Paediatrics Flashcards
1
Q
What is the paediatric weight calculation for 1-5yrs?
A
(2 x age in years) + 8
2
Q
What is the paediatric weight calculation for 5-12 years?
A
(3 x age years) + 7
3
Q
What are the paediatric weight calculations for different age categories?
A
< 1 year = (0.5 x age months) + 4
1-5years = (2 x age years) + 8
5-12 years = ( 3 x age years) + 7
4
Q
What is Sandel Tape?
A
Length based way of calculating weight
5
Q
How should an OP airway be inserted in paediatric patients?
A
Using tongue depressor and right way up
6
Q
When does DAS recommend surgical airway in paeds?
A
SATs <80% and falling
7
Q
What does DAS recommend for a surgical airway in under 1yrs?
A
ENT
8
Q
What does DAS recommend in age 1-8 yrs as first line for surgical airway?
A
Percutaneous cannula unless ENT experience
- surgical if failed
9
Q
When do DAS recommend surgical airways as first line?
A
> 8 years
10
Q
Where should an IO be avoided in pre-school kids?
A
Humeral head as not ossified enough
11
Q
When should ionotropes be started in paeds (according to ABC PHC)
A
After 40ml/kg fluids
12
Q
Describes the parts of the FLACC pain scoring system in paeds
A
Face
Legs
Activity
Cry
Consolability
13
Q
What is the FLACC score for paeds pain out of?
A
10
14
Q
How are Wong-Baker faces used to assess paeds pain?
A
6 faces - score 0 to 10
15
Q
When can Wong-Baker faces be used to assess pain?
A
> 3 years
16
Q
Describe the visual analogue scale (VAS) for assessing paeds pain
A
10cm line with no pain on one end and worst pain imaginable on the other. Child marks where there pain is
17
Q
What is the dose of adrenaline nebs for paeds stridor?
A
5ml of 1:1000
18
Q
What are the doses of adrenaline in paeds anaphx?
A
> 12 years = 500mcg
6-12 years = 300mcg
6months-6 years = 150mcg
<6 months = 100-150mcg
19
Q
When does NICE recommend febrile seizures be conveyed? (5)
A
- First seizure
- < 18 months old
- Complex seizure
- Diagnostic uncertainty
- Parental anxiety/unable to cope
20
Q
What makes a febrile seizure complex? (4)
A
- > 15mins
- Focal
- More than 1 episode within 24 hours
- Incomplete recovery
21
Q
What are 3 differences in the distribution of traumatic injury in paeds? (3)
A
- Younger ages less likely to have c-spine injury
- Complaint chest means can have little external evidence of injury but can have lung injury
- Liver/spleen more exposed therefore more prone to injury
22
Q
Before CPR in paeds resus what should be done?
A
5 rescue breaths
23
Q
What is less likely to be a cause of arrest in paeds?
A
Dysrhythmia
24
Q
Under what age should the brachial pulse be used to check of a pulse?
A
< 1 yr
25
When should the 'encircling technique' be used for CPR?
< 1 year
26
What are the ventilation rates for paeds patients during resus? (RCUK) (5)
neonate = 30
< 1 year (infant) = 25
1-8 years = 20
8-12 years = 15
>12 = 10-12
27
How much of a babies birth weight is expected to be lost by week one and when should they regain it?
1. 10%
2. Week 2
28
How should temperature be measured in babies <4 weeks?
Electronic thermometer in axilla
29
How should temp be measured in children 4 weeks to 5 years?(3 options)
1. Electronic thermometer in axilla
2. Chemical dot thermometer in axilla
3. Infra-red tympanic thermometer
30
Under what age should babies have full septic work up?
