WETFLAGS
- Weight
- Energy
- Tube
- Length: Age/2 + 12 cm
- ID: Age/4 + 4 cm
- Fluid
- 20 ml/kg sepsis
- 10 ml/kg trauma
- Lorazepam
- Adrenaline
- 0.01 mg/kg
- = 0.1 ml/kg of 1/10,000
- Glucose
- Sodium bicarbonate
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
|
|