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