3 months
31
If a child > 3 months with a fever only has green features but no source what should be done? (2)
1. Urine sample
2. Assess for signs of pneumonia
32
What is an amber flag for paeds re: skin colour
Pallor reports by parents
33
What are red flags for paeds re: skin colour? (3)
1. Pale
2. Mottled
3. Blue
34
What are amber flags for paeds re: activity? (4)
1, Not responding normally to social cues
2. No smile
3. Only wakes on prolonged stimulation
4. Decreased acitivity
35
What are red flags for paeds re: activity (4)
1. No response to social cues
2. Appears ill to healthcare professional
3. Does not wake or stay awake
4. Weak/high pitched/continous cry
36
What are amber flags in paed fevers < 5yrs re: resp (4)
1. Nasal flaring
2. RR > 50 in 6-12 months
RR > 40 > 12 months
3. <95% SATs
4. Crackles on chest
37
What are red flags in paeds re: resp (3)
1. Grunting
2. RR >60
3. Mod-severe chest indrawing
38
What are amber flags in paeds fever < 5yrs re: CVS (4)
1. HR
>160bpm < 1year
> 150bpm 1-2 years
> 140bpm 2-5 years
2. CRT > / 3 secs
3. Poorer feeding
4. Decreased UO
39
What are paeds red flags re: CVS? (1)
Increased skin turgor
40
What are the other paeds amber flags (5)
1. 3-6 months and fever >39
2. Fever 5 days or more
3. Rigors
4. Swelling of joint/limb
5. NWB limb
41
What are the other paeds red flags? (7)
1. <3 months and fever >38
2. Non blanching rash
3. Bulging fontanelle
4. Neck stiffness
5. Status epilepticus
6. Focal neurology
7. Focal seizures
42
What are the 5 parts of the Westley croup score?
1. Stridor
2. Retractions
3. Air entry
4. SATs <92%
5. Reduced GCS`
43
Describe the Westley croup score
44
How will acute epiglotitis present differently to croup? (3)
1. Less stridor
2. Quicker onset
3 More unwell
45
What are the criteria for diagnosis of paeds DKA? (3)
1. Gluc > 11 (can be normal)
2. Acidosis - PH <7.3 of HCO3 <15
3. Blood ketones > 3mmol/l or urinary ketones > ++
46
What is the management of paed DKA who is alert, not vomiting and not dehydrated?
1. sc insulin
2. PO fluids
47
When should insulin be started in paeds DKA?
After at least 1 hour of fluids
48
Over what period should IV maintenance be calculated in paeds DKA and why?
1. 48 hours
2. Avoid cerebral oedema
49
What should be given in paeds DKA in the case of cerebral oedema and at what dose (BSPED)?
1. hypertonic saline (2.7% or 3% 2.5-5 ml/kg over 10-15 minutes)
or
2. mannitol (20% 0.5-1 g/kg over 10-15 minutes)
50
What are 5 'red flags' for patients presenting with eating disorders?
1. HR < 40bpm
2. syncope
3. postural drop
4. high levels of dysfunctional exercise
5. possible daily episodes of purging behaviours)
51
Under what age should all limping children be investigated?
Under 3 years
52
What are the criteria for conservative management of a limping child? (4)
1. 3–9 years
2. Afebrile
3. Mobile
4. Symptoms for less than 72 hours, or more than 72 hours and improving
53
How is mild/moderate/severe DKA defined in paeds according to BSPED?
1. Mild = PH 7.2-7.29 or HCO3 < 15
2. Moderate = 7.1-7.19 or HC03 < 10
3. Severe = PH < 7.1 or HC03 < 5
54
How much and what fluid should be given in paeds DKA initially and over what time according to BSPED:
1. No shock
2. Shock
1. 10ml/kg over 30mins normal saline
2. 10ml/kg bolus isotonic crystalloid (hartmanns/plasmolyte) or normal saline if not available, up to maximum of 40ml/kg (above this call PICU)
55
Below 6 months of age what type of laryngoscope could be considered?
Miller if experience allows
56
What should be done in a paeds RSI to try and reduce the dead space? (3)
1. Compress catheter mount
2. Paeds filter
3. Paeds ventilator circuit if TV <250ml
57
What is more important to ensure we have done post RSI in children compared to adults?
OG tube to decrease gastric volume and increase ventilation
58
What additional drug should be drawn up during a paeds RSI and at what dose?
