Pediatrics

Question 1

Red flags for otitis media/ Indications for immediate treatment with antibiotics

Answer 1

1. Child <6months old
2. Immunocompromised child
3. Aboriginal or Torres Strait Islander children
4. Only hearing ear
5. Child has a cochlear implant
6. Possible suppurative complication

Question 2

Formula for weight

Answer 2

(Age+4) * 2

Question 3

Formula for ETT size and length

Answer 3

Size (cuffed tube)= age/4 + 3.5

Length= age/2 + 12

Question 4

Drug therapy in resuscitation (dose calculations):
Adrenaline
Amiodarone
Atropine
Bicarbonate
Adenosine
Diazepam/Midazolam
Glucose

Answer 4

Adrenaline = 10mcg/kg IV/IO
Adrenaline = 100mcg/kg ETT
Amiodarone = 5mg/kg
Atropine = 0.02mg/kg IV/IM
Bicarbonate = 1mmol/kg stat if pH <7.1
Adenosine = 0.1mg/kg, repeat at 0.2mg/kg, then 0.3mg/kg (max 12mg)
Diazepam = 0.2mg/kg
Midazolam = 0.15mg/kg
Glucose = 2-5ml/kg 10%

Question 5

Idiopathic Thrombocytopenic Purpura

Answer 5

Reduction in platelet count in the absence of any other cause <100*10^9/L

• most common sign is petechiae on the kin or mucosa
• bone marrow aspirate is only recommended if there is persistent bleeding in spite of platelet count >20
• Rx:
  1. Steroids: Prednisolone 1-2mg/kg OD for 3weeks, than taper/ Methylprednisolone 30mg/kg/day3days then 20mg/kg/day4days
  2. IVIg- consider if there is significant bleeding (0.8-1gm/kg)
  3. Platelet transfusion if there is ICH/significant bleeding
• Avoid NSAIDs
• Older children to avoid contact sports
• Admit if there is significant bleeding/unclear diagnosis/problematic social situation

Question 6

Indications for intubation in anaphylaxis

Answer 6

Refractory hypoxia
Cardiac arrest
Upper airway obstruction
Apneoa/loss of respiratory drive
Coma
Refractory shock

Question 7

Scarlet fever type rash

Answer 7

Blanching, sandpaper like rash, usually more prominent in skin creases, flushed face/cheeks with peri-oral pallor

Question 8

Anaphylaxis: clinical diagnosis

Answer 8

Acute onset of either:

1. Typical skin features (urticaria, flushing and/or angioedema) plus features of anaphylaxis involving one or more system OR
2. Hypotension, bronchospasm or upper airway obstruction where anaphylaxis is possible

Question 9

Management of anaphylaxis

*If NOT improving

Answer 9

**Keep patient supine- DO NOT let them stand or walk suddenly
IM Adrenaline 10mcg/kg or 0.01ml/kg of 1:1000 (max 0.5ml)
**1. Give oxygen
2. Second dose of adrenaline
3. Consult senior staff
4. Commence adrenaline infusion (0.05-0.5 mag/kg/min)
5. Consider nebuliser adrenaline
6. BMV for apnoea, until ETT inserted
7. 0.9% NS boluses 20ml/kg IV until adrenaline infusion is commenced