Paediatrics 1 Flashcards

Question

Acute asthma general management

Answer 1

- Maintain oxygen saturations between 94-98% with high flow oxygen if necessary. - Administer inhaled salbutamol - Proceed to nebulised salbutamol if necessary - Add nebulised ipratropium bromide - If O2 saturations remain <92%, add magnesium sulphate - Add intravenous salbutamol if no response to inhaled therapy - If severe or life-threatening acute asthma is not responsive to inhaled therapy, add aminophylline - All patients should receive steroids, given IV only if the patient is unable to take the dose orally - If the patient is not responding to salbutamol or ipratropium, consult with a senior clinician

Answer 2

- Able to talk in sentences - SpO2 >92% - PEF >50% best or predicted - In children >5: heart rate <125/min, respiratory rate <30/min - In children 1-5: heart rate <140/min, respiratory rate <40/min

Answer 3

- SpO2 <92% - PEF 33-50% best or predicted - Too breathless to talk or feed - Heart rate: >125 (>5 years), >140 (1-5 years) - Respiratory rate: >30 breaths/min (>5 years), >40 (1-5 years) - Use of accessory neck muscles

Answer 4

- SpO2 <92% - PEF <33% best or predicted - Silent chest - Poor respiratory effort - Agitation - Altered consciousness - Cyanosis

Answer 5

- Bronchodilator therapy: give a beta- 2 agonist via a spacer (for a child <3 years use a close fitting mask). Give 1 puff every 30-60 seconds up to a maximum of 10 puffs. If symptoms are not controlled repeat beta-2 agonist and refer to hospital - Steroid therapy: should be given to all children with an asthma exacerbation, treatment should be given for 3-5 days - Will need regular nebulisers (salbutamol) until able to maintain oxygen saturation above 94% in air and clinically the work of breathing improves at which point can be switched to an inhaler via a space

Answer 6

- Oxygen via facemask - Nebulised salbutamol; 5mg - Consider Prednisolone 30-40mg or IV Hydrocortisone 4mg/kg - If poor response add nebulised Ipratropium Bromide 250mg - Will need regular nebulisers (salbutamol) until able to maintain oxygen saturation above 94% in air and clinically the work of breathing improves at which point can be switched to an inhaler via a space

Answer 7

- <5: clinical diagnosis - >5: offer investigations every 6-12 months if unable to perform initially - Initially: spirometry with bronchodilator reversibility. This is enough to diagnose - 2nd line: FeNO (>35) and Peak flow variability (20%). If one is positive can suspect asthma and start treatment

Answer 8

- Oxygen - Nebulised salbutamol 5mg plus Ipratropium Bromide 250micrograms - Consider IV Hydrocortisone 4mg/kr or 100mg - Discuss with consultant paediatrician - Will need regular nebulisers (salbutamol) until able to maintain oxygen saturation above 94% in air and clinically the work of breathing improves at which point can be switched to an inhaler via a space

Answer 9

- No daytime symptoms - No night-time awakening due to asthma - No asthma attacks - No need for rescue medication - No limitations on activity including exercise - Normal lung function (FEV1 and/or peak expiratory flow (PEF) > 80% predicted or best) - Minimal side-effects from treatment

Answer 10

1. Newly diagnosed asthma: SABA 2. Not controlled by step 1 or Newly diagnosed asthma with symptoms >=3/week or night time waking= SABA + paediatric low dose ICS 3. SABA + paediatric low dose ICS + LTRA 4. SABA + paediatric low dose ICS + LABA. Stop LTRA 5. SABA + switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a paediatric low-dose ICS 6. SABA + paediatric moderate dose ICS MART

Answer 11

1. Newly diagnosed: SABA 2. Not controlled on previous step OR newly diagnosed asthma with symptoms >=3/ week or night time waking= SABA + an 8 week trial of paediatric MODERATE dose ICS 3. SABA + paediatric low dose ICS + LTRA 4. Stop the LTRA and refer to an paediatric asthma specialist

Answer 12

After 8-weeks stop the ICS and monitor the child's symptoms: - if symptoms did not resolve during the trial period, review whether an alternative diagnosis is likely - if symptoms resolved then reoccurred within 4 weeks of stopping ICS treatment, restart the ICS at a paediatric low dose as first-line maintenance therapy - if symptoms resolved but reoccurred beyond 4 weeks after stopping ICS treatment, repeat the 8‑week trial of a paediatric moderate dose of ICS

