Paeds Flashcards
(41 cards)
Acute Asthma Attack
History
HPC - timeframe, cough, wheeze
PMH - previous attacks, developmental, allergies
Social history - exacerbations
Acute Asthma Attack
Differentials
Foreign body
PE
Pneumothorax
Pneumonia
Acute asthma attack
Impending resp failure
Exhaustion no speaking colour hypoxia despite oxygen Silent chest Tachy Drowsiness
Acute Asthma Attack
Exacerbation scale
Moderate - over 92 sats, absence of severe symptoms.
Severe - <92sats, no tealking, HR >130, RR>50, accessory muscles
Life threatening - <92 sats PLUS colour, conscious, agitaiton, resp effort, silent chest
Acute Asthma Attack
Moderate Treatment
B2 agonist 2-10 puffs VIA SPACER plus facemask
reassess afer 15 mins
Responding - 1-4hrls salbutamol
Give prednisolone sluble orally
Not responding - repeate B2 agonist, prednisolone, admit
Acute Asthma Attack
Severe - Treatment
nebulised B2 agonist 2.5mg (5 if over 5) salbutamol/terbutaline 5mg (10 if over 5)
02 via face mask
Soluable prednisolone 20mg or IV hydrocortisone
not responding - ipatropium bromide 0.25mg
- bolus IV salbutamol
X-ray, bloods
Acute Asthma Attack
Discharge
continue B2 agonist 4 hrls predniolone daily for 4days @20mg PROVIDE WRITTEN ASTHMA PLAN REVIEW REGULAR TREATMENT Arrange GP follow up check inhaler technique
Acute Asthma Attack
Management summary
ABC obstruction hf oxygen start regular inhaled beta agonist via nebuliser cardiac monioring- why? oral pred/IV hydrocortisone Blood gases and cx ray
Acute Asthma attack
Discharge quesitions
How often does he miss his regular drugs?
• Is there parental supervision?
• What device does he use? Children rarely use
• Consider changing to a combined steroid/long-acting β-agonist inhaler.
• Ask about smoking – him and his family. Adults should be encouraged to
stop smoking or to smoke outside.
• Educate about allergen avoidance, e.g. daily vacuuming to reduce house
dust mites. Consider measuring total IgE and specific allergen IgE (RAST)
if the history suggests allergies.
• All asthmatics should have a written home management plan.
• Provide an asthma symptom diary and arrange hospital follow-up until
control improves. Most children can and should be managed in primary
care. Primary care and hospital-based asthma specialist nurses are very
helpful.
ADHD (3 pillars)
Inattention
hyperativity
Impulsiveness
ADHD further quesitons
Chronology of symptoms How evolved across 3 pilars School behaviour Family and socail history bedtime routine mothers concern/agenda
Differentials of ADHD
Learning difficulty from hearing impariement
Psychosocial involvement in developement
Antisocial behaviour disorder
Thyrotoxicosis
ADHD management
behaviour modifying - structured environment - reinforcement - self control educational - classrom help
Drug treatment -ritalin
Ritalin side effects
growth
hypertension
requie a drug holiday once a year
Anaphylaxis
Differentials
Acute Exacerbation of asthma
Anaphylaxis Tests
Blood gas and bloods
Anaphylaxis
Management
CONSTNAT OBS
ABC
Breathing oxygen and neb salbutamol
IM adrenaline 10ug/kg
Circulaton - 20ml/kg of 0.9% saline as in shock
repeat every 5 mins if no improvement
Anaphylaxis tx once stabe
IV hydrocortisone
IV chlorpheniramine
Skin prick
serum IgE
RAST tests
All done a wek after last steroid given
Anaphylxis discharge
Conservaitve- food avoidance
Medical - oral anthistmaines
- IM adrenaline pen
- how to use
MDT - paediatrician for allergen
dietician
educate - family and school
Appendicitis (differnetials)
-Gastro Appendicitis Obstruction Mesenteric adenitis Gastroenteritis Crohns Hepatitis
DKA
Psychological
Urinary - UTI
Gynae - Ovulation pain ovarian cyst ectopic PID
Testicular torsion for male
Appendicitis Ivx
FBC inflammatory markers LFTS Dip urine Imagine Pregnancy Tesyt
Appendicits management
Medical
- Fluids and Abx
Surgical
Admission for surgicla opinon
- N.B.M
Appendectomy.
Causes of acute abdo pain
Surgical
Medical
Extra abdominal
Surgical Causes of acute abdo pain
Appendicitis intestinal obstruction Inguinal hernia Peritonitis Inflamed Meckel deverticulum Pancreatitis Trauma
