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

• 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)

• 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