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Pg 5 - Flashcards

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1
Q

How do you measure Cap refill?

A

5 secs of blanching pressure. Prolonged if > 2 secs to return

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2
Q

What is AVPU scale?

A

• Assesses the level of consciousness in children.
• A= Alert, V= responds to Voice, P= Responds to Pain, U=
Unresponsive

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3
Q

What is the most common cause for CPR in children?

A

Hypoxia secondary to respiratory or neurogenic shock.

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4
Q

In the seriously injured child what are the additional steps to ABC?

A

• Cervical spine: manual in-line stabilisation, followed by head blocks
and straps (no routine collar anymore)
• Deal with catastrophic haemorrhage before ABC

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5
Q

What are the underlying mechanisms in respiratory failure?

A

• Decreased alveolar ventilation, diffusion impairment, intra-pulmonary
shunting, and ventilation-perfusion mismatch.
• Causes hypoxemia, tissue hypoxia and hypercapnia => CO2 narcosis.
• Severe respiratory distress may lead to exhaustion and respiratory
arrest.

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6
Q

What are the indicators of respiratory distress in a child?

Moderate:

A
  • Tachycardia
  • Tachypnea; RR>50
  • Nasal flaring
  • Use of accessory muscles
  • Sternal and subcostal recessions
  • Head retraction
  • Inability to feed.
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7
Q

What are the indicators of respiratory distress in a child?

Severe:

A
  • Cyanosis
  • Getting tired
  • Reduced level of consciousness
  • Sat <92 despite O2 therapy
  • Rising PCO2
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8
Q

What are the steps of supportive measures in respiratory distress child?

A
  • O2 needed if sats below 92%
  • Nasal cannula or face mask
  • CPAP or BiPAP with NIV
  • Intubation and mechanical ventilation in ICU
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9
Q

What are the indications of intubation and mechanical ventilation in
respiratory failure?

A
  • Severe respiratory distress

* Progressive NM weakness. E.g. GBS

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10
Q

What are the clinical signs of shock?

Early compensated:

A

• Tachypnea
• Tachycardia
• Dehydration (Pale mottled cold skin, decreased skin turgor, sunken
eyes and Fontanelles, Core-peripheral T gap > 4, decreased urinary
output)

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11
Q

What are the clinical signs of shock?

Late decompensated:

A
  • Acidotic (Kaussmal breathing).
  • Bradychardia
  • Severe dehydration (Absent urine output)
  • Hypoxemia: Blue peripheries
  • Hypercapnia: Confusion
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12
Q

Outline fluid resuscitation in shock, both initial and maintenance?

A

v• 20 mls/ Kg of 0.9% IV crystalloid saline, repeat twice to transfer to
PICU
• Maintenance 100ml/ 10 Kg/ 24 hrs. (First 10), 50 ml/ 10 Kg (Next 10).
So anyone above 15 already has 1500 mls. 20 mls/ Kg for subsequent
Kg.

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13
Q

What is sepsis and what are its clinical features?
• SIRS+ Infection focus
Sx
Signs

A

• Symptoms: Fever, poor feeding, irritability, lethargy+ infection focus.
• Signs: Tachypnea, tachycardia and hypotension, Rash, shock and
multi-organ failure

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14
Q

What is sepsis 6?

A
  • Take 3 (Blood cultures, lactate, urine output)

* Give 3 (IV Antibiotics, IV fluids, O2 to keep stats > 94%)

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15
Q

What is the ER management of anaphylaxis?

A

• Adrenaline auto injector
• Call ambulance (High flow O2, resuscitation fluids, IM or slow IV
Chorphenamine and hydrocortisone +/- salbutamol. Monitor: Sats and
BP, ECG.

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16
Q

What are the management steps for status epilepticus?

A
  • Buccal midazolam
  • IV lorazepam
  • Re-assess diagnosis and call for help
  • Iv phenytoin
  • IV phenobarbital
  • PR paraldehyde
  • Induction of anaesthesia via thiopental
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17
Q

What are the neuroprotective measures if there is raised ICP?

