Paeds things Flashcards
Definition of BRUE
Less than 12 months old
Duration <1min (typically 20-30 seconds)
Sudden onset, accompanied by return to baseline state
Characterised by 1+ of:
- cyanosis or pallor (COLOUR)
- absent, decreased or irregular breathing (BREATHING)
- marked change in tone (hypertonia or hypotonia) (TONE)
- altered level of responsiveness (ALERTNESS)
- not explained by identifiable medical conditions
Low risk BRUE criteria
No concerning features on history or examination and all of:
- age >60 days
- born 32+ weeks gestation and corrected gestational age 45+ weeks
- no CPR by trained healthcare professionals
- first event
- event lasted <1 minute
Pyloric stenosis key facts
2-6 weeks of age
Progressive non-bilious vomiting
Risk factors
- male
- first born
- parental history of HPS (especially if mother affected)
Hypochloraemic hypokalaemia metabolic alkalosis
Management priorities
- treat dehydration + electrolytes as indicated
- allow to continue feeding (with NG sited) for comfort, unless concerns about aspiration
- USS diagnosis
- surgical referral
Jaundice key points
Risk factors MATERNAL - blood group O, Rh - - FHx, East Asian/mediterranean descent - poorly controlled diabetes - previously jaundiced baby requiring phototherapy NEONATAL - breast fed, and/or low volume feeds - haematoma or bruising - polycythaemia - haemolytic factors - bowel obstruction - infection, preterm, male
Urgent investigation if <24 hours old, including septic screen
If over 24 hours and well child, plot TSB on nomogram
If conjugated hyperbilirubinaemia, further workup required
the MISFITS
T: trauma (including NAI), tumour, thermal
H: heart disease, hypovolaemia, hypoxia
E: endocrine (CAH, DM, thyroid)
M: metabolic disturbances (electrolytes)
I: inborn errors of metabolism
S: seizures or CNS abnormalities
F: formula dilution or over concentration (Na+)
I: intestinal catastrophes (intussusception, volvulus, NEC)
T: toxins (including home remedies eg baking soda for burping)
S: sepsis
Haemolytic uraemic syndrome pentad
(FAT RN)
F: fever
A: anaemia (microangiopathic haemolytic)
T: thrombocytopaenia
R: renal problems
N: neurological problems (headaches, confusion, seizures) - more likely in TTP
Intussusception peak incidence and clinical features
PEAK: 4-10 months (range up to 36 months)
FEATURES
- abrupt onset
- intermittent, colicky abdominal pain
- episodes of crying and pulling the knees up
- pallor (with episodes)
- vomiting
- often quite well between episodes
Limp in a toddler (1-4 yrs)
Developmental hip dysplasia
Toddlers fracture
Transient synovitis of the hip (irritable hip)
Child abuse/NAI
Limp in a child (4-10 yrs)
Transient synovitis of the hip (irritable hip)
Perthes disease
Limp in an adolescent (10+ years)
Slipped upper femoral epiphyses (SUFE)
overuse syndrome
Limp in any age group
Infections (OM, septic arthritis, soft tissue, viral myositis)
Trauma
NAI
Malignancy (ALL, bone tumour)
Rheumatological disorders and reactive arthritis
Intra-abdominal pathology (eg appendicitis)
Inguinoscrotal disorders (eg testicular torsion)
Functional
Irritable hip
3-8 years
history of recent viral URTI
usually able to walk but painful
child otherwise well
mild-moderate ROM loss, especially IR
diagnosis of exclusion
Perthes disease
Avascular necrosis of capital femoral epiphysis
2-12 years (mostly 4-8)
20% bilateral
restricted ROM on exam
SUFE
Late childhood/early adolescence
Often overweight
Hip or knee pain + limp
Hip appears externally rotated and shortened
Decreased ROM especially IR
May be bilateral
Kawasaki disease diagnosis
Fever at least 5 days without any other explanation, plus 4 of 5:
- bilateral bulbar conjunctival injection
- oral mucous membrane changes, including injected or fissured lips, injected pharynx, or strawberry tongue
- peripheral extremity changes, including erythema of palms or soles, oedema of hands or feet, periungual desquamation
- polymorphous rash
- cervical lymphadenopathy (at least one LN >1.5cm diameter)
