/antihistamines not helpful
unwell/perforation/otorrhoea -> immediate amoxicillin, otherwise delayed
pen-allergic -> clari
acute epiglottitis
senior support
ENT/anaesthetics
blood cultures
IV ceftriaxone 7-10/7
consider supplemental O2, steroids, Adr
stable + extubated -> PO co-amox
acute epiglottitis prophylaxis
rifampicin (good gram -ive cover)
mild allergic rhinitis
allergen avoidance
consider nasal irrigation
1st line: intranasal antihistamines
PO non-sedating antihistamines
2nd line: intranasal chromone
mod/severe allergic rhinitis
continue previous Rx
1st: + intranasal corticosteroid
2nd: consider short course PO corticosteroids for 3-7/7
allergic rhinitis with poor response to therapy
nasal congestion -> intranasal decongestant (ephedrine)
rhinorrhoea -> intranasal anticholinergic (ipratropium)
asthma -> LTRA
follow up for allergic rhinitis
review in 2-4 weeks for consideration of step up Rx
asthma <5, long term Rx
1: SABA
2: + paediatric low dose ICS
3: + LTRA
4: stop LTRA + refer
asthma 5-16, long term Rx
1: SABA
2: + paed low dose ICS
3: + LTRA
4: stop LTRA, + LABA
5: switch to MART + paed low dose ICS
6: increase ICS
7: consult specialist
asthma non-pharmacological Rx
assess baseline
education
action plan
immunisations
trigger avoidance
asthma review
confirm adherence
review technique
assess status
ask about triggers
PEFR asthma severity
> 50-75% = moderate
33-50% = severe
<33% = life-threatening
SpO2 asthma severity
> 92% = moderate
<92% severe/life-threatening
consciousness asthma severity
sentences = moderate
can’t complete sentences = severe
altered consciousness/confusion = life-threatening
HR/RR asthma severity
1-5 years:
moderate = <140, <40
severe = >140, >40
5+ years:
moderate = <125, <30
severe = >125, >30
signs of life-threatening asthma attack
silent chest
normal pCO2
poor respiratory effort
exhaustion
hypotension
cyanosis
acute life-threatening asthma attack Rx
admit, ABCDE, senior support
oxygen
salbutamol nebs (6L/min)
ipratropium nebs
mag sulphate (150mg)
prednisolone
monitor PEFR + sats
2nd line:
IV slabutamol
IV aminophylline
IV mag sulphate
acute moderate asthma exacerbation Rx
admit, ABCDE
oxygen
SABA via spacer
ipratroprium bromide
prednisolone
monitor PEFR + sats
prednisolone dose for asthma attack
1-2mg/kg/day PO OD
max 40mg/day
IM if oral not possible
acute asthma exacerbation follow up
admitted = <2 days of d/c
not admitted = <2 days of presentation
assess:
Sx
PEFR
inhaler technique
treatment
possible non-compliance
consider referral if >2 attacks <12 months
dxic Ix for bronchiectasis
high res CT:
bronchial wall thickening
signet ring
bronchiectasis general Rx
treat underlying cause
pneumococcal + influenza vax
bronchiectasis Ix for underlying cause
CF: sweat chloride test
antibody deficiency: IgG, A, M
primary ciliary dyskinesia
non CF bronchiectasis acute exacerbation Rx
airway clearance +/- saline nebs
abx
1st line abx for bronchiectasis
1month - 11yrs = amox, clari
12 - 17yrs = doxy
2nd line: co-amox
empirical IV abx for bronchiectasis
co-amox
pip-taz
cipro (seek specialist advice)
when to refer to secondary care in bronchiectasis
≥3 infective exacerbations in 1 year
severe infection
ineffective abx therapy
cardiorespiratory failure
sepsis
indications for admission in bronchiectasis
increased RR
increased WoB
cyanosis
circulatory/resp failure
temp ≥ 38
unable to take oral meds
bronchiectasis resources
British Lung Foundation patient info leaflet
Bronchiolitis Rx
humidified O2
CPAP
fluids
if secretions -> upper airway suction
Bronchiolitis prevention
infection control measures
Palivizumab
indications for admission in bronchiolitis
apnoea
central cyanosis
persistent low sats (<92% <6wks, <90% >6 wks)
50-75% reduced fluid intake
severe resp distress:
grunting
recessions
RR > 70
mild/moderate IgE/non-IgE mediated CMPA
allergy testing
paeds dietician referral
breastfeeding -> exclude cow’s milk from mother’s diet + calcium + vitamin d supplements
