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20 Cards in this Set
- Front
- Back
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How to recognise unwell child? |
Hypothermia, fever Tachycardia Hypoxia, tachypnoea Hypotension altered conscious state unwell looking |
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Management of unwell child |
call for help A - check if resp support needed (NIV, so if depressed conscious state, need intubation) O2 (8L/min using face mask) Establish IV access else IO Take BC, BG levels, BG Also FBE, UEC, Urine? CXR and LP (although not urgent) Give ABx - benpen if <1 mo, flu+genta if normal CSF, flu+cefotaxime if unknown CSF Give fluid bolus - 20ml/kg over max of 10 min and watch for improvement if not, keep giving boluses upto a max of 40ml/kg Ionotropes - noradrenaline if warm shock, dobutamine if cold shock ICU transfer |
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How to do a quick assessment of an unwell child? |
Tone - is child moving around and active or listless? Irritability/mental state - how alert is the child Consolability - can the child be consoled by the carer? Look/gaze - Does the child fix eyes on object or a glassy eyed stare Speech/Cry - strong or hoarse |
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What is anaphylaxis? |
Anaphylaxis is a multi-systemicallergic reaction characterised by: At least one respiratory or cardiovascular feature and At least one gastrointestinal or skin feature. |
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Common causes of anaphylaxis |
Most reactions occur within 30minutes of exposure to a trigger. Common causes of anaphylaxis in childreninclude: Foods (the most common cause) - Peanut, tree nuts, cow milk, eggs, soy, shell-fish, fish and wheat Bites/stings - Bee, wasp, jumper ants Medications- Beta-lactams, monoclonal antibodies (Infliximab) anaesthetics Others - including exercise induced anaphylaxis, idiopathic anaphylaxis, and latex anaphylaxis, hydatid cyst rupture, biological fluid transfusion (e.g. blood, antivenom), food additives, etc. |
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What are some of the resp and CV features to be aware of ? |
Respiratory/chestfeatures (Most common in children) Tongue swelling Stridor Hoarse voice or change in character of the cry Subjective feeling of swelling or tightness/tingling in the throat Persistent cough Wheeze Dysphagia Cardiovascularfeatures Pale and floppy infant Palpitations Tachycardia Bradycardia Hypotension Cardiac arrest Altered consciousness/confusion |
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What are the gastro and skin manifestations of anaphylaxis? |
Gastrointestinalfeatures Nausea Vomiting Diarrhoea Abdominal/pelvic pain Mucocutaneous Generalised pruritus Urticaria/ intense erythema Conjunctival erythema and tearing Flushing Angioedema Neurological features Headache (usually throbbing) Dizziness Confusion Collapse with or without unconsciousness |
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Management of anaphylaxis? |
Posture: treat the patient in supine position, or left lateral position for vomiting patient (or sitting at 45 degrees if breathing is difficult Legs should be elevated in the setting of hypotension. Do not stand. Intra-muscular adrenaline 0.01ml/kg of 1/1000 (maximum 0.5ml), into lateral thigh which should be repeated after 5 minutes if patient not improving. Do not use subcutaneous adrenaline, as absorption is less reliable than the intramuscular route. Do not use IV bolus adrenaline unless cardiac arrest is imminent. |
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Common causes of meningitis |
The commonest organisms causing bacterial meningitis in children over 2months of age are:
Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae type B (in unimmunised children) Organisms to consider in infants less than 2 months of age include thoselisted above and the following: Group B streptococcus E. coli and other Gram-negative organisms Listeria monocytogenes Encephalitis can be caused by: Enterovirus HSV Other herpes viruses (EBV, CMV, HHV6, VZV) Arboviruses. Less commonly, encephalitis can be caused by bacteria, fungi or parasites. |
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Meningitis - Qs on Hx |
Features on history: Infants with meningitis frequently present with non-specific symptoms such as fever, irritability, lethargy, poor feeding, rash, vomiting and diarrhoea Older children may complain of headache or photophobia Seizures Hx of travel PHx of immunosuppression, ventricular shunts, CNS abnormalities Prior antibiotics - clinical presentation may be altered by prior use of antibiotics. Immunizations |
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Meningitis - Features on Exam |
In infants, the fontanelle may be full
