Child safeguarding - Radiology- X-ray changes in fractures:
- Peaks:
- Resolution of soft tissue changes: 4-10 days
- Sub-periosteal new bone formation (SPBNF): 10-14 days
- Soft callus formation: 14-21 days
- Causes loss of fracture line definition
- Hard callus formation
- These processes are very variable and all overlap
- Extremely hard to reliably date fractures
- No-one has any idea what vitamin D deficiency does to fracture risk + healing time
- LOADS of kids are vit D deficient
- 50% of acute rib fractures are not visible on CXR
- Much easier to see after callus formation
- Brain haematomas
- Extradural are convex
- Lens-shaped
- Because they're bounded by the dura
- Subdural are concave
- Timing
- CT or X ray is good for acute changes
- MRI is better for later changes
Asthma teaching
- Upper airway obstruction can be very difficult to distinguish from lower airway obstruction
- Because it's transmitted - especially in children
- Listen all over the lungs - if the sound doesn't change, it's probably from the upper airways
- Atopy tetrad
- Asthma
- Eczema
- Allergies
- Hay fever
- Triad of airway narrowing in asthma
- Pressure-Volume curves
- Volume on the X-axis!
- Work done is area under the line / Area enclosed by a closed cycle
- At high lung volumes (i.e. with air trapping)...
- Compliance is less
- So dV/dP is lower
- So the area enclosed by the breathing cycle is bigger
- => Raised WOB in a hyperinflated lung
- Biologics used in asthma
- Omalizumab
- IgE MAb
- Binds free IgE
- Useful in severe
persistent allergic asthma patient who have a positive skin test or in vitro reactivity to a perennial aeroallergen
- Mepolizumab
- Golimumab
- Anti-TNF alpha
- Poor side-effect profile - discontinued
- Etanercept
- Anti-TNF
- Very modest improvement
Nutrition
- Domains:
- What you eat (nutrient balance)
- What you are (body composition)
- What you do (functional)
- Birth weight definitions
- LBW < 2500 g
- VLBW < 1500 g
- ELBW < 1000 g
- Neonatal calorie requirements
- 40 kcal/kg/day just to lie still
- Additional 40-80 kcal/kg/day to grow, cry, etc
- Calorie density in foods
- Fats: 9 kcal/g
- Glucose: 4 kcal/g
- Breast milk: 70 kcal/100 ml
- Weight triples between 29-40 weeks gestation
- Much of this is fat
- Due to increasing fetal insulin production
- Babies can breast feed at around 33-34 weeks gestation
- Reflexes not developed before then
- Can't give hypertonic fluids (e.g. TPN) through a peripheral line
- => Oedema => Leakage into tissues => Tissue damage (e.g. calcium)
- Breast feeding => 5-fold reduction in NEC
- Even with bank milk (pasteurised)
- Breast feeding effect on IQ
- Normally 2-6 point increase
- Even more effect for pre-term babies
- Due to lipids needed for brain development
Histories
- DRILL DOWN
- Home nebs
- Why?
- Where from?
- Do you know how to use them?
- Food allergy
- What happens?
- Have you consulted anyone?
- Who were they?
- Were they medically trained or just a "nutritionist"
- NB Dieticians are registered and licensed but most other "nutritionists" aren't
- What medication do you have?
Notes
- Eczema first presenting in the first year of life tends not to persist
- Croup really just refers to the noise (from any cause)
- What we mean is laryngotracheobronchitis (LTB)
- Anion gap is predominantly due to proteins
- RDS => Chronic lung disease of prematurity
- WOB in RDS rips lungs apart within 15 mins
- => Usefulness of HFOV
- Base excess is measured in mmol/L
- => Direct measure of how much bicarb you need to use to correct acidosis
- Normally only "half-correct" to avoid giving too much sodium
- Fluid from a ruptured Baker's cyst tracks down between soleus + gastrocnemius and gives calf/Achilles pain
- The most dangerous thing about home nebs is being falsely reassured by decreased WOB, when it's actually due to exhaustion
- Spacers must be held at 45 degrees when used with a face mask, to keep the valve open
- Term is 37 - 42 weeks
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