A 
• Tilt head 20-30
• Intubate and ventilate, monitor CO2 and Oximetry, Hypothermia and
keep BP normal high.
• Restrict fluids
• Mannitol
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18
Q

What are the components of GCS?

A

• Eye (4): Open, demand, pain, None
• Verbal (5): Speaks, words, sounds, cry, mute.
• Motor (6): Move, localisepain, flex to pain, Decorticate, decerebrate,
none

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19
Q

What are the pupillary signs in coma?

A

• Unilateral dilatation: Expanding lesion, pontine herniation, 3rd nerve
palsy.
• Bilateral dilatation: Severe hypoxia, hypothermia, and post-ictal.

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20
Q

What is BRUE and how it is managed?

A

One or more of the following that happens and resolve suddenly in previously
well child.
• Cyanosis or pallor
• Absent, decreased or irregular breathing
• Change in tone (increased or decreased)
• Altered level of responsiveness.

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21
Q

When does SIDS peak and what are its risk factors?

A

• 2-4 months
• Infant (Small prem boy who was sick yesterday, environmental
(Sleeping prone, swaddled on a billow, near mother in a hot room,
Parents (young couple with low education and income who smoke and
drink in an overcrowded house).

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22
Q

What are the main congenital infections?
What are their clinical
features?
How are they diagnosed?

A

o TORCH.

o Growth restriction, Microcephaly, CHD and PDA, eye and ear
defects, hepatosplenomegaly and haematological, Blueberry
muffin rash.

o Maternal serconversion, Fetal: CVS, amniocentesis, PCR, baby:
fluid samples.

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23
Q

What is the most common congenital infection?
What is the most
common complication?

A

o CMV
o Sensorineural hearing loss and other neurodevelopmental
disabilities

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24
Q

What are the main steps for intra to extra uterine life

transmission?

A

o Lung expansion => reduced pulmonary vascular resistance =>
Increased Left atrial filling => Closure of foramen ovale, DA =>
Establishment of adult circulation