Neck stiffness may or may not be present (not a reliable sign in young children) A purpuric rash is suggestive of meningococcal septicaemia Kernig's sign: hip flexion with an extended knee causes pain in the back and legs CSF shunts, spinal and cranial abnormalities (eg dermal sinuses) which may have predisposed a child to meningitis Signs of encephalitis: altered conscious state, focal neurological signs Later stages may have focal neurological signs indicative of subdural effusion |
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Meningitis - Ix |
Lumbar puncture (LP)
Prior to performing a LP You must always discuss with a senior registrar or consultant. Read the Lumbar Puncture guideline. See CSF Interpretation guideline Sterilisation of the CSF can occur -within 2 hours after a dose of Ceftriaxone 50 mg/kg/dose (2g) iv 12H /Ceftriaxone for N. meningitidis and within 4 hours for S. pneumoniae Blood tests: Full blood count, Glucose, urea and electrolytes, Blood cultures |
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CSF interpretation |
http://www.rch.org.au/clinicalguide/guideline_index/csf_interpretation/ CSF findings in bacterial meningitis may mimic those found inviral meningitis (particularly early on). It may be possible withmodest accuracy to judge whether bacterial or viral is more likelybased on CSF parameters. However if the CSF is abnormal thesafest course is to treat as if it is bacterialmeningitis. |
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Management of meningitis |
Immediate Abx: if <2mo: Cefotaxime + benpen if >2mo: just benpen Although if sepsis suspected and CSF unknown : give Flucloxacillin and Cefotaxime If encephalitis suspected: aciclovir steroids may reduce the risk of hearing loss in bacterial meningitis.Consider givingDexamethasone to children > 2 months of age 15 minutes prior toparenteral antibiotics or, if this is not possible, within one hour ofreceiving their first dose of antibiotics: 0.15mg/kg IV. Consider givingsteroids at the time of lumbar puncture if the clinical suspicion of meningitisis high If seizures: give benzos and load with phenytoin IV Fluids Monitor: Neurological observations including blood pressure should be performed every 15 minutes for the first two hours and then at intervals determined by the child's conscious state. Weight and head circumference should be monitored on a daily basis. Electrolytes and glucose should be checked 6-12 hourly until the serum sodium is normal (and/or the child is no longer on IV fluids). Ensure adequate analgesia |
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Duration of treatment for meningitis |
N. meningitidis -Benzylpenicillin 60mg/kg/dose (max 3g), iv 4 hourly for 7 days
pneumoniae (Penicillin sensitive) -Benzylpenicillin 60mg/kg/dose (max 3g), iv 4 hourly for minimum of 10 days Haemophilus influenzae type b- Ceftriaxone 50 mg/kg/dose (2g) iv 12H Other If an organism is not isolated, but significant CSF pleocytosis is present, a minimum of 7 days treatment with intravenous Ceftriaxone 50 mg/kg/dose (2g) iv 12H is recommended. Prolonged therapy will be required for neonatal and Gram-negative bacillary meningitis. |
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Causes of persistent fever in bacterial meningitis |
Nosocomial infection
Subdural effusion -Subdural empyema (ie, abscess) is an intracranial focal collection of purulent material located between the dura mater and the arachnoid mater. Because the symptoms might be very mild initially, rapid recognition and treatment are important; the early institution of appropriate treatment gives the patient a good chance of recovery with little or no neurological deficit. Other foci of suppuration Less common: inadequately treated meningitis, parameningeal focus or drugs. |
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Follow up for meningitis |
All children with bacterial meningitis should have a formal audiology assessment 6-8 weeks after discharge (earlier if there are concerns regarding hearing). Neurodevelopmental progress should be monitored in outpatients. |
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Contact chemoprophylaxis |
http://www.rch.org.au/clinicalguide/guideline_index/Contact_Chemoprophlaxis_Table/ |
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DKA |
please see notes :) |
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Hypoglycaemia - Causes |
Hypoglycaemia is the most frequent acute complication of type1 diabetes
Hyperinsulinism is the most common cause ofpersistent hypoglycaemia under 2 years Accelerated starvation (previously known as “ketotichypoglycaemia”) is the most common cause of hypoglycemia beyond infancy,usually presenting between 18 months to 5 years Hypoglycaemia may be an early manifestation of other serious disorders (eg. sepsis, congenital heart disease, tumours) |