Atropine
20mcg/kg
+ consider hypertonic if TBI (AAGBI)
59
What does JRCALC recommend for a bolus in paeds shock caused by:
1. Trauma
2. Medical
3. Heart failure/renal failure
1. 5ml/kg
2. 10ml/kg
3. 5ml/kg
60
What does JRCALC say about follow up fluid bolus in paeds in:
1. Trauma
2. Medical
1. Give 5ml/kg aliquots until 'significantly improved'
2. Can give one further 10ml/kg bolus only
61
What does JRCALC recommend for paeds DKA fluid bolus in:
1. Shocked patients
2. Non-shocked patients
1.10ml/kg over 15 mins
2. 10ml/kg over 30 mins
62
What does JRCACL state re: further fluid bolus in paeds DKA?
May need further 5ml/kg bolus but only after discussion with senior clinician
63
What method of assessing paeds pain does JRCALC mention? (2)
1. FLACC - pre verbal
2. Wong-Baker faces
64
What does the Serious Crime Act 2015 place a duty on healthcare workers to report? (5)
1. Serious domestic abuse (serious not defined)
2. FGM
3. Child sexual exploitation/abuse
4. Gang related activity
5. Cybercrime
65
What does JRCALC state should happen with non-mobile babies and injury/
Needs assessment from clinician and d/w on call paediatrician or conveyence
66
What defines a moderate asthma exacerbation (NICE/SIGN/BTS)?
1. PEFR more than 50–75% best or predicted (50% paeds) +
2. normal speech +
3. no features of acute severe or life-threatening asthma.
67
What defines acute severe asthma exacerbation in paeds? (7)
1. PEFR 33–50% best or predicted (less than 50% best or predicted in children)
2. SATS <92%
3. Respiratory rate of :
> 12 years = > 25/min
5-12 years = > 30/min
2-5 years = > 40/min
4. HR of:
> 12 years = > >110
5-12 years = > 125
2-5 years = > 140
5. Inability to complete sentences in one breath
6. Accessory muscle use
7. Inability to feed (infants)
68
What are the HRs that define acute severe asthma in:
> 12 years =
5-12 years =
2-5 years =
> 12 years = > >110
5-12 years = > 125
2-5 years = > 140
69
What are the RRs that define acute severe asthma in:
> 12 years
5-12 years
2-5 years
> 12 years = > 25/min
5-12 years = > 30/min
2-5 years = > 40/min
70
What defines life threatening asthma in paeds? (10)
1. SATS <92% +
2. PEFR less than 33% best or predicted,
3. Cyanosis
4. Poor respiratory effort
5. Silent chest
6. Cardiac arrhythmia
7. Hypotension
8. Altered consciousness
9. Exhaustion
10. Confusion
71
What is the dose of:
1. Salbutamol
2. Ipratropium
Nebs in paeds
1. 5mg > 5 years
2.5mg 2- 5 years
2. > 12 = 500mcg
2-12 = 250mcg
72
What are the doses of prednisolone in paeds asthma?
> 5 years = 30–40 mg
2-5 years = 20mg
< 2 years = 10mg
73
What are the dose of hydrocortisone in paeds asthma?
4ml/kg (RCUK)
74
What are the doses of IM adrenaline in paeds?
> 12 years = 500mcg
6-12 years = 300mcg
6months to 6 years = 150mcg
<6months = 100-150mcg
75
What percentage of children only have one febrile convulsion and how many go on to develop epilepsy?
1. 66%
2. 5%
76
How does JRCALC define status?
Bilateral tonic-clonic seizure lasting > 5mins
77
When does JRCALC recommend giving a dose of benzodiazepine in paeds seizures?
After 5 mins or if child has had 3 or more focal/GTC seizures in 1 hour
Usually rectal diazepam or bucacal midazolam
78
What does JRCALC recommend for second benzodiazepines in paeds seizures?
Further dose at 10 mins after 1st dose given + ideally IV
79
What does JRCALC state about a third dose of benzodiazepines in paeds seizure?