formula/mixed -> extensively hydrolysed formula
severe IgE mediated CMPA
as for mild/moderate
consider elemental formula
Sx of severe NON-IgE mediated CMPA
skin: pruritus, erythema, atopic eczema
GI: GORD, d&v, food aversion
Resp: cough, wheeze, SoB
severe NON-IgE mediated CMPA
interim Rx + urgent referral to local paeds allergy service + dietician
weaning in CMPA
reintroduce after 6 months then every 6-12 months
tolerance -> milk ladder from allergy UK
CMPA resources
British Dietetic Association fact sheet
All severities of croup Rx
0.15mg/kg PO dexamethasone
repeat after 12hrs if required
PO not possible:
2mg inhaled beclomethasone
0.6mg/kg IM dexamethasone
mild croup Rx
supportive care
safety net
moderate croup Rx
oxygen
severe croup Rx
admit
oxygen
adrenaline nebs (1 in 1000, 1mg/ml)
CF Rx
MDT approach
pulmonary: physio + mucolytics
infection: prophylactic abx
nutrition: high calorie + enzymes
psychosocial: support
CF mucoactive agents
1st line: rhDNase
2nd: hypertonic NaCl +/- frhDNase
3rd: mannitol dry powder
CF abx therapy
s. aureus prophylaxis -> fluclox
pseudomonas -> azithro, colistin
food allergy Rx
dietary:
exclude
dietician referral
pharm:
mild -> non-sedating antihistamine
severe -> IM adrenaline +/- salbutamol
educate:
action plan
epipen use
food challenge:
after 6-12 months Sx free
food challenge in food allergy
medical supervision
direct mucosal exposure
titrated oral ingestion as tolerated
previous severe reaction -> consider in hospital, usually after 2 years Sx free
prognosis of food allergies
milk and eggs - resolve early
nuts and seafood - persist
foreign body removal
1st line: flex/rigid bronchoscopy
2nd line: surgery, thoracotomy
pharm Rx of pneumonia
low/moderate -> amox, clari
severe -> co-amox +/- clari
PO if tolerated
scarlet fever Rx
notifiable disease
pen V QDS 10/7
pen allergic -> azithro
school exclusion until 24hrs after commencing abx
safety net + follow up
sinusitis Rx
< 10/7 -> do not offer abx
> 10/7 -> high dose nasal corticosteroid for 14/7
consider delayed abx
1st line: pen V
2nd line: co-amox
indications for admission in pharyngitis/tonsillitis
difficulty breathing
clinical dehydration
abscess/cellulitis
systemic illness/sepsis
indications for abx in pharyngitis/tonsillitis
Group A strep
FeverPAIN ≥4
Centor ≥3
severe/high risk of complications
abx therapy for pharyngitis/tonsillitis
pen V for 5-10/7
pen allergic -> clarithromycin
avoid amoxicillin
viral induced wheeze
salbutamol burst therapy + weaning regime
monitor for 4hrs
d/c w. salbutamol + spacer
10 puffs every 4hrs
no response -> return to A&E
whooping cough
notifiable disease
within 21 days onset:
<1month = clarithromycin
>1 month = azithromycin
if macrolides CI: co-trimoxazole
indications for admission in isolation in whooping cough
<6 months
acutely unwell
apnoea/cyanosis
complications (seizures/pneumonia)
exclusion for whooping cough
until 48hrs of abx therapy
or 21 days after cough onset
coeliac disease
strict gluten free diet
assess for nutritional deficiencies
annual review
coeliac disease annual review components
height, weight, BMI
review Sx
review adherence: IgA-tTG 3 monthly until normalised then yearly
bone mineral density concerns -> DEXA
coeliac disease resource
coeliac UK
pharmacological Rx of constipation
disimpaction regimen:
movicol escalating dose over 2/52
+ dietary/lifestyle modis
unresponsive -> + Senna
maintenance regimen:
effective dose for 3-4/52
can sub in Senna +/- softener
behavioural interventions for constipation
bowel habit diary
scheduled toileting
reward system
address anxieties
posture
high risk Crohn’s Rx
induction + maintenance regimen
infliximab (anti-TNF)
+/- methotrexate (immunomodulation)
low risk Crohn’s Rx
induction: exclusive enteral nutrition for 12 wks
OR corticosteroids
maintenance: methotrexate
can escalate w. anti-TNF therapy
Crohn’s monitoring
faecal calprotectin + CRP
trough [anti-TNF]
paeds Crohn’s disease activity index