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25
What are the main components of Apgar score?
``` Heart rate > 100 Respiratory effort = strong cry Muscle tone: Well flexed, active Reflex irritability: Cry and cough Colour: Pink ```
26
What are the main steps in neonatal resuscitation and what are the extra measures taken for preterm babies?
``` o Clock, dry, stimulate, o Assess and REASSESS: o Tone, breathing and HR (The most important; check each 30 secs; should be above 60) o Airway: o Breathing: Failed intubation? DOPE: • Displaced, Obstructed, Patient, Equipment o Circulation: CPR (3:1); 90 compressions: 30 ventilations. o Disability: Avoid hypothermia: o Drugs: Centrally (Umbilical venous catheter); Adrenaline, Volume supports. ```
27
What is the cause and Mgt and complications of meconium aspiration syndrome?
o Cause: Distress of term or post-term baby. o Mgt: Lung inflation > suction => CPAP o Complications: Chemical/ bacterial pneumonitis, pulmonary hypertension.
28
What are the diagnostic tests, risk factors and Mgt of DDH?
``` DX: Barlow: Adduct and down to dislocate Ortolani: Abduct and up to relocate Positive finding is a palpable clunk. Hip US ``` RF: Female, Breech, BW > 4.5, FHX, NMD Mgt: Refer to orthopaedics Splinting in abduction
29
DDX for tense fontanelles
Crying, High ICP (hydrocephalus), meningitis (late).
30
DDx for absent red reflex
Cataract, retinoblastoma, glaucoma
31
DDx for increased/ decreased femoral pulses?
Increased FP: PDA | Reduced FP: Coarctation
32
What is the most common benign neonatal rash?
Erythema toxicum: Transient urticarial rash with central white papules. Mainly on trunk but change location
33
What is the difference between nevus flammenus and strawberry naevus?
o Flammenus= Port-wine stain= stork bite: red macula on face; may need laser o Strawberry = Cavernous haemangioma = Raised lesion, grows until 15 months hen regresses, may need topical or po propranolol
34
Innocent murmur management in a neonate? Measure upper and lower limb BP, measure pre-ductal (right hand) and post-ductal (left hand) sats. Urgent ECHO.
positional, Soft, Systolic, asymptomatic, LSB Reassure and FU
35
What is the most common congenital anomaly and what is its prevalence?
CHD (7%)
36
Significant murmur management in a | neonate?
Measure upper and lower limb BP, measure pre-ductal (right hand) and post-ductal (left hand) sats. Urgent ECHO.
37
What are the tests used in newborn hearing screening?
o Initial: otoacoustic emissions (OAE); cochlear function | o Then: auditory brainstem response (ABR).
38
How is CHD screened for in the newborn?
o Pre-ductal (right hand) oximetry o Identifies duct dependent circulation (shock after 1-2 days) o Keep duct open by PG
39
When is the heel-prick test performed? What does it screen for?
``` o Within 5-7 days. o Congenital hypothyroidism o CF (high IRT => DNA) o 6 IEM: § MSUD § MCAD § PKU § HCU § Isovaleric academia § Glutaric aciduria type 1 ```
40
What are the causes of HIE?
o Antenatal: Placenta, cord, maternal, fetal ``` o Labour: Asphyxia (Only if) Acidosis in labour Needed resuscitation Born with HIE features Multi-organ failure No ante or post natal cause identified other ``` o Post-natal: Kernicterus, IEM
41
What are the clinical manifestations of HIE?
o Mild: Irritable, hyperventilation, Staring eyes. o Moderate: seizure, hypotonia, feeding problems. o Severe: Refractory seizures, multi-organ failure.
42
What is the Mgt and prognosis of HIE?
Therapeutic hypothermia: Rectal T at 33 for 3 days for those 36 weeks onward with M-S HIE (NNT = 8) Supportive and monitor by amplitude-integrated EEG (confirm encephalopathy and monitor seizures). Mild => Recover. Moderate => Can recover. Severe => CP
43
What are the types of neonatal extra cranial haemorrhage?
o Caput: Under skin, crosses sutures o Cephalohaematoma: Between bone and peri-ostium, confined by sutures, usually parietal and has soft centre o Chignon: Oedema and bruising from Ventouse delivery. o Sub-aponeurotic (Sub-galeal) bleeding: Can cause shock.
44
What are the common problems encountered by pre-term infants?
``` o RDS o NEC o IVH o Metabolic o Hypothermia o Hypotension and PDA o Haematological o Sepsis o Jaundice o Nutrition o RoP ```
45
``` RDS & pneumothorax RF Clinical presentation DX Mgt ```
RF: Pre-maturity, CS, DM Presentation: Resp distress (Cyanosis, apnoea, recessions, tachy), => Pneumothorax if : increased O2 requirements, decreased chest movements and breath sounds on the affected side. DX: CXR; ground glass appearance => Transillumnation (pneumothorax) Mgt: Decompression by chest drain (PNX). Surfactant X 2 (by endotracheal tube, CPAP) (RDS)
46
What are the features and TX of PDA:
