PEM Flashcards
DKA severity
Mild: pH 7.20-7.29 +/- Bicarb 20, dehydration -5%
Moderate: pH 7.1-7.19 +/- Bicarb 15, dehydration -5%
Severe: pH <7.1 +/- Bicarb 10, dehydration -10%
APGAR
One point each, 7 is ok
Appearance (colour)
0 pale/blue
1 blue peripheries
2 pink
Pulse
0-no pulse
1 >100
2 <100
Grimace (responsiveness)
0 nil
1 some movement
2 Cry
Activity (tone)
0 limp
1 some flexion
2 flexed
Resp
0 no cry
1 weak cry
2 strong cry
NICE criteria for admission for bronchiolitis
Apnoea-observed or reported
50-75% of normal oral fluid intake
Persistent Sats <92%
Resp distress: grunting, marked chest recession, RR>70
NICE RF for severe bronchiolitis
age<3 months
chronic lung disease
haemodynamically unstable heart disease
immunosuppressed
Prem esp <32/40
neuromuscular disorders
Weight calc <1yo
0.5kg/month +4kg
weight calc 1-5yo
2kg/yr +8kg
weight calc 6-12
3kg/yr + 7kg
Old weight est
2x(age+4)
Finger count weight est
left hand-age/yrs, odd numbers from 1, right hand weight in kg, start at 10kg & go up by 5kg each finger
est ETT size
Age/4 + 4 uncuffed, (-0.5 for cuffed)
Cardiversion Energy est
4 joules per kg
Fluid bolus
10ml/kg
IV glucose bolus
2ml/kg of 10% dex
lorazepam
100mcg/kg
Adrenaline in arrest
0.1ml/kg of 1:10 000
Adrenaline dose-anaphylaxis
1:1000
<1yo: 50-100mcg/0.05-0.1ml
1-5yo: 150mcg/0.15ml
6-12: 300mcg/0.3ml
>12: 500mcg/0.5ml
BRUE definition
<1yo ,1min of unexplained-change to breathing/apnoea/cyanosis/pallor/reduced tone then returns to baseline
Criteria for low risk BRUE
> 60 days old
Delivered 32/40 or more/ 45 or more weeks post conception
Normal examination
No CPR by a healthcare provider
Energy for paeds DC cardioversion
1J/kg, then 2J/kg upot to 4J/kg is considered.
US findings in pyloric stenosis
pyloric sphincter >4mm thick & 16mm long
Pyloric stenosis more common in m or f
males
Paediatric GCS <2
Eye opening
E4 Spontaneous
E3 To voice
E2 To pain
E1 None
C Eyes closed (by swelling or bandage)
Verbal
V5 coos, babbles
V4 irritable cry
V3 Cries to pain
V2 Moans to pain
V1 No response to pain
T Intubated
Motor
M6 spontaneous puposeful movements
M5 withdraws to touch
M4 Withdraws to pain
M3 Flexion to pain (decorticate)
M2 Extension to supraorbital pain (decerebrate)
M1 No response to supraorbital pain (flaccid)
Red flags for neonatal risk of early infection
Maternal IV ABX during labour
Concurrent pregnancy with proven infection
Kocher’s criteria for ?septic arthritis
Investigate further if any of the following 4 criteria are present
-WCC>12
-ESR>40
-Inability to weight bear
-Hx of fever
Westley Croup score
Mild (croup score 0-2)
Moderate (croup score 3-5)
Severe (croup score 6-11)
Impending respiratory failure (croup score 12-17)
-Stridor (none0, upon agitation 1, at rest 2)
-Level of consciousness (normal 0, decreased 5)
Cyanosis (none-0, w/ agitation-+4, at rest +5)
air entry (reduced-1, markedly reduced 2)
chest wall retractions (mild1, moderate2, severe 3)
3 criterion for nephrotic syndrome
oedema
3+ proteinuria or urine protein to Cr ratio of >200mg/mmol
Hypoalbuminaemia <25g/L
Criteria for atypical UTI
If any of the following
non E.coli
raised Cr
Bladder/abdo mass
no response following 48hr ABX
Seriously ill
septicaemia
Poor urine flow
SALTER Harris classification
1-Slipped
2-Above, through metaphysis (proximally)
3-Lower, through epiphysis (distally)
4-Together, through metaphysis & epiphysis
5-R-ruined/crushed
Higher number worse prognosis.
Acceptable pre ductal sats
2mins 65%
5mins 85%
10mins 90%
Dose of intranasal diamorphine
0.1mg/kg monitor 20mins after
paeds paracetamol dose
initial 20mg/kg
<10kg-10mg/kg, max 30mg/kg/day
10-50kg- 15mg/kg, max 60mg/kg/day
>51kg- 1g, 4g max per day.