Answer 13

- itchy, erythematous rash - repeated scratching may exacerbate affected areas - in infants the face and trunk are often affected - in younger children, eczema often occurs on the extensor surfaces - in older children, a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck

Answer 14

- avoid irritants - simple emollients= large quantities should be used. The emollient should be applied first followed by waiting at least 30 minutes before applying the topical steroid. - Thin emollients: E45, Diprobase cream, Aveeno cream - Thick, greasy emollients: 50:50 ointment, Diprobase ointment - topical steroids - wet wrapping= large amounts of emollient (and sometimes topical steroids) applied under wet bandages - in severe cases, oral ciclosporin may be used

Answer 15

- Mild: Hydrocortisone 0.5%, 1% and 2.5% - Moderate: Eumovate (clobetasone butyrate 0.05%) - Potent: Betnovate (betamethasone 0.1%) - Very potent: Dermovate (clobetasol propionate 0.05%)

Answer 16

- Outward behaviour like aggression, defiance, hyperactivity and impulsivity - Examples: ADHD, Oppositional Defiant Disorder (ODD) and Conduct disorder - ODD: exhibit a pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least six months. For example, frequent temper tantrums - Conduct disorder: repetitive patterns of behaviour where social norms/rules are violated. May be aggressive towards people or destroy property

Answer 17

- Examples: anxiety disorders. mood disorders - Inward focused behaviours like depression, anxiety and social withdrawal Management= CBT and psychotherapy, no medical treatment available

Answer 18

prematurity, low birth weight, low paternal education, prenatal smoking, maternal depression.

Answer 19

- Does not follow through on instructions - Reluctant to engage in mentally-intense tasks - Easily distraction - Finds it difficult to sustain tasks - Finds it difficult to organise tasks or activities - Often forgetful in daily activities - Often loses things necessary for tasks or activities - Often does not seem to listen when spoken to directly

Answer 20

- Unable to play quietly - Talks excessively - Does not wait their turn easily - Will spontaneously leave their seat when expected to sit - Is often 'on the go' - Often interruptive or intrusive to others - Will answer prematurely, before a question has been finished - Will run and climb in situations where it is not appropriate

Answer 21

- ADHD is a condition incorporating features relating to inattention and/or hyperactivity/impulsivity that are persistent. - There has to be an element of developmental delay and symptoms must be present for up to 6 months. - For children up to the age of 16 years, six of these features have to be present; - 17 or over, the threshold is five features. - Four times as common in boys, normally diagnosed between 3 and 7. - Symptoms are present in 2 or more setting i.e. home or school. Some symptoms should be present before 12 Following presentation, a ten-week 'watch and wait' period should follow to observe whether symptoms change or resolve. If they persist then referral to secondary care is required. Parents can attend education and training programmes

Answer 22

- Last resort, only available to 5 and above - Methylphenidate is first line in children and is initially given on a six-week trial basis. In children, weight and height and blood pressure should be monitored every 6 months. Can cause growth retardation, weight loss, tachycardia and hypertension. - If there is inadequate response, switch to lisdexamfetamine; - Dexamfetamine should be started in those who have benefited from lisdexamfetamine, but who can't tolerate its side effects. - All these drugs are potentially cardiotoxic, perform a baseline ecg before starting treatment

Answer 23

- Simple behaviour management: reward charts, positive redirection, 1-2-3 reward visuals and self imposed concentration breaks. - Therapy: CBT, behavioural therapy and psychoeducation - Extra support at school - Medical management: methylphenidate or amphetamine

Answer 24

- Lower educational and employment attainment - Poor self-esteem - Criminal behaviour - Relationship issues - Sleep disturbance - Substance abuse - Road traffic accidents - Self-harm

Answer 25

hearing impairment, global development delay, autism spectrum disorder, specific language disorders, neglect, attachment disorder, selective mutism.

Answer 26

is three to four times more common in boys than girls, around 50% of children with ASD have an intellectual disability

Paediatrics 1 Flashcards

(50 cards)