``` Increased O2 requirement and difficulty weaning of mechanical ventilation. o Bounding pulses o Machinery murmur o Active precordium o TX: Ibuprofen => Ligation ```
47
What are the principles of O2 therapy in infants?
o Use air if Term o Use 21-30% O2 if pre-term Sats > 95% RoP Sats < 91% NEC
48
What are the types of newborn venous access and what are their specific indications?
o Peripheral IV: Routine o Umbilical venous: Resuscitation, PREM, Hyper-osmolar o Umbilical artery: BP monitoring, frequent blood gas analysis
49
NEC ``` RF Clinical presentation DX Mgt Comp ```
RF: PREM, formula-fed. CP: Abdominal distension, bile-stained vomiting, PR bleeding +/- peritonitis DX: X-Ray, trans illumination Mgt: Supportive or surgery (perforation) Comp: Peritonitis, sepsis, strictures, malabsorption
50
What is the IVH? | How is it classified?
Bleeding in the germinal matrix (floor of lateral ventricles, above caudate nucleus), may extend into the ventricles or brain parenchyma. Grade 1: Bleeding in GM Grade 2: Blood in ventricles Grade 3: Ventricular distension Grade 4: Parenchymal bleed
51
what is peri-ventricular leukomalacia
inflammation => cysts and loss of white matter => Diplegic cerebral palsy DX: Head US. Complications: CP (PVL, Grades 3-4), hydrocephalus
52
Retinopathy of prematurity? What is the treatment?
Vascular proliferation at the junction of vascularised and nonvascularised retina => Fibrosis => detachment and blindness. TX: Anti-VEGF and laser
53
causes of neonatal jaundice?
< 24 hrs: Haemolysis (ABO: O mum and A baby, Rh, Polycythaemia, Bruising, G6PD, HSC), congenital infection 24h-2 W: Physiological, breast milk > 2 W: Conjugated (Physiological, breast milk). Unconjugated >25 (Bile duct obstruction, neonatal hepatitis).
54
What is the treatment of neonatal jaundice?
Hydration and Phototherapy => Intensive phototherapy => IVIG => Exchange transfusion (if severe) => Phenobarbital (very rarely).
55
What are the main considerations in neonatal assessment?
o SGA WRT S: Severity (Transcutaneous Bilimeter, blood sample). > 17 mg/dl is pathological G: Gestation: PREM? A: Age of Oncet: < 1 day or after 7-10: worrisome W: Well? Sepsis? Dehydration? ``` R: Risk factors (Haemolysis, infection, Hepatitis, biliary obstruction) • FBC, blood film, DCT, blood types. • Sepsis work-up, MSU for UTI • Congenital infection screen • Urinalysis for reducing substances (Galactosemia) • A1AT • HIDA scan • CF sweat test ``` T: Treatment needed? Plot on gestation specific chart and monitor change velocity to predict severity.
56
respiratory distress in infants | Signs:
``` Tachypnea Tachycardia Increased work of breathing • Accessory muscles • Sub-costal and intercostal recessions • Sternal retractions Nasal flaring Expiratory grunting Cyanosis ```
57
respiratory distress in infants | Causes:
``` Transient tachypnea of the newborn RDS, Pneumothorax Pneumonia Aspiration (Meconium, milk) CHD Diaphragmatic hernia. HIE ```
58
What are the most common causes of neonatal sepsis? | o Early onset:
Time: < 48 hours. Source: Ascended from birth canal (GBS, E-COLI) or through placenta (Congenital infection, Listeria). CP: pneumonia and sepsis. Listeria: Typically meconium stained liquor and rash. Mgt: Septic screen, CXR => IV amoxicillin and gentamicin +/- CSF => Ceftriaxone
59
What are the most common causes of neonatal sepsis? | o Late-onset:
Time: > 48 hours Source: Nosocomial (CoNS and G-) CP: Non-specific Mgt: Same: TX: IV Fluoxacillin + gentamicin
60
What are the indications for Intrapartum antibiotics prophylaxis for GBS?
``` Previous infant with GBS disease Urine/ blood isolate Pre-term labour Pyrexia in labour PPROM and Prolonged ROM > 18 hrs ```
61
What are the causes of neonatal strokes?
``` o HIE o CP o Hypoglycaemia o Meningitis o Vascular (Ischemia, haemorrhage) o Malformations ```
62
What are the causes, embryology, complications and Mgt of cleft lip and palate?
o Causes: Inherited (polygenic) Syndromes (Chromosomal) Maternal anti-convulsants o Lip: failure of frontonasal and maxillary fusion o Palate: Failure of palatine and nasal processes fusion o Complications: Feeding and OM o Mgt: Lip: Closed at 3 M. Palate: Closed at 6-12 months
63
presentation of oesophageal atresia?
o Absent stomach pubble on antenatal scan o Constant drooling, salivation o Feeding: cough, chock, Cyanosis and aspiration o Continuous suction => surgical repair
64
small bowel obstruction causes presentation Mgt
o Causes: Duodenal atresia (DS), volvulus. o CP: Bile-stained vomiting, absent meconium, abdominal distension.
65
large bowel obstruction causes
o HSP disease (DS) | o Rectal atresia

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