Paeds Mx Flashcards
Paeds BLS
Unresponsive?
- Shout for Help
- Open airway
- Check breathing (look listen feel 10s)
- Give 5 rescue breaths.
- check circulation 10s (brachial/radial pulse)
- 15 chest compressions (120bpm) . 2 rescue breaths.
Call Resus team.
high risk Sepsis
Fever <5yo Traffic Light Scoring Red: Colour: Pale, mottled, ashen, blue. Activity: appears ill. not rousable. weak high pitched continous cry. no response to social cues. Resp: RR>60. grunting. indrawing chest. o2 <90. Circulation: reduced skin turgor. other: <3m temp >38 non blanching rash bulging fontanelle. neck stiff, status epilepticus. focal neurology, focal seizures.
-> immediate senior review.
o2.
VBG: lactate, glucose, FBC, CRP, U+E, Clotting.
Broad spec abx max dose.
Monitor GCS.
Consider IV fluids. (lac >2) 10-20ml/kg over 10mins.
Monitor Uo
Critical care review lactat)e>4
Moderate risk sepsis
Yellow: Colour: pale reported by carer. Activity: Reduced. needs Prolonged stimul to wake. no smile. Resp: Nasal flaring. RR >50 6-12M Circulation: HR >160 <12m >150 12-24 >140 2-5y CRT >3 dry MM reduced feeding. reduced UO fever >5days temp >39 3-6m rigors swelling limb NWB limb
ix: FBC, blood culture, CRP, urinalysis, LP, CXR.
CI LP: ICP, focal neuro, shock.
LP if <1m suspected sepsis,
1-3m appear unwell/WCC <5/>15.
Mx: VBG - lactate, glucose blood cultures. FBC, CRP, U+E, rv lactate in 1h. Lactate >2 /AKI -> High risk. Lactate <2: hrly review. senior review within 3h.
Anaphylaxis
Sit up if breathing difficulty.
Lie flat +/- legs elevated if low BP/faint.
Recovery position if breathing but conscious.
O2.
Iv fluids.
IV chlorphenamine 10mg.
Iv Hydrocortisone 200mg.
IM adrenaline 0.5mg
1 in 1000. AL thigh.
assess response after 5mins.
Repeat at 5 min intervals.
Monitor throughout day.
carry epipen. allergy clinic.
NAI
Presentation: broken bones bruising drowsiness neglect FTT
Are they in danger?
Involve seniors.
Call social services. + formal referral.
Consider Police: Child abuse Investigation team (CAIT)
Consider Multiagency safeguarding Hub (MASH)
Ix: Skeletal survey Bloods. - exclude leukaemia, ITP. Fundoscopy - retinal haemorrhages. CT head Admit child if any concerns.
Asthma paeds
Ix: A-E. examine chest. Obs: RR. SpO2, BP, HR. PEFR ABG
Moderate PEFR >50% - normal speech. HR <140 2-5.
<125 >5y.
RR <40 (2-5), <30 (>5y)
PEFR 33-50 severe incomplete sentences. spo2 <92 HR >140 2-5 >125 >5y RR >40 2-5 >30 >5. accessory muscle use.
PEFR <33 exhaustion, arrhytmias hypotension low GCS silent chest
admit if severe or life threatening.
Prescribe 3d oral prednisolone.
Mod: o2, oral pred ipratropium, SABA. severe: o2, venturi/nasal cannula. saba, ipratropum oral pred. IM adrenaline. Mgso4. ICU
Not in hosp:
SABA + large volume spacer. 1 puff every 30-60s. 10 puffs. 5 tidal breaths per puff.
Oral pred 3-7d.
abx if infection.
follow up in 48h.
admitted - within 2 working days of d/c.
Bronchiolitis
admit if Sats <92% persistently. central cyanosis RR > 70, Chest recession, grunting. apnoea Looks unwell to clinician.
consider if
cant breastfeed/oral fluids
clinical dehydration
RR >60.
Ix: Examine. wheeze, crackles.
Obs.
CXR.
Nasopharyngeal swab -> IF -> RSV
Mx:
Not severe: Gets better itself over 2 weeks.
Safetynet.
good hydration, paracetamol.
warn of red flags.
aim o2 >90%
Humidified o2.
consider CPAP.
Fluids. OGT/NGT/IVs. if reduced.