MRI small bowel/endoscopy
clinical dehydration Rx
≥5% WL
75ml/kg oral rehydration solution every 4 hours
fluid resuscitation
20ml/kg IV bolus of 0.9% saline
dehydration correction calculation
% dehydration x kg x 10
over 48hrs
fluid maintenance
0-10kg = 100ml/kg
10-20kg = 50ml/kg
20+ kg = 20ml/kg
over 24hrs
neonatal fluid resuscitation
day 1: 50-60ml/kg/day
2: 70-80
3: 80-100
4: 100-120
5-28: 120-150
indications for abx in gastroenteritis
sepsis
specific bacterial/protozoal infection
extra-intestinal bacterial spread
salmonella <6 months/malnourished/immunocompromised
GORD initial Rx if breastfed
breastfeeding assessment
smaller more frequent feeds
consider alginate for 1-2/52
GORD initial Rx if formula fed
review feeding Hx
aim 150-180ml/kg/day
1st: smaller more frequent feeds
2nd: thickened formula
3rd: alginate therapy w.o. thickener for 1-2/52
indications for PPI
2-4/52 trial if:
unexplained feeding difficulties
distressed behaviour
faltering growth
failed alginate trial
inguinal hernia
surgical referral <2/52
small asymptomatic umbilical hernia
observe
elective repair at 4-5yrs
large symptomatic hernia
> 1.5cm
elective repair at 2-3yrs
incarcerated hernia
manually reduced and surgical repair ASAP
Hirschsprung disease
initial: bowel irrigation
surgical: anorectal pull-through
infantile colic
reassure (resolve by 6 months)
calming environment
follow up
infantile colic resources
NHS choices
health visitor
support groups: Cry-sis
intussusception
ABCDE
fluids +/- NG tube aspiration
1st: rectal air insufflation
clindamycin + gentamicin
2nd: surgical reduction + broad spec abx
indications for immediate laparotomy in intussusception
peritonitis
perforation
asymptomatic Meckel’s diverticulum
no Rx
symptomatic Meckel’s diverticulum
excision
malrotation
Ladd procedure
cefazolin
active bleeding ulcer
endoscopy
PPI
surgery/embolisation
non-bleeding ulcer
H pylori -ive -> treat underlying cause + PPI
H pylori +ive -> PPI + clari + amox 7/7
pyloric stenosis definitive Rx
Ramstedt pyloromyotomy
mild-moderate UC
1: Topical/oral ASA
2: Consider oral prednisolone
3. consider oral tacrolimus
severe UC
high dose IV methylpred
stop oral 5-ASA
parenteral nutrition
+/- abx
surgical: colectomy
monitoring in UC
FBC
B12 & folate
calcium & vit D
assess risk of osteoporosis
assess mood
UC support/resources
Crohn’s and Colitis UK
CICRA
volvulus
supportive
obstruction -> NGT
broad spec abx
IV fluids
emergency surgery: Ladd procedure
biliary atresia definitive Rx
Kasai procedure <60 days of life
abx cover
2nd: liver transplant
biliary atresia complications Rx
ursodeoxycholic acid
nutritional supplements
fat soluble vitamins
prophylactic abx (co-trim)
abx for meningitis <3 months
IV amp/amox + cefotaxime
abx for meningitis >3 months
IV ceftriaxone
meningitis supportive therapy
analgesia + antipyretics
oxygen
0.9% NaCl + 5% dextrose
meningitis in primary care
IM/IV benpen + ambulance transfer
indications for dexamethasone in meningitis (>3 months)
frankly purulent CSF
CSF WBC > 1000
bacteria on gram stain
DO NOT USE IN MENINGOCOCCAL SEPTICAEMIA
meningitis d/c and follow up
r/v by paeds 4-6/52 after d/c
audiological assessment
contact Rx for meningitis
ciprofloxacin
meningitis support/resources
Meningitis Now
exclusion for chickenpox
until lesions are crusted over
chickenpox
supportive care
consider: PO acyclovir if adolescent + <24hrs of rash onset
chickenpox Rx in immunocompromised children
IV acyclovir
T cell deficient -> HVZIG prophylaxis
glandular fever
supportive care
upper airway obstruction/haemolytic anaemia -> admit + oral pred
AVOID AMP/AMOX
encephalitis
IV acyclovir
+/- broad spec abx
supportive care in ICU
f/u for 1year post d/c
antivirals for encephalitis
HSV -> acyclovir
VZV -> acyclovir/ganciclovir
CMV -> ganciclovir + foscarnet
EBV -> acyclovir (or dicofovir)
traffic light: intermediate risk signs
pallor
change in behaviour
poor feeding
reduced UO
nasal flaring
6-12 months: RR>50
>12 months: RR>40