European peadiatric rheumatology soc. diagnostic criteria for HSP
palpable purpura plus one of the following:
-bld/protein in urine
-renal involvement
-abnormal renal histopathology
-arthralgia
Diagnostic criteria for pertussis
Cough for 2/52 AND a least one of the following:
-inspiratory whooping
-coughing fits
apnoea +/- vomiting in infants
-post pertussive vomiting without another cause.
Intussuseption M:F
M2:1F
Intussuseption Ix
Ultrasound
Perthes disease
4-12yo
avascular necrosis of femoral head
5x more common in boys
Most sensitive clincal sign is pain on intenal rotation
10-15% bil
RF maternal smoking & prematurity
conservative Mx-can remodel, but older & more severe may have osteotomy.
SUFE
teens
3x more common in boys
klein’s line, along lateral neck, should transect the lateral epiphysis, if it does not, this is Trowthewn’s sign
UK vaccination schedule
8 weeks DipTP/HIB/IPV/Hep B, rotovirus, Men B
12 weeks DipTP/HIB/IPV/Hep B
pneumococcal, rotovirus
16 weeks DipTP/Hib/Hep B, Meb B
1 year Hib/Men C, Men B, pneumococcal, MMR
3 years, 4 months DipTP/MMR
12 HPV
2+ intranasal flu
Extra
flu for clinically vulnerable
TB for those w/grandparents from countires w/ high rates of TB & those that live in parts of the UK w/ incidence of >40:100 000
Hep B at birth 4 weeks & 12 months for those born to infected mothers.
Pregnant women:
flu
16/40 ptussus
28/40 RSV
kawasaki’s disease
<5yo WARM CREAM
Temp >4/7
AND 4 out of this 5
-Conjuntivitis, no exudate
-Rash- polymorphus, worst in groin
-Erythema-palms & soles w/ swelling, then desquamation
-Adenopathy-unilateral
-Mucus membrane-dry cracked lips, strawberry tongue
5x more common in females
2mg/kg of IVIG & aspirin
echo
aim to treat before D10
Incomplete kawasaki’s
fever & 2-3 from CREAM or >7 fever in <6month old without a source
check CRP & ESR, if raised…
Check alb, ALT, plts, WCC, Hb
If fingers desquamating, get echo.
Criteria for ABX in otitis media
<3/12
<6/12 & febrile
Systemically unwell
Complications
<2 yo & bil
Otorrhoea
Can give delayed course for ottrrhoea or bil <2
Give amox or clary if pen allergic or erythromycin in pregnancy
PEM Dose of adenosine
<1yo: 150mcg/kg, increase 100mcg every 1-2mins. Max for neonates is 300mcg/kg
1-12yo:100mcg/kg increased by 100mcg/kg every 2 mins up to 500mcg/kg
12+: 3mg, then 6mg, then 12mg
PEM Dose of amiodarone
5mg/kg over 20 mins
Should be given before 3rd DC cardioversion, while getting in touch with a paediatric cardiologist.
PEM dose of atropine
<12yo: 20mcg/kg
12+yo: adult dose
PEM bradycardia algorithm
<1yo <80bpm
>1yo <60bpm
Oxygenate
If still unconscious start CPR
Give atropine
Then give adrenaline 10mcg/kg, rpt if req.
Very rarely transcutaneous pacing
PEM magnesium dose (torsade de point)
25-50mg/kg max dose 2g, given over 15-20mins
PEM: SVT/VT threshold for DC cardioversion
Compensated
-vegal manoeuvres, consider adenosine
Decompensated
-reduced LOC
-weak peripheral pulses
-CRT >2s
-Systolic BP <5th centile for age
<1month:<50,
<1yo: <70,
<5yrs: <75,
<10yr: <80
infant HR >220
child HR >180
Narrow or broad needs shock (1j/kg), unless chemo cardioversion is going to be quicker for some reason.
Sedate w/ ket if conscious (IM or intranasal ok)
adenosine if SVT
2nd shock 2-4j/kg
amiodarone before 3rd shock.
Injuries that raise suspicion of NAI
Bruising in non-mobile infants.
* Bruising on non-bony parts of the body.
* Bruising of similar shape and size.
* Multiple bruises or bruises in clusters.
* Laceration in a non-mobile infant.
* Thermal injury in a non-mobile infant.
* Thermal injury where the mechanism doesn’t fit or suggests forced submersion.
* Fractures with no suitable mechanism, especially if multiple fractures or occult
fractures, such as rib fractures in infants.
* Intracranial injury.
