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14.01.08 Paeds

WETFLAGS

  • Weight
    • Under 1 year
      • Months/2 + 4
    • 2 - 6 years
      • Age x 2 + 8
    • 7 - 12 years
      • Age x 3 + 7
  • Energy
    • 4 J/kg
  • Tube
    • Length: Age/2 + 12 cm
    • ID: Age/4 + 4 cm
  • Fluid
    • 20 ml/kg sepsis
    • 10 ml/kg trauma
  • Lorazepam
    • 0.1 mg/kg
  • Adrenaline
    • 0.01 mg/kg
    • = 0.1 ml/kg of 1/10,000
  • Glucose
    • 2 ml of 10 % per kg
  • Sodium bicarbonate
    • 1 ml of 1.84 % per kg


Organisms causing meningitis

  • Neonates
    • Group B streptococci
    • Listeria monocytogenes (cover with Amoxicillin)
    • Escherichia coli
  • Infants and young children
    • H. influenzae type b (if younger than 4 years and unvaccinated)
    • Neisseria meningitidis
    • Streptococcus pneumoniae
  • Adults and older children
    • S. pneumoniae
    • H. influenzae type b
    • N. meningitidis
    • [Gram-negative bacilli, Staphylococci, Streptococci, L. monocytogenes]
  • Elderly and immunocompromised
    • S. pneumoniae
    • L. monocytogenes
    • TB
    • Gram-negative organisms
  • Hospital-acquired and post-traumatic
    • Klebsiella pneumoniae
    • E.coli
    • Pseudomonas aeruginosa
    • Staphylococcus aureus

Tonsillitis in children
  • Centor criteria
    • History of fever
    • Tonsillar exudate
    • Tender anterior cervical adenopathy
    • Absence of cough
  • Management
    • 10 days phenoxymethylpenicillin (penicillin V)
  • Rationale
    • Worried about GpA BHS
      • Can => Scarlet fever (notifiable)
        • 2 to 4 day incubation
        • Sudden onset of sore throat, fever, headache, vomiting, abdominal pain, myalgia
        • Scarlatiniform rash follows 12-48 hours after the fever
          • Neck/Chest/Scapular => Trunk + Legs
          • Coarse texture
          • Punctate on a diffuse erythematous base
          • Circumoral pallor
        • Tongue has a characteristic appearance:
            • White strawberry tongue over first 2 days - Covered by prominent red papillae seen through a white 'fur'
            • Fur is lost after 2 days => Tongue appears to look more raw and red, but still has prominent papillae ('raspberry tongue' or 'red strawberry tongue')
      • Can progress to rheumatic fever (0.3%) or acute renal failure (post-streptococcal glomerulonephritis)


Jones Criteria for rheumatic fever
  • Evidence of recent streptococcal infection (eg history of scarlet fever, positive throat swab or rising or increased ASOT >200U/mL or DNase B titre)
  • Plus 2 major criteria, or 1 major and 2 minor criteria
  • Major criteria:
    • Arthritis
    • Carditis (occurs in 40% of patients)
    • Chorea (also known as Sydenham's chorea and 'St Vitus' Dance')
    • Subcutaneous nodules
    • Erythema marginatum
  • Minor criteria:
    • Fever
    • Raised ESR, CRP
    • Arthralgia
    • Prolonged PR interval
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