12.08.29 Ward round notes

Assessing breathing in a child

• • Effort

    • Head bobbing indicates accessory muscles

    • Grunting

    • Nasal flaring

    • Recession

  • Efficacy

    • Colour

    • Sats

  • Effect

    • CVS (tachcardia)

    • Neuro (decreased consciousness)

Bronchiolitis

• • Viral disease

    • Usually RSV in infants

    • May also be metapneumovirus, influenza, parainfluenza, coronavirus, adenovirus, and rhinovirus

  • Treatment is primarily supportive

    • Fluids

    • O2

    • Temperature control (paracetamol)

    • May use nebulized epinephrine or hypertonic saline

  • CXR not usually indicated

Atelectasis

• • Collapse or closure of alveoli resulting in reduced or absent gas exchange

  • May affect part or all of one lung

  • It is a condition where the alveoli are deflated, as distinct from pulmonary consolidation

Febrile neutropenia in an infant

• • Extremely serious

    • Neutrophils >2 => Probably OK, but give antibiotics

    • Neutrophils <1 => Definitely admit and treat aggressively

  • Treat with tazocin (piperacillin + tazobactam) and gentamycin

  • Beware introducing infections through Portacath

Erythema toxicum neonatorum

• • Common rash in neonates

    • Appears in up to half of newborns carried to term, usually between day 2-5 after birth

  • Characterized by blotchy red spots on the skin with overlying white or yellow papules or pustules

    • Lesions may be few or numerous

  • The eruption typically resolves within a few days

Random notes

• • A crying dehydrated child might make no tears

  • Measure CRT centrally (sternum) as well as peripherally