If 10 mins post second dose of benzodiazepine and hospital still over 15mins away then seek clinical advice as to giving 3rd dose - MUST be IV/IO
80
What does JRCALC define as time critical seizure transfers? (3)
1. Still seizing
2. Status
3. Suspected meningitis
81
What does JRCALC state needs conveying in terms of paeds seizures? (6)
1. Children 2 or less
2. First febrile seizure
3. Children needing more than 1 dose benzo
4. Children not fully recovered
5. Status or still convulsing
6. Suspected meningococcal disease
82
What is the dose of PR diazepam in paeds? (2)
5 or older = 10mg
< 5 year = 5mg
83
What is the approx dose of IV diazepam in paeds seizures according
To JRCALC
> 10yrs = 10mg
Below that approx 1mg/yr age (not exactly)
84
What helps distinguish herpes simplex encephalitis?
Focal neurology or focal seizures
85
What does JRCALC state should be done with children featuring red traffic light features?
Convey and consider blue light
86
What does JRCALC state should be done with children featuring amber traffic light features in fever <5 years?
- can be considered for alternative pathway
- multiple amber features must be considered for hospital
87
If not conveying an child with amber traffic light signs or green but no source for fever, what does JRCALC state must be done? (3)
1. Must be discussed with GP or paeds and follow up arranged
2. Direct handover important to doctor (may not be possible)
3. Arrangements must be made by ambulance staff, can't just say to see GP
88
What are the red flags that JRCALC mandate conveying kids with fevers? (9)
- febrile <1/12
- under 3/12 with no obvious source
- under 3 years without cause if a urine can't be arranged by GP
- Any child with fever but not localising signs who have received abx in last 48 hours (partially treated meningitis)
- immunosuppressed children inc. steroids
- Those with signs of serious medical illness
- doubt over might be ill
- any psychosocial factors meaning may not be cared for well enough at home
- those with medical protocol stating they must be conveyed
89
What does E.coli 0157 lead to in paeds gastroenteritis? (2)
Bloody diarrhoea and haemolytic ureamic syndrome
90
What criteria must be met to diagnose a BRUE? (PIER) (5)
1. Must be < 12 months old +
-
2. Duration <1 minute (typically 20-30 seconds)
3. Complete return to baseline
4. Characterised by ≥1 of the following:
- cyanosis or pallor
- absent, decreased or irregular breathing
- marked change in tone (hypertonia or hypotonia)
- altered level of responsiveness
5. Not explained by identifiable medical conditions
91
What criteria make a BRUE low risk? (4)
No concerning features on hx and examination and
1. age >60days
2. Born >32 weeks gestation (or if premature corrected gestational age > 45 weeks)
3. No CPR from healthcare professional
4. 1 episode only
92
In a low risk BRUE what can be considered?
1. Discharge home
2. ECG
3. Period of observation in ED
4. NPA +/- pertussis
5. Education of parents around BRUE, low risk = no increased risk of SIDS
6. CPR training
93
When should patients being admitted with bronchiolitis according to NICE? (4)
1. Apnoea (observed or reported)
2. Persistent SATS:
<90% if 6 weeks or older
<92% if <6 weeks or any underlying health condition
3. Inadequate oral fluid intake (50% to 75% of usual volume)
4. Persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute.
94
When does NICE recommend considering hospital with bronchiolitis? (5)
1. RR >60
2. Persistent SATS <92%
3. Clinical dehydrated
4. Decreased oral intake (<50%)
5. Have lower threshold if < 3/12 or premature or any pre-existing medical issues
95
What does NICE/BTS recommend for treatment of mild-moderate asthma? (2)
1. INH salbutamol via MDI
2. Steroids
96
What does NICE/BTS recommend for children with acute severe asthma (3)
1. Oxygen driven salbutamol nebs
2. Ipratropium is poor response to initial salbutamol
3. Neb magnesium to every neb in first hour if short hx of acute severe asthma and SATs <92%
97
In children with poor response to first line treatment for acute severe / life threatening asthma what does NICE/BTS recommend as first line IV and subsequently? (4)
1. IV magnesium first line
2. Bolus IV salbutamol
3. IV salbutamol infusion with specialist input
4. Consider aminophylline
98
What are the 4 abnormalities associated with ToF?