sats ≤95% RA
crackles
<12 months: HR>160
12-24 months: HR>150
2-5 years: HR>140
CRT ≥ 3seconds
3-6 months: T ≥ 39
fever ≥ 5 days
rigors
non-weight bearing
traffic light: high risk signs
pale/mottled/blue
dehydrated
sleepy
no response to social cues
grunting
RR > 60
chest recessions
<3 months T ≥ 38
non-blanching rash
bulging fontanelle
focal seizures
traffic light: high risk management
immediate ambulance transfer/urgent assessment <2hrs
FBC, CRP, U&Es, blood gas, culture
urine dip
CXR, LP
slapped cheek/parvovirus/fifth disease/erythema infectiosum
paracetamol or ibuprofen
fluids + rest
> 3 weeks -> IVIG 5/7
impetigo
local & non-bullous -> topical hydrogen peroxide 1%
OR topical fusidic acid 2%
widespread & non-bullous -> topical fusidic acid 2%
consider PO fluclox
bullous -> PO fluclox
impetigo f/u
if unresolved after 1/52
r/v dx
swabs (check for MRSA)
consider PO abx
kawasaki disease
IVIG + high dose aspirin 24-72hrs + low dose aspirin 8/52
2nd line: corticosteroids + infliximab
3rd line: cyclosporin OR anakinra OR plasma exchange
echocardiogram
measles
notifiable disease
paracetamol + ibuprofen
PO vit A for 2/7
exclusion for 4 days from rash onset
mumps
notifiable disease
self-limiting
analgesia + fluids + rest
safety net
exclude for 5 days from swollen glands onset
rubella
notifiable disease
self limiting - 1 week
supportive
avoid pregnant women
safety net
mild/moderate acne
benzoyl peroxide
clindamycin
moderate acne unresponsive to first line
oral abx OR topical azelaic acid
oral antiandrogens
COCP
isotretinoin
severe acne
refer to derm
PO isotretinoin
high dose PO abx for 6/12
flares -> PO corticosteroids
eczema
avoid triggers
emollients
+ topical corticosteroids
OD/BD to active areas
2nd line: + topical calcineurin inhibitors
bandage use in eczema
chronic lichenified skin
absorption and protection
do not use with calcineurin inhibitors
infected eczema
swab
hygiene
fluclox (PO or topical)
alt: erythromycin
eczema herpeticum
same day referral
oral acyclovir
eczema support/resources
British assoc. of dermatologists
national eczema society
itchywheezysneezy.co.uk
hand, foot, and mouth disease
self-limiting
supportive care
resolves in 7-10 days
mild asymptomatic nappy rash
zinc/castor oil barrier protection
persistant nappy rash/candidal infection
NO barrier protection
topical imidazole
persistant nappy rash/bacterial infection
PO fluclox 7/7
alt: clarithromycin 7/7
scabies
5% permethrin
OR 0.5% malathion lotion
wash off after 12 hours
ringworm
topical antifungal
severe -> systemic antifungal
guttate psoriasis
self limiting within 3-4/12
1: phototherapy
topical emollient
problematic -> potent topical steroid w. vit D +/- salicylic acid
HSP
most self-limiting within 4/52
joint pain -> paracetamol/ibuprofen
scrotal involvement/severe oedema or abdo pain -> oral pred
nephrotic range proteinuria/rapid renal decline -> IV corticosteroids
hydrocoele <2yrs
most resolve by 2yrs
observe
persistent -> surgical exploration/repair
testicular torsion
immediate admission
refer to uro/paeds surgery
surgical exploration and repair
manual de-torsion if surgery unavailable < 6 hrs
undescended testes < 3 months
senior paeds referral <24hrs if:
disorder of sexual development
bilateral at birth
paeds referral <2/52 if:
bilateral at 6-8 weeks
unilateral at birth -> r/v at 6-8wks, 4-5months
6 months -> paeds surg referral
surgical Rx of undescended testes
palpable -> orchidoplexy
non-palpable -> lap exploration + orchidopexy/orchidectomy
ALL
same day paeds referral
supportive therapy:
fluids
allopurinol
treat pancytopenia
induction - maintenance chemo
Hodgkin’s lymphoma
combo chemo (ABVD)
+/- radiotherapy
ITP: asymptomatic/minor bleeding
observe
ITP: major bleeding
corticosteroids + IVIG
consider platelet transfusion
chronic ITP
mycophenolate mofetil
rituximab
2nd line: splenectomy
SCD prophylaxis
encapsulated organisms vax
daily pen V + folic acid
minimise exposure to triggers
acute SCD crisis
