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