1. VDS
2. Overriding aorta
3. RV hypertrophy
4. Pulmonary valve stenosis or pulmonary outflow tract obstruction
99
When should an APGAR should be routinely done following birth and what is a normal range?
At 1 and 5 mins
7-10 is normal
100
How is an APGAR score calculated and what is normal range
7-10 normal
101
What is the fluid requirement calculation for DKA outlined by BSPED?
Hourly rate = ({Deficit – initial bolus} / **48hr**) + Maintenance per hour
102
How does BSPED work out the fluid deficit on DKA?
1. Use blood gas:
Mild-moderate = 5%
Severe = 10%
2. Minus the initial fluid bolus (10ml/kg) given in the non-shocked patient from this
3. Any fluid bolus given in shocked patients is not subtracted
103
What formula does BSPED state to use for calculating maintenance fluids in paeds DKA?
Holliday-Segar formula
* 100 ml/kg/day for the first 10 kg of body weight
* 50 ml/kg/day for the next 10 to 20 kg
* 20 ml/kg/day for each additional kilogram above 20 kg
104
What is the max weight used to calculate paeds DKA fluids (BSPED)?
75kg or 97th centile for age, whichever is lower
105
What is the hourly fluid requirement for a 20 kg 6 year old boy who has a pH of 7, no signs of shock
79ml/hr
106
What is the hourly fluid requirement for a 60 kg 15 year old girl with a pH of 6.9 who was shocked at presentation has received 30ml/kg of 0.9% Saline for resuscitation.
221ml/hr
107
What type of fluid should be used in paeds DKA maintenance (BSPED)?
Normal saline +/- potassium
108
What do the BSPED guidelines states re: oral fluids in patients having IV fluids in DKA? (3)
1. Do not give oral fluids to a child or young person who is receiving intravenous fluids for DKA until ketosis is resolving and there is no nausea of vomiting.
2. A nasogastric tube may be necessary in the case of gastric paresis.
3. If oral fluids are given before the 48hr rehydration period is completed, the IV infusion needs to be reduced to take account of the oral intake.
109
What does BSPED state about K+ in DKA replacement fluid? (3)
1. If K+ normal = all fluids except for initial bolus should have 40mmol KCl in 1L
2. If K+ is high only give if one of the following:
- once passed urine
- hx of recently passing urine
- drops <5.5 following initial bolus
3. If K+ low (<3.0) consider delaying insulin until >3.0 and placing CVP to give increased dose K+
110
What dose of insulin does BSPED recommend commencing and when?
After 1-2 hours fluid
- 0.05units/kg/hr
- 0.1units/kg/hr only in severe DKA or adolescents
111
What does BSPED recommend doing with
1. Long acting insulin
2. Insulin pump
If on fixed rate infusion for DKA?
1. May continue
2. Stop pump
112
When does BSPED recommend switching fluid to 5 % dextrose ?
Glucose < 14
113
What is the peak age for bronchiolitis?
3-6 months
114
What is first line for suspected bacterial meningitis and what should be used if severe allergy?
1. Ceftriaxone or benpen (if no cef)
2. Chloramphenicol (although advised not to give abx if severe pen allergy OOH)
115
When should dexamethasone be used to treat meningitis?
1. If over 3/12 and strong suspected give with first dose abx
No routinely given in meningococcal disease
116
Which ionotropes (2) should be used pre-hospital in paeds sepsis, at what dose according to resus council?
Which should be avoided and why?
1. Adrenaline 0.05-0.3mcg/kg / min and/or
Noradrenaline via central line 0.05mcg/kg/min
2. Dopamine causes vasodilation as well as ionotropy and should be avoided in sepsis
117
What is the dose of buccal midazolam for seizures? (RCUK)
0.3-0.5 mg/kg
118
What do resus council status algorithm state for second line agents for paediatric seizures and which one has the best evidence?
