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12.09.06 Teaching notes

Paediatric history
  • PC
  • HPC
  • Drug Hx
  • Drug allergies
  • Other allergies
  • PMH
  • Pregnancy + birth Hx
  • Developmental Hx
    • Domains
    • Schooling
      • Mainstream?
      • Statement?
  • FHx
    • Siblings' health
    • Inherited conditions
  • SHx
    • Care during day
    • Childminders
    • Smoking
    • Pets
    • Housing conditions
    • Problems
      • Social workers?
      • Child safeguarding plan?

Unwell baby

  • Causes sieve
    • 1: Sepsis
    • 2: Cardiac
    • 3: Metabolic
      • Often causes metabolic acidosis
  • Approach
    • ABC !!!

Causes of neonatal tachypnoea

  • RDS
  • Congenital
    • Heart
    • Lungs
  • Infection
    • Usually congenital in neonates
  • Meconium aspiration syndrome
    • Tends to be in post-term babies
      • Except when caused by infection (GBS, Listeria)
    • See meconium in amniotic fluid
  • TTN
    • Often in elective caesarian

Resp exam

  • Inspection
    • Chest shape
    • Resp rate
      • Key sign in kids
      • Don't forget not-respiratory causes
        • Heart failure
        • DKA
    • Scars
    • Rash
    • Tug
    • Recession
    • Indrawing
    • Harrison's groove
      • Horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm
      • Usually caused by chronic asthma or obstructive respiratory disease
      • May also appear in rickets
  • Auscultation
    • Don't ask them to breathe - just listen to normal breathing
    • Secretions in the nasopharynx can cause sounds to be transmitted to the chest


Croup

  • Aetiology
    • Caused primarily by parainfluenza virus
  • Presentation
    • Barking cough
    • Stridor
  • Management
    • Oral dexamethasone
    • Budesonide nebs (more expensive)
    • Adrenaline nebs


Paediatric asthma

  • Triggers
    • Allergens
    • Exercise
    • Anxiety
  • Management
    • 10 puffs of salbutamol via spacer
      • Take each puff separately (5 deep breaths)
      • Each one is 100 ug (i.e. 1 mg total)
    • Or 2.5 mg /  5 mg nebulised
    • Oral prednisolone
    • IV hydrocortisone
    • Ipratropium bromide
      • Anti-cholinergic
    • MgSO4 bolus
      • Induces bronchial smooth muscle relaxation in a dose-dependent manner:
        • Inhibits calcium influx into the cytosol
        • Inhibits histamine release from mast cells
        • Inhibits acetylcholine release from cholinergic nerve endings
      • May increase the bronchodilator effect of β2-agonist by increasing the receptor affinity
    • IV salbutamol
    • IV aminophylline
      • Nonselective adenosine receptor antagonist and phosphodiesterase inhibitor


Notes

  • Tell kids to do stuff; Don't ask them
  • RSV => Supportive care only
  • Foetal distress is a VERY BROAD term
    • PROM
    • Placental insufficiency
    • Many other causes
  • Acrocyanosis
    • Persistent blue or cyanotic discoloration of the extremities
    • Most commonly occurs in the hands, although it also occurs in the feet and distal parts of face
  • Common allergens
    • Spring: Trees
    • Summer: Grass
    • Autumn: Moulds
    • House Dust Mites (HDM) / Pets

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