Acutely unwell child Flashcards
(22 cards)
Age > 3 months with suspected bacterial meningitis
IV ceftriaxone for 10 days
Give dexamethasone (0.15 mg/kg to a maximum dose of 10 mg, 4 times daily for 4 days) if lumbar puncture shows signs of bacterial meningitis:
cloudy CSF, WBC > 1000, protein > 1, bacteria on gram stain
do not start dexamethasone more than 12 hours after starting antibiotics
Age < 3 months with suspected bacterial meningitis
IV cefotaxime + amoxicillin/ampicillin for 14 days
DO NOT give corticosteroids
Suspected bacterial meningitis with travel history / exposure to Abx
vancomycin + standard protocol of:
ceftriaxone for age > 3 months
cefotaxime for age < 3 months
Contraindication for ceftriaxone use
calcium-containing infusions –> give cefotaxime as alternative
In age < 3 months, ceftriaxone MAY be used as alternative to cefotaxime. When should this definitely not happen?
ceftriaxone should not be given to premature babies or babies with jaundice, hypoalbuminaemia, acidosis
–> may exacerbate hyperbilirubinaemia
Age > 3 months with H.influenza type b meningitis
IV ceftriaxone for 10 days
Age > 3 months with S.pneumoniae meningitis
IV ceftriaxone for 14 days
Age < 3 months with group B streptococcal meningitis
IV cefotaxime for 14 days
Age < 3 months with L.monocytogenes bacterial meningitis
IV amoxicillin/ampicillin for 21 days + gentamicin for first 7 days
Age < 3 months with gram-negative bacilli bacterial meningitis
IV cefotaxime for 21 days
Confirmed meningococcal disease
IV ceftriaxone for 7 days
Suspected meningococcal disease
IV ceftriaxone for 7 days
What should you assess for in patient with bacterial meningitis?
signs of shock
raised intracranial pressure
signs of dehydration
When should you restrict fluids?
raised ICP
increased ADH secretion –> hyponatraemia
How to treat shock?
give immediate IV fluid bolus 10ml/kg of NaCl 0.9% over 5-10mins
If shock persists, give further 10.
After 40, if shock persists, push another 10, call for anaesthetics for tracheal intubation and mechanical ventilation, administer vasoactive drugs
Patient is self ventilating with signs of respiratory distress, what do you give?
15L oxygen via reservoir rebreathing mask
Patient has loss of airway latency
implement airway opening manoeuvres
start bag-valve mask ventilation in preparation for tracheal intubation
Shock that is unresponsive to vasoactive agents
low-dose corticosteroids (hydrocortisone 25 mg/m2 four times daily) - only when directed by senior member
Signs of meningococcal disease
Fever and non-blanching rash
Purpura
Capillary refill time >= 3 secs
Neck stiffness
Signs of meningitis
Fever
Neck stiffness
Herpes simplex encephalitis
Fever + focal neurological signs
Pneumonia
Fever + increased resp rate