* Levetiracetam 30–60 mg kg-1 (over 5 min, max 3 g)
OR
* Phenytoin 20 mg kg-1 by slow IV infusion
over 20 min with ECG monitoring
OR
* Phenobarbital 20 mg kg-1 by IV infusion over 5 min
All have been shown to be equally effective if several trials
119
After what period of time does likelihood or seizure termination decrease and what consequence does this have to the status algorithm
After 5 mins which is when resus council define status
Means first dose benzo should only be given after 5 mins.
120
When giving phenytoin IV, what must be considerd?
If given as bolus will lead to bradycardia/hypotension +/- asystole
121
What induction agents are mentioned by resus council for third line status tx?
There is no evidence for the ideal third line agent:
1. thiopentone,
2. propofol
3. ketamine
4. midazolam
all appropriate
122
How does RCUK define warm and cold shock?
Warm = high cardiac output, low SVR
Cold = low CO high SVR
123
What are the parts of paeds development milestones? (4)
1. Gross motor
2. Vision and fine motor
3. Hearing/speech and language
4. Social and emotional
124
What are the normal paeds milestones for a:
3 month old
6 month old
9 month old
125
What are the normal paeds milestones for a:
1 year old
18 month old
2 year old
126
What is the dose of IN fentanyl in paeds?
First dose 1.5mcg/kg
Subsequent doses 0.75-1.5 mcg/kg titrated to affect
127
What temperature should be targeted post ROSC in paeds?
36.0-37.2 degrees C
128
In a low risk BRUE pre-hospital, what should be done?
Convey to local ED - discharge on scene discouraged
129
What ages can the following be used?
1. Electronic axillary thermometer
2. Axllary Tempa.Dot
3. Tympanic thermometer
4. Rectal thermometer
1. Any age
2. > 4 weeks
3. > 4 weeks
4. Not in children, especially < 5 yrs
130
What is the paeds dose of keppra?
40mg/kg with a max 3g
131
What should be used to perform a thoracostomy:
1. < 5yrs
2. 5-12 yys
3. > 12 yrs
1. Mosquito forceps
2. Artery forceps
3. Spencer wells
132
What size chest drain should be placed in paeds trauma?
Size (Fr) = 4 x ETT size
133
How far should an chest drain be placed into paeds trauma patient?
4cm i.e. make sure last hole is 4cm into thorax
134
What defines a massive haemothorax in paeds?
20ml/kg initially
or 3-4 x ml/kg/hr thereafter
135
What are the weak (4) and strong (4) risk factors for febrile convulsions?
Strong risk factors
1. Hx of febrile convulsion in 1degree relative
2. >6/12 + < 5 years
3. High peak temperature
4. Viral infection
Weak risk factors
1. Prematurity
2. Maternal smoking during pregnancy
3. Iron deficiency
4. Zinc deficiency
136
What drugs does RCUK recommend for RSI in paeds sepsis/shock?
Ketamine +/- atropine
137
What does NICE state about pre-hospital abx for ?meningitis? (3)
Give IV/IM benpen/cef if:
1. Suspected bacterial meningitis if significant delay to hospital.
2. Meningococcal disease ASAP unless delays hospital
3. Do not give if severe antibiotic allergy to either ceftriaxone or benzylpenicillin.
138
How is hypoglycaemia defined in neonates?
2.5mmol/L or less
139
What is the issue with CBG measurement in neonate?
Handheld machines can be innacurate when levels low so may need lab glucose
140
How should neonates be managed with CBG of 2-2.5
If well encourage feeding at least 3 hourly and monitor CBG just prior to each feed until >2.5 for 2 consecutive readings.
If clinical signs hypoglycaemia:
1. IVA
2. Bloods (incl. formal Blood Glucose)
3. Screen for sepsis
4. and then 10% Glucose (2.5ml/kg) and start infusion of 10% Glucose at 90ml/kg/day.
