Neonatal Emergency
Jaundice in the first 24 hours is normal.
True or False
False. This is pathological jaundice.
Stroke volume is fixed in the newborn.
True or False
True.
Stroke volume is relatively fixed in the newborn due to the poorly compliant ventricular muscle.
CO = SV X HR
Therefore, an increase in Cardiac Output is achieved by an increase in heart rate. Bradycardia in Paeds is baaaaad.
Normal HR in a well neonate
120-160
Give 1 complication of this classic vaccine-preventable rash #1 that starts behind the ear, to the face and then the body.
Measles - Cough Coryza Conjunctivitis.
Complications
Pneumonia
Gastroenteritis
Encephalitis
Late complication - Subacute Sclerosing PanEncephalitis (SSPE)
It’s 10pm on a busy afternoon shift. A 3 year old child has accidentally ingested her grandparent’s tablet (1 tablet of 5mg glipizide) 3 hours ago. She looks well with normal blood glucose level. The nurse ask if the child can go home, as she’s the most well child in the department. You say...
No. The child should be admitted because Glipizide is a sulphonylurea and with long half life - she would require regular BGL overnight and observation period of 24 hours.
Sulphonylurea is one of the ‘One Pill can Kill’ in children and can present with delayed hypoglycemia.
Treatment - Oral glucose, Dextrose IV, Octreotide.
A 4-week old underweight baby, born at 32-weeks, presents with lethargy, distended abdomen, and PR bleeding.
What is the most concerning diagnosis?
Necrotising Enterocolitis (clue : Risk factors - prematurity, underweight)
Other Important differential
- Intussusception
- Volvulus
- Sepsis
Treatment
- Resuscitation
- Antibiotics + Pain relief
- NG tube for gastric decompression. Do not feed the baby.
- Urgent Paeds Surgical referral
- Total parenteral feeds
Surfactant is released by this type of cell in the alveoli
Type 2 pneumocytes
(Age/4)+4 is the formula for
Size of Uncuffed paediatric ETT.
Go down 0.5 size for Cuffed tube.
Also
Rash #2 when associated with arthritis, abdominal pain and renal impairment is likely to be
Henoch Schonlein Purpura
A 2 year old child presented with suspicion of Button battery ingestion at 10pm. What is your management plan?
Pre-treatment with oral honey.
Confirmation of ingestion with xray without delay.
Resuscitation if required.
Urgent request for endoscopy - call Starship Paeds Surgical.
Point to safe areas where you can insert Intraosseous line in neonates
And give 2 contraindications to IO insertion
Proximal medial Tibia
Proximal Humerus
Distal medial Tibia
Contraindications
The larynx of neonates/infants is located more anterior and higher level relative to cervical vertebrae.
Which cervical vertebrae is this referring to?
The larynx is more anterior and is situated at a higher level relative to the cervical vertebrae (C3 to C4 at birth) compared to an adult (C6).
Defibrillation energy dose in a child (J/kg)
4J/kg
Yes you should be scared when you see an unwell child with this Rash #3 which is caused by bacteria called _________
And who do you treat?
Nisseria Meningitides
Treatment - of patient AND close contacts.
List 4 paediatric ‘One Pill can Kill’ medications and their life-threatening effects.
A - Antidepressant - Tricyclic antidepressant TCA - cardiac arrest
B - Beta blockers - cardiogenic shock
C - Calcium Channel Blockers - cardiogenic shock
D - Diabetes meds - Sulphonylurea - prolonged hypoglycemia
E- Ecstacy/Meth - Symphatomimetic toxidrome
F- Freaking painful - Opioids - respiratory depression
Give 4 examples of Cyanotic Congenital Heart Disease
CyanoTIC - Has all the T
Transposition of the Great Arteries
Tricuspid Atresia
Tetralogy of Fallot
Truncus Arteriosus
TAPVD (Total Anomalous Pulmonary Venous Drainange)
The paediatric diaphragm has fewer type 1 muscle fibres than adults and is therefore prone to fatigue.
True or False?
True.
(Age x 2) + 80 is the formula for
Normal paediatric systolic blood pressure. Paeds BP is lower due to lower peripheral resistance
‘Slapped cheek’ is the classic appearance of this disease called ________ and is caused by Parvovirus B____. It’s usually well tolerated unless the person has this type of blood disorder.
Fifth Disease - Parvovirus B19 - Sickle Cell disease.
In Sickle Cell, Parvovirus B19 can cause severe bone marrow necrosis and vaso-occlusive events.
Which 2 of the following are not considered teratogenic?
Clindamycin
Lithium
Digoxin
Warfarin
Sodium valproate
Isotretinoin
Clindamycin
Digoxin
All others are teratogenic
Lithium - cardiac abnormalities eg Ebsteins anomaly
Warfarin - fetal haemorrhage, blindness
Sodium valproate - Spina bifida
Isotretinoin - Neural tube defect
Congenital Adrenal Hyperplasia, caused by 21-hydroxylase deficiency results in aldosterone and cortisol deficiency. This causes the child to present looking unwell with
Hypoglycemia or Hyperglycemia
Hypokalemia or Hyperkalemia
Hyponatremia or Hypernatremia
Hypoglycemia - Cortisol deficiency
Hyperkalemia - Aldosterone deficiency
Hyponatremia - Aldosterone deficiency
Emergency management = Hydrocortisone 4mg/kg
(Plus treat the hypoglycemia and hyperkalemia)
Draw an example of Salter-Harris III fracture
SALTR TROUT - 3 goes Out (into epiphysis). Because up and down can be confusing.
In the 7 years from 2009 to 2015, there were ________ deaths as a result of Child Abuse and Neglect.
Of that, what is the commonest cause of death?
56 deaths :(
Traumatic head injury was reported as the cause of death for 65 percent of all those killed by direct physical assault.
Source: FAMILY VIOLENCE DEATH REVIEW COMMITTEE FIFTH REPORT DATA: JANUARY 2009 TO DECEMBER 2015
DOUBLE POINTS !!!!!
1000 points for providing ALL of the following on Kawasaki Disease
- Symptoms (all 6)
- Feared complications (1)
- Specific Treatment (2)
Kawasaki motorcycle CRASH and Burn
Conjunctivitis, Rash, Adenopathy, Strawberry Tongue, Hands and feet swelling
Burn = Fever for more than 4 days (updated criteria)
Complication - coronary artery aneurysm
Treatment - Aspirin (prevents thrombosis) and IVIG (prevents coronary artery aneurysm)
Pharmacology - Which one(s) are true?
A) Cutaneous absorption in Paediatrics is lower due to thinner stratum corneum
B) Albumin levels are lower in neonates and infants, increasing the free fraction of highly protein-bound drugs.
C) Hypoglycaemia occurs more readily because of decreased glycogen stores.
B & C
Cutaneous absorption in Paediatrics is HIGHER due to thinner stratum corneum