Surgery Flashcards
How do you calculate children’s weight?
2 x (age + 4)
How do you calculate children’s blood volume?
80mls/kg
How do you calculate children’s urine output?
0.5-1mls/kg/hours
How do you calculate children’s insensible fluid loss?
20ml/kg/day
How do you calculate children’s systolic BP?
80 + (2 x age)
What are the normal vitals of a child < 1?
- RR 30-40
- HR 110-160
- SBP 70-90
What are the normal vitals of a child 2-5?
- RR 25-30
- HR 95-140
- SBP 80-100
What are the normal vitals of a child 5-10?
- RR 20-25
- HR 80-120
- SBP 90-110
What are the normal vitals of a child >10?
- RR 15-20
- HR 80-120
- SBP 100-120
What are the big differences between children and adults?
- Communication
- Signs
- Disease processes
- Physiological parameters
- Expectations
- STRESS
What is the WHO pain ladder?
- Paracetmol
- NSAIDs
- Weak opioid
- Strong opioid
What sentinel signs occur in children?
- Feed refusal
- Bile vomits
- Colour
- Tone
- Temperature
What history may be obtained from a child with abdominal pain?
Pain
- Closer to umbilicus less chance of pathology
- Colic vs constant
- Movement (speed bump test)
Vomiting
- Increases significant
- Bile is important
What colour is bile vomit?
Green
What investigations should be carried out for abdominal pain?
- Urine
- FBC if diagnostic doubt
- Electrolytes if sick or dry
- Rarel x-rays
What is the basis of management?
- Does this child need a surgical opinion?
- Does this child need an operation?
What is the incidence of classical appendicitis?
- Unusual >4 years
- Can be difficult diagnosis
- 20% of admissions
How does classical appendicitis present?
- Murphy’s triad (pain, vomiting, fever)
- Tenderness over Mcburney’s point
What clues point to classical appendicitis?
- Moderate temperature with vomiting
- Child looks unwell;
What are the possible complications of classical appendicitis?
- Abscess
- Mass
- Peritonitis
What is the incidence of non-specific abdominal pain?
- F>M
- 45% of admissions
- Often recurrent
What are the features of non-specific abdominal pain?
- Short duration
- Central
- Constant
- Not made worse by movement
- No GIT disturbance
- No temperature
- Site and severity of tenderness vary
What can non-specific abdominal pain mimic?
Appendicitis
What would suggest non-specific abdominal pain was due to mesenteric adenitis?
- High temperature
- URTI often
- Not unwell