5. No IVA = 40% Glucose gel (200mg/kg) into buccal mucosa OR IM Glucagon (200mcg/kg)
141
How should neonates be managed with CBG of 1.0-1.9
If well give 40% buccal glucose (200mg/kg) and re-check CBG 30-60mins later. Continue feeding as per normal. Second dose if needed. If still low treat as below
If clinical signs hypoglycaemia:
1. IVA
2. Bloods (incl. formal Blood Glucose)
3. Screen for sepsis
4. and then 10% Glucose (2.5ml/kg) and start infusion of 10% Glucose at 90ml/kg/day.
5. No IVA = 40% Glucose gel (200mg/kg) into buccal mucosa OR IM Glucagon (200mcg/kg)
142
How should neonates be managed with CBG of <1.0
1. IVA
2. Bloods (incl. formal Blood Glucose)
3. Screen for sepsis
4. and then 10% Glucose (2.5ml/kg) and start infusion of 10% Glucose at 90ml/kg/day.
5. No IVA = 40% Glucose gel (200mg/kg) into buccal mucosa OR IM Glucagon (200mcg/kg)
143
How is corrected age calculated?
Actual age – weeks of prematurity (40 weeks being term)
= baby who is 24 weeks old but was born at 28 weeks gestation = 12 weeks (actual age) – 12 (weeks premature) = corrected age of 12-weeks.
144
Where should children with acute hemiplegia be taken to according to RCPCH?
Nearest acute paediatric hospital for CT <1 hour and then onward time critical transfer if needed
145
What are the issues with children with cerebral palsy airway? (4)
1. Copious secretions
2. TMJ spasticity
3. poor dentition
4. risk of gastrointestinal reflux.
146
What has no role in the treatment of bronchiolitis?
Nebulised medication
147
What percentage of children with bronchiolitis need intubation?
3%
but up to 25% if < 3 months old
148
What is the most common congenital heart disease?
VSD
149
How should prostaglandins be delivered in CHD?
5-10mcg/kg/min as an infusion (never bolus)
150
What are the end points for fluid resusitation in sespis (4 )(RCUK)
1. CRT >2
2. UO >1ml/kg;hr
2. Normal pulses
4. Normal mentation
151
When does RCUK recommend commencing ionotropes in paeds sepsis? (2)
1. >40ml/kg fluid bolus
2. Signs of heart failure
152
If using an adrenaline infusion for sepsis peripherally, what should be done?
Dilute it from recommended RCUK starting dose (0.05-0.3mcg/kg/hr)
153
What should be remembered when giving phenytoin IV?
Rapid bolus can lead to hypotension/bradycardia and arrhythmia
154
What dose of steroids should be given in paeds asthma?
4ml/kg hydrocortisone
155
What are the loading doses and administration of anti-epileptics in paeds status ?(RCUK0
1. Keppra 40mg/kg (max 3g) over 5 mins
-
2. Phenytoin 20mg/kg (over 20mins + with ECG monitoring)
-
3. Phenobarbitol 20mg/kg (over 5 mins)
156
What FB are considered dangerous when ingested? (PIER) (5)
1. Button Batteries and other batteries
2. Magnets
3. Large Objects (length>6cm or width >2 cm)
4. Sharp Object (including fish bones)
5. Children with pre existing GI pathology
157
What discriminates how FBs should be managed in terms of location?
Above clavicle - ENT
Below clavicle - Surgeons
158
If radiolucent FB and normal XR, what should occur? (PIER)
Refer surgical team
159
If a button battery is above clavicle how quickly should it be removed?
< 2 hours
160
If button battery has passed stomach what should be done?
D/w surgeons but should be conservatively managed with XR follow up (unless co-ingested magnet)
161
What are the criteria for discharge with regards to a super-strong magnet? (8)
1. Single magnet ingestion
2. Asymptomatic
3. Accidental ingestion
4. No co-morbidities
5. Tolerating oral intake
6. Presents within 24hr of ingestion
7. Care-giver able to provide close observation
8. Easily able to return to the hospital in event of deterioration
162
Should parents check stools for FBs?
No
163
What % SIDS are due to NAI and what % are unexplained?
10% NAI
Up to 50% unexplained
