(SYNOPTIC) Neonates + Paediatrics Flashcards
How should pain be assessed when they are unable to tell you verbally, i.e. a neonate?
Facial Expression?
0 - relaxed
1 - grimace
Crying?
0 - no
1 - whimper
2 - vigorous crying
Arms?
0 - relaxed
1 - flexed/ extended
Legs?
0 - relaxed
1 - flexed/ extended
Posture?
0 - relaxed
1 - flexed/ extended
State of arousal?
0 - asleep/ awake
1 - restless
Heart rate?
0 - baseline
1 - increase by 10-40BPM
2 - increase by ≥40BPM
Respiratory rate?
0 - baseline
1 - alteration in breathing
When observing pain of a neonate, and having allocated a score, how are the scores interpreted?
1-3: Nurse-controlled measure
- non-nutritive sucking
- repositioning
4-7: Consider sucrose/ alternative pain relief + nurse-controlled measures
8-10: Review with medical team
- discuss alternative prescription for pain relief
What is FLACC, with regard to pain?
Pain assessment score
Face Legs Activity Crying Consolability
What are some physiological indicators of pain?
- heart rate
- respiratory rate
- blood oxygen
- blood pressure
For what patient age group is codeine considered suitable?
Patients older than 12
For what patient age group is codeine contraindicated?
All children under 18yrs who undergo removal of tonsils/ adenoids
For the purpose of sleep apnoea
What is the management of suspected asthma in neonates and paediatrics?
Initiation of treatment with very low-> low dose ICS
What is the management ladder of diagnosed asthma in neonates and paediatrics?
(1) Regular preventer
(2) Initial add-on therapy
- VERY low dose ICS
- ≥5 LABA/ LTRA
- <5 LTRA
(3) Consider increasing ICS to low dose
(4) Refer for specialist care
What is LTRA treatment?
Leukotriene receptor antagonist therapy
What dose of beclometasone dipropionate is considered to be a very low dose for use in children?
50 microgram
2 puffs
BD
What dose of beclometasone dipropionate is considered to be a low dose for use in children?
100 micrograms
2 puffs
BD
What dose of beclometasone dipropionate is considered to be a medium dose for use in children?
200 micrograms
2 puffs
BD
What is the treatment for mild atopic eczema in children?
- emollients
- mild topical corticosteroids (hydrocortisone)
What is the treatment for moderate atopic eczema in children?
- emollients
- moderate topical corticosteroids (betamethasone/ clobetasone)
- topical calcineurin inhibitors
- bandages
What is the treatment for severe atopic eczema in children?
- emollients
- potent topical corticosteroids (betamethasone/ mometasone)
- topical calcineurin inhibitors
- bandages
- phototherapy
- systemic treatment
Name some side effects of systemic corticosteroid use.
- impairment of growth and healing
- fluid retention
- osteoporosis
- weight gain
- peptic ulcers
- altered mood/ psychosis
- electrolyte imbalances
- blood glucose increase
Name some side effects of topical corticosteroid use.
- may thin skin if very potent
- if used on younger children, may get systemic exposure via skin
When should oral antihistamines be offered to children with eczema?
Not to be used routinely
Offer 1 month trial of NON-SEDATING to children with SEVERE atopic eczema/ severe itching
Offer 7-14 day trial of SEDATING if ≥6 months with sleep disturbance
What is the first line treatment for secondary infections of eczema in children?
Flucloxacillin
Erythromycin
- if penicillin allergy
What is the treatment for a meningitis infection in children?
Broad spectrum ABx
(1) Cephalosporin
- ceftriaxone
- cefotaxime
(2) Add amoxicillin for babies <3 months
What is a potential complication of this drug when used in children?
Chloramphenicol
Neonates cannot metabolise
Can result in grey baby syndrome
Liver is not mature enough to metabolise correctly
What is a potential complication of this drug when used in children?
Sulfonamides
Kernicterus in neonates
- Brain damage due to high levels of bilirubin in blood
What is a potential complication of this drug when used in children?
Ceftriaxone
Kernicterus in neonates
- Brain damage due to high levels of bilirubin in blood
Forms precipitate with calcium
What is a potential complication of this drug when used in children?
Nitrofurantoin
Haemolytic anaemia in children <3 months
What is a potential complication of this drug when used in children?
Tetracyclines
Bind to calcium in growing bones + teeth
Causes discolouration
What is a potential complication of this drug when used in children?
Quinolones
Arthopathy in children
- joint disease
What are some common reasons for having to admit term babies?
- Hypoglycaemia
- Hyperbilirubinaemia
- Infection
- Poor feeding
- Asphyxia during birth
What are some common issues for preterm babies?
- hypoglycaemia
- electrolyte imbalance
- hyperbilirubinaemia
- infection/ necrotising colitis
- respiratory distress syndrome
- patient ductus arteriosus
ø condition where blood flows back to lungs from heart - intraventricular haemorrhage
