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