analgesia (avoid morphine in <12yrs)
fluids
abx
oxygen
acute chest syndrome, priapism, stroke -> exchange transfusion
SCD long term Rx
recurrent hospital admission -> hydroxycarbamide
consider splenectomy
consider HSCT
SCD prognosis
premature death from complications
50% w. severe disease die <40yrs
DDH
1st: observe
2nd: splint/Pavlik harness
3rd: surgical reduction + spica casting
indications for USS at 6wks for DDH
breech at 36wks regardless of delivery
breech delivery
FHx
septic arthritis abx
IV for 2/52 + PO for 4/52
< 3 months = IV cefotaxime
3 months - 5 yrs = IV ceftriaxone (or clindamycin)
≥ 6 yrs = IV fluclox (or clindamycin)
oral stepdown:
co-amox
fluclox
SUFE
keep non-weight-bearing
analgesia
immediate ortho referral
surgical repair: in situ screw fixation across growth plate
autism spectrum disorder
psychosocial
SALT
support for carers
SENCO
pharmacological Rx in autism
consider if behaviour issues make psychosocial interventions ineffective
r/v at 3-4/52
stop at 6/52 if no clinical indication
treat comorbidities
cerebral palsy
MDT:
SALT
PT/OT
SENCO
medication:
stiffness => diaz, baclofen
sleep disturbance => melatonin
constipation => laxatives
drooling => anticholinergic
DMD
physio
glucocorticoids
ataluren: restores dystrophin synthesis
overnight CPAP
may require surgery
AED therapy
tonic clonic -> valproate
myoclonic -> valproate
focal -> levetiracetam, lamotrigine
absence -> ethosuximide
childbearing potential -> levetiracetam
other aspects of epilepsy Rx
education
ketogenic diet
vagal nerve stimulation
localised structural cause -> surgery
febrile seizure >5 mins
buccal midaz OR rectal diazepam
can repeat after 10 mins
check blood glucose
indications for admission in febrile seizure
<18 months
dxic uncertainty
complex (>30 mins, focal features, recurrence <24hrs)
neurological deficit
hydrocephalus
ventriculoperitoneal shunt
migraine
1: simple analgesia
2: nasal sumatriptan
3: nasal triptan + NSAID/paracetamol
f/u <4/52
status epilepticus
1:
ABCDE
blood glucose
2: (5 mins)
IV loraz OR buccal midaz OR rectal diaz
3: (15 mins)
2nd dose
call senior
prep phenytoin
4: (25 mins)
anaesthetist/ICU input
20 mg/kg IV phenytoin over 20 mins
5: (45 mins)
rapid sequence induction w. sodium thiopental
consider dexamethasone
congenital adrenal hyperplasia long term Rx
hydrocortisone: suppress ACTH
fludrocortisone: salt loss
additional hormone replacement if ill/surgery
monitor growth
CAH: salt losing crisis
IV saline + hydrocortisone 200mg + dextrose
delayed puberty in boys
1st: observe
2nd: short course oxandrolone/testosterone (3-6/12)
delayed puberty in girls
1st: observe
2nd: short course oestrogen (3-6/12)
DKA fluids
10ml/kg 0.9% NaCl IV bolus _{maintenance fluids
NO DEXTROSE until glucose <14mmol/L
then +5% glucose
40mmol/L KCl
DKA insulin therapy
start 1-2hrs after beginning fluid therapy
FRII 0.05-0.1 u/kg/hr
continue long-acting insulin
SC insulin 30mins before stopping IV insulin
DKA monitoring
every 1hr:
obs
CRT
fluid balance
modified GCS
2hrs post-Rx then every 4hrs:
glucose
pH and pCO2
U&E
ketones
continuous ECG
cerebral oedema
mannitol or hypertonic saline
support/resources for diabetes
Diabetes UK
T1DM insulin therapy
3 types:
basal-bolus
continuous SC infusion
1-3 injections per day
T1DM general Rx
dietary management
lifestyle
monitoring
psychosocial support
education and safety netting
T1DM monitoring
5x per day
fasting: 4-7
post meal: 5-9
driving: >5
HbA1c <48
ketone strips/meter if ill/hyperglycaemic
pharmacological Rx of anaphylaxis
IM adrenaline 1:1000
< 6 months = 100-150mcg
6 months - 6 yrs = 150mcg
6 - 12 yrs = 300mcg
> 12 years = 500mcg
10mg IV chlorphenamine + 200mg IV hydrocortisone
neonatal resuscitation
birth:
delay cord clamping
dry baby
<30 sec:
assess tone, RR, HR
<60 sec:
5 inflation breaths
repeat
HR <60bpm -> ventilate for 30sec
chest compressions 3:1
do not require school exclusion
conjunctivitis
slapped chek
roseola infantum
mono
head lice
threadworms
