Unwell child Flashcards
In what cases would you do a septic screen?
A child that is showing signs of sepsis, or one who has signs of an infection
What does a septic screen consist of?
- Blood tests, blood gas
(FBC, U+E, lactate, glucose) - Urine sample
- LP
- CXR
What methods are there of getting a urine sample from a child?
Clean catch
Supra-pubic aspirate
Catheter
What are the signs that a patient is going into septic shock?
Hypovolaemia
Low BP, tachycardia, tachypnoea, delayed capillary refill, pallor
What is the diagnosis for these cases?
- Meningococcal bacteria grown from blood cultures, CSF clear
- Nothing grown from blood cultures, signs of bacterial infection detected in CSF
- Meningococcal bacteria grown from blood cultures and signs of bacterial infection detected in CSF
- Meningococcal septicaemia
- Meningitis
- Meningococcal sepsis with meningitis
You’re an F1 working in AAU. You receive the results from the LP of a poorly child.
The CSF protein is high, glucose is low, white cell count is high and consists mainly of neutrophils.
What’s the likely pathology?
Bacterial meningitis
Remember bacteria use up glucose to reproduce, hence low glucose!
Also CSF is turbid/cloudy
You’re an F1 working in AAU. You receive the results from the LP of a poorly child.
The CSF protein is normal, glucose is normal, white cell count is high and consists mainly of lymphocytes.
What’s the likely pathology?
Viral meningitis
Normal glucose, viruses don’t use up glucose? (possibly not true but a good way to remember it)
You’re an F1 working in AAU. You receive the results from the LP of a poorly child.
The CSF protein is increased, glucose is normal, white cell count is raised.
What’s the likely pathology?
A sub-arachnoid haemorrhage
The CSF could have frank blood in it or be xanthochromic
What is the immediate management of a very unwell child presenting to A+E?
Talk about both assessment and actions you would undertake.
ABCDE approach
A
Assess: is airway patent, can they cry/talk
Action: head tilt-chin lift, jaw thrust, remove blockage, high flow oxygen
B
Assess: cyanosis, o2 stats, respiratory distress, rate, auscultation etc.
Action: ventilate, intubate
C
Assess: pulse, colour, BP, cap refill
Action: cannulate (bloods out, fluid bolus in)
D
Assess: AVPU, pupils, meningism, GCS, DEFglucose
E
Assess: head-to-toe trauma, wounds, bleeding etc, temperature
Action: maintain body temp
What is AVPU?
A quick way to assess a person’s level of consciousness
A: awake
V: responds to voice
P: responds to pain
U: unresponsive
What is the sepsis six?
Guidance on managing a child with sepsis
- High flow oxygen
- IV access (take blood)
- IV antibiotics
- IV fluid bolus
- Ensure senior doctor attends
- ICU + inotropic support (adrenaline, dopamine)
What is the point of inotropic support in septic children?
What does inotropic support involve?
Uses drugs that stimulate the sympathetic nervous system (adrenaline, dopamine)
Thus increasing cardiac output and constricting blood vessels (keeping BP from dropping)
What is purpura? (pathophysiology is a different question)
What are the names of the different sizes of purpura?
Purple-ish discolouration of the skin.
Small spots: petechiae
Bigger: purpura
Large areas: ecchymosis
What’s the pathophysiology of purpura?
Disseminated intravascular coagulation (DIC)
Bacteraemia causes widespread thrombosis in microvasculature. The platelets are used up and the liver can’t produce enough clotting factors, so bleeding occurs which leaks into skin
What’s the bug that’s responsible for meningococcal septicaemia?
How is it spread?
Neisseria meningitides
Respiratory secretions, but only spreads in very close or lengthy contact
Which contacts of a patient with meningitis should receive prophylaxis?
People living in the same house, boy/girlfriends, in direct contact with patient’s oral secretions
What drugs are used for prophylaxis of contacts of a meningitis patient?
What info do you need to give them?
Rifampicin, ciprofloxacin
Rifampicin stains urine orange and it interacts with the OCP
Which meningitides are currently vaccinated against?
Men B in infants
Men AWXY in adolescents
Which are the two common bugs that cause UTIs in children?
E coli
Klebsiella
What’s the first line antibiotic used to treat UTI in children?
Give two other 2nd line ones
Trimethoprim
Amoxicillin
Nitrofurantoin
What antibiotics should you prescribe for an infant with meningitis?
Cefotaxime (used in all children)
Plus amoxicillin to cover for listeria
A child presents with 3 day history of fever which resolved and then a Maculopapular rash developed. What’s the likely cause? What bug is causing it?
Roseola infantum
Often presents with a rash that appears after fever resolves
Herpes virus
A 2 month old baby presents with a fever of 38.1 but no other symptoms. Should you admit them to hospital?
Yes. All children under 3 months with fever should be admitted
A child presents with a fever which is followed by a rash that is that is vesicular (fluid filled). What’s the likely diagnosis? What bug is causing it?
Chickenpox
Varicella zoster
A child presents with fever, malaise and conjunctivitis.
They have a rash that’s blotchy. You see white spots in their mouth.
What’s the likely diagnosis? What bug is causing it?
Measles
Measles virus
A child presents with fever, malaise and pain in their ears and jaw when eating.
What’s the likely diagnosis? What bug is causing it?
Mumps
Mumps virus
A child presents with red cheeks, malaise and fever.
What’s the likely diagnosis? What bug is causing it?
Slapped cheek
Parvovirus B19
A child presents with fever, tonsillitis, bright red tongue. They have a rash on their body but not face.
What’s the likely diagnosis? What bug is causing it?
Scarlet Fever
Group A strep
A child presents with malaise, fever and vesicular rash around the mouth, hands and feet.
What’s the likely diagnosis? What bug is causing it?
Hand, foot and mouth
Coxsackie A16
What antibiotic would you give immediately to a septic looking child?
IV cefotaxime
What ages can you give cefotaxime or ceftriaxone?
Cefotaxime - all
Ceftriaxone - not under 3 months
How do cephalosporins work?
M
What antibiotics would you give as prophylaxis for a UTI?
What about for just a UTI?
Amoxicillin
Trimethoprim
Trimethoprim first line, amoxicillin second.
How does trimethoprim work?
Blocks folate metabolism in bacteria causing their death
How does amoxicillin work?
Beta lactamase
Inhibits cross linking in cell wall so bacteria breaks down!
Management of DKA?
Normal saline bolus + fluid replacement Insulin (after 1-2hrs) K replacement Antibiotics HCO bicarbonates
Why can’t you give normal fluid bolus to DKA patient?
Cerebral oedema
Clinical features of DKA?
Diuresis, delirium, dizziness, dehydration
Ketoic breath, kussmal respirations (deep laboured breathing)
Abdo pain