Upper airway suction if apnoea, secretions.
infection control
Pavalizumab if CF, Congenital heart disease, bronchopulmonary dysplasia.
Cows milk protein allergy symptoms
Regurgitation vomiting diarrhoea eczema, urticaria colic (crying, irritability) wheeze, chronic cough. angioedema, anaphylaxis.
Ix: skin prick/patch testing.
IgE, specific IgE (RAST)
Mx CMPA/CMPI
Formula fed: start on extensive hydrolysed formula (hypoallergenic formula).
if severe amino acid formula.
Breastfed: Continue BF.
Stop mum intaking cows milk protein.
calcium, vit D supplements.
monitor growth.
offer MDT: paeds dietician - nutritional counselling.
revaluate tolerance every 6-12m.
reintroduce with Milk ladder (Allergy UK)
support from British dietetic association (fact sheet).
Croup
Freq barking cough
chest recession
stridor at rest -> admit
give all: Oral dexamethasone 0.15mg/kg immediately.
rpt at 12h if needed.
if admitted:
OBs. examine.
clinical dx.
CXR - subglottic narrowing steeple sign.
hosp Mx: high flow o2
oral dex/inhaled budesonide.
nebs adrenaline
if severe: 100% o2. oral/iv dex. nebs adrenaline.
closely monitor
Gets better in 48h. steroids.
if worse come back.
Tonsilitis
Ix: rapid strep antigen test.
Centor score.
Mx: Pen V 10 days.
or clari (if pen allergic).
fluid intake.
p + I
salt water gargling, lozenges, anaesthetic sprays.
return to school when fever resolved, after 24h abx.
recurrent: ENT -> tonisllectomy.
Coeliac
TTG + -> flat mucosa on jejunal biopsy
explain dx: Inability to digest gluten (barley, rye, wheat).
common (1 in 100) and treatment is just gluten free diet.
MDT: dietician.
important to keep to strict diet - otherwise risks of malnutrition and cancer.
give vit D +/- iron.
Follow up every 6-12 months
Advise regular height and weigh measurements on centile charts.
annual review:
IgA ttG titre every 3m until normalised then yearly.
consider - bloods: serology, FBC, TFT, LFT, vit D, B12, folate, calcium, U+E.
BMD evaluated after 1 year.
Support Coeliac UK.
eczema
Identify triggers (clothes, soaps, food, inhalation)
Emollients: e45, diprobase. as a soap substitute.
Steroids: od/bd 3-14 days.
Mild: Hydrocortisone 1%
Mod: Betametasone valerate 0.025%
Severe: Betamatasone valerate 0.1%
topical tacrolimus.
oral steroids.
infected: oozing, red, fever: flucloxacillin topical/oral.
Eczema herpeticum - oral aciclovir.
around eyes, widespread –IV
dont stcratch, explain association with other conditions.
Support - itchywheezysneezy, -emollients
British association dermatology - leaflet
national eczema society.
Refer if eczema herpeticum
severe not responding after 1w.
failed bacterial tx.
Acne vulgaris
Dont overclean pH close to skin products avoid picking eat healthy can take 8w for tx to work, can irritate skin.
Mild: Topical adapalene, topical benzoyl peroxide.
Topical clindamycin 1%
azelaic acid.
Mod: oral Lymecycline 3months
then another one.
COCP.
Severe: Scarring, not responding -> refer derm for Isotretinoin. (Roaccutane).
if psych distress.
review at 8-12 w.
Neonatal jaundice
Early: Rh incomaptibility, ABo incompatibility Congenital infections Hereditary spherocytosis G6PD
Intermediate: Physiological, breast milk jaundice, sepsis
Prolonged >14 days:
Obstruction (pale stools, dark urine) - biliary atresia, neonatal hepatitis, cholestasis.
Hypothyroidism
Urinary tract infectiosn
Mx:
Physiological: Immature liver cant break down blood cells correctly. -> high bilirubin level.
-> reassure, and onbserve.
Ix: Conj/Unconj Br LFTs FBC Blood film DAT test TFTs Urine MC + S, reducing sugars. U+Es
Plot Br levels Phototherapy hydration IVIG Exchange transfusion monitor Br stay in after. check hyperbilirubinaemia. continue breast feeding. cover eyes, blood samples.
resources: NHS choices. Breastfeeding network.
Bliss.
