12.09.19 Ward round notes

Guillain-Barre Syndrome - 6 Types

Weird ECG stuff in kids

    • Heart rate >100 beats/min

    • Rightward QRS axis > +90°

    • T wave inversions in V1-3 (“juvenile T-wave pattern”)

      • Dominance of right ventricle

    • Dominant R wave in V1

    • RSR’ pattern in V1

    • Marked sinus arrhythmia

    • Short PR interval (< 120ms) and QRS duration (<80ms)

    • Slightly peaked P waves (< 3mm in height is normal if ≤ 6 months)

    • Slightly long QTc (≤ 490ms in infants ≤ 6 months)

    • Q waves in the inferior and left precordial leads.

Acute pancreatitis

    • Glasgow criteria: 3 of:

      • P02 Oxygen < 60mmHg or 7.9kPa

      • Age > 55

      • Neutrophilia White blood cells > 15

      • Calcium < 2 mmol/L

      • Renal Urea > 16 mmol/L

      • Enzymes Lactate dehydrogenase (LDH) > 600iu/L Aspartate transaminase (AST) > 200iu/L

      • Albumin < 32g/L

      • Sugar Glucose > 10 mmol/L

RASopathies

Pre- and Post- Ductal Sats

    • Difference of ≥10% suggests marked pulmonary hypertension or PDA dependent leison

    • Immediately after birth, post-ductal sats are lower due to unoxygenated blood coming across from the pulmonary artery

      • i.e. R => L shunt

      • Should normally disappear within 15 mins after birth

    • Pre-ductal > Post-ductal

      • Persistent pulmonary hypertension

      • Left heart problem

        • Aortic arch hypoplasia, critical aortic stenosis, interrupted aortic arch

      • NB These will tend to be more of a CYANOTIC picture but may be CARDIOVASCULARLY NORMAL

        • Unoxygenated blood comping across

        • But plenty of blood getting out to the body

    • Post-ductal > Pre-ductal

      • TGA

        • Small amount of oxygenated blood from a closed pulmonary loop in making it across to the aorta

      • CoA

Tanner stages

Notes

    • Atravent

      • Ipratropium bromide

      • Blocks the muscarinic acetylcholine receptors in the smooth muscles of the bronchi in the lungs, opening the bronchi

    • Key finding in tumor lysis syndrome

      • Hyperkalemia

      • Hyperphosphatemia

      • Hypocalcemia

      • Hyperuricemia / hyperuricosuria

      • Lactic acidosis

    • No evidence for salbutamol or ipratropium bromide in bronchiolitis

    • Wheeze in a young child?

      • Bronchiolitis UPO

      • See hyperinflation on CXR

    • Thymic shadow in infants' CXR

    • AVM

      • Lesion of the vasculature that develop such that blood flows directly from the arterial system to the venous system without passing through a capillary system

    • Oral baclofen and clonidine to treat children with spasticity

    • Kepra = Levetiracetam

      • Epilepay, esp. partial seizures

    • Acute asthma guidelines

    • https://docs.google.com/a/kieran101.com/open?id=1braurjMtMAgqDvZD6uGep9pyT-AtFDYOIpMv5jSCnXl_s4r-tzIprJ2N5Mh4

    • Octreotide

      • Mimics natural somatostatin pharmacologically, though it is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone

    • Moro reflex

      • Present up to 4 or 5 months of age as a response to sudden falling

        • spreading out the arms (abduction)

        • unspreading the arms (adduction)

        • crying (usually)

    • ITP pharmacological management

      • Steroids

      • IVIG

      • Rituximab

      • NO aspirin / NSAIDs

    • MCV lower limit: 70 + age

    • Anaemia => Pica

    • Cyclic neutropenia

        • Tends to occur every three weeks and last three to six days at a time

        • Hereditary

        • Use G-CSF

        • esult of autosomal dominantly inherited mutations in ELA2, the gene encoding neutrophil elastase