Paediatrics Flashcards
Predict head injury guidelines
Head injury presenting within 72hrs of injury
Any high risk features:
Age < 6 months
Neurodevelopmental concerns
VP shunt
Concern for NAI
Bleeding disorder
Drugs or alcohol
GCS </= 13 get a CT scan
GCS 14-15 look for risk factors:
All children
- high risk mechanism
- seizures
- GCS 14
- Abnormal neurology
< 2 years old
- non frontal haematoma
- palpable skull fracture
- LOC > 5s
- behaving differently
2 years +
- signs of BOS #
- vomiting
- severe headache
If high risk features - CT
- BOS #
- palpable skull fracture
- persisting GCS 14 or neurology
Intermediate risk
- 2 + risk factors
- or post traumatic seizure
- or persistent headache or vomiting 4hrs post injury
——- consider CT
Low risk
- no high or intermediate risk features and symptoms improving
Very low risk
Otitis media
Red flags
- age < 6 months
- ATSI
- cochlear implant
- immunocompromised
Unwell or red flags or symptoms > 48hrs
- amoxicillin 30mg/kg
Well with symptoms < 48hrs
- analgesia and discharge with advice
- if symptoms improving then no abx if not then as above
Examination of the unwell child
Colour: pale, mottled, cyanosed
Activity: flat, lethargic, high pitched cry
Breathing: grunting, hypoxia, increased WOB, respiratory effort
Circulation: poor CRT, reduced UO, dry mucous membranes, tachycardia
Neurological: bulging fontanelle, seizure, neck stiffness, focal neuro signs
Other: petechial rash, fever > 5 days, joint swelling, night symptoms, non weight bearing
Don’t miss fractures - NAI
Skull fractures, rib fractures, femur fracture if non-ambulant, mid-shaft ulna (defensive fracture), digital fracture of non-ambulant, metaphyseal fractures, proximal humerus/spiral fracture of humerus, scapular or sternal fractures
TEN 4 FACES p
When is bruising concerning in < 4yrs
Torso
Ears
Neck
Under 4 months with any bruising
Frenulum
Angle of jaw
Cheeks
Eyelids
Subconjunctiva
Patterned bruising
BRUE
Definition:
< 12 months
< 1 minutes
Sudden onset and complete resolution
No explanation by medical cause
Involves: cyanosis, reduced resp effort, reduced GCS or change in tone
Low risk BRUE:
Age > 60 days
Born at > 32 weeks
< 1 minute
First episode
No CPR by trained provider
Blistering rash differentials
SSSS
SJS/TEN
Drug hypersensitivity
Burns
Bullous impetigo
Viral exanthem
Hypoglycaemia
BGL low enough to cause symptoms < 3.3 or < 2.6 in neonates
Causes:
Also think toxins - sulphonylurea, beta blockers, sodium valproate
Neonate: IUGR, macrosomia, diabetic mother, sepsis
Neonate-2yrs: congenital hyperinsulinism, inborn errors, CAH
Child: accelerated starvation, GH deficiency
Adolescent: insulinoma, eating disorder, adrenal insufficiency
All ages: sepsis, T1DM, adrenal
Autonomic symptoms: sweating, anxiety, palpitations
Severe: lethargy, irritability, seizures, hypothermia
Neonates: apnoea, jittery, poor feeding, high pitched cry
Bloods during episode: ketones, FFA, insulin and c peptide, lactate, ammonia, cortisol, carnitine, growth hormone, LFTs, electrolytes
Treatment: 2ml/kg 10% glucose
Discharge:
Neonate BSL > 2.6 for 3 normal feeds
Child BSL > 3 4hrs post feed
Accelerated starvation: diagnosis of exclusion, period of fasting with low BSL and raised ketones, BSL normalises with feed
Nitrous use
Indications: short procedures < 30 minutes, diagnostic and therapeutic e.g LP, IVC insertion, IDC insertion, suturing, foreign body removal, burns dressings, I+D, simple fracture manipulation
Absolute Contraindications: reduced GCS from head injury, risk of gas expansion (pneumothorax, bowel obstruction), pulmonary hypertension, painful or prolonged procedures
Relative contraindications: inadequate fasting time, acute respiratory infection, age < 6 months
Complications:
Vomiting, nausea, dizziness
Aspiration, airway obstruction, diffusion hypoxia (give 100% O2 after), hallucinations, failure
Can start at 70% nitrous (no need to titrate)
Ensure patient fasted 2hrs
Procedure:
Minimum 2 staff
Sats probe
Mask with good seal
Start with 100% O2 then up to 70% nitrous ~ 5 minutes to reach adequate sedation.
Ensure bag inflating and deflating
100% O2 at end of procedure
