Paediatrics - Queensland Health - Queensland Government

More documents

Recommendations

Info

Meningitis • In the critically ill, shocked or septic child with suspected meningitis e.g. unresponsive, poorly perfused, purpuric rash, it is appropriate to first give a bolus of intravenous or intraosseous fluids (initially 10 - 20 mL / kg of normal saline [1]) before giving antibiotics. Otherwise restrict total fluids to 10 mL / kg. • MO to consult as soon as possible with Paediatrician 3. Clinical assessment • Obtain as complete a patient history as possible according to the circumstances of the presentation. Of particular importance in a sick looking child is: -- -headache, irritability, fever, ask about any rash, neck stiffness • Perform standard clinical observations + -- weight (if able) -- GCS -- O saturation 2 • Perform physical examination: -- inspect all skin surfaces for any skin rash especially at pressure points and under nappies and clothing. Note: petechiae and purpura do not fade on pressure -- assess hydration status -- -inspect and palpate the ears, nose and throat -- palpate the fontanelle in young baby - feeling for fullness -- check for neck stiffness - with patient lying down, put hand behind head and gently raise -- auscultate the chest for air entry and any added sounds (crackles or wheezes) • Check vaccination status, especially Hib / meningococcal / conjugate pneumococcal 4. Management • Consult MO who will arrange / order: -- evacuation / hospitalisation -- monitor clinical observations closely -- continue IV / IO fluids at 50% of maintenance fluids (10 mL / kg). If the child is drinking ensure total fluids do not exceed 10 mL / kg (or 50 % of maintenance fluids) -- if meningitis is suspected, stat dose of parenteral antibiotics must be given before transfer to hospital. Blood samples for culture and PCR should be taken where possible but should not delay initial treatment -- give IV ceftriaxone (can be given by IM route if unable to obtain IV access) 100 mg / kg / dose to a total of 4 grams daily (or 50 mg / kg / dose bd to a total of 2 grams bd) [3] • Give paracetamol for fever, pain or distress See Simple analgesia back cover 5. Follow up All children with suspected meningitis should be managed in an appropriately equipped hospital Notify the Public <strong>Health</strong> Unit of any suspected case of bacterial meningitis as soon as possible Chemoprophylaxis will be required for close contacts of a patient with either meningococcal or Hib meningitis. Unvaccinated contacts of Hib meningitis
6. Referral / consultation Consult MO immediately on all occasions if meningitis is suspected Most will require urgent treatment and evacuation / hospitalisation Respiratory problems References 1. The Royal Children’s Hospital. Fluid management in meningitis. 2005 [cited 2011 March ]. 2. The Royal Children’s Hospital. Meningitis guideline. 2009 [cited 2011 March ]. 3. Therapeutic Guidelines. Meningitis: empirical therapy (organism or susceptibility not yet known). 2010 [cited 2011 March]. Upper respiratory tract infection - child Common cold, sore throat, tonsillitis Recommend Remember the symptoms and signs of an upper respiratory tract infection (URTI) may be a precursor to more serious illnesses such as meningitis Always be alert to the relationship between group A streptococcal sore throat and ARF / APSGN. These complications are common and serious but potentially avoidable in Aboriginal and Torres Strait Islander children Ten (10) days of oral antibiotics, or one dose of benzathine penicillin IM, is required to eradicate group A streptococcus Background The vast majority of URTI are caused by viruses and do not require antibiotics. However a viral URTI can be complicated by secondary bacterial infection such as otitis media or pneumonia, requiring antibiotics Other complications include exacerbation of asthma Related topics Meningitis Immunisation program Pneumonia Acute otitis media Pertussis (whooping cough) Croup / epiglottitis Bronchiolitis 1. May present with • Watery or purulent nasal discharge and / or sneezing • Sore / red throat and / or tonsils with or without pus • Difficulty swallowing, cough, chest wheeze, earache • Enlarged tender cervical (neck) lymph nodes • Fever, headache, general malaise 2. Immediate management Not applicable 3. Clinical assessment • Take patient history including: - - past episodes, history of asthma, complications such as ARF / APSGN - - otitis media, measures taken to treat including medications taken • Perform standard clinical observations + -- collect urine for MC/S and test for nitrates • Perform physical examination including: -- overall appearance e.g. smiling? agitated? lethargic? -- respiratory effort e.g. chest recession, nasal flaring, grunting (noisy breathing), abdominal breathing -- inspect the ears, nose and throat Primary Clinical Care Manual 2011 Controlled copy V 1.0 561
Page 1 and 2: Section 6 Paediatrics
Page 3 and 4: Paediatric presentation History and
Page 5 and 6: Paediatric presentation Presentatio
Page 7 and 8: Paediatric presentation Standard cl
Page 9 and 10: Paediatric presentation Physical ex
Page 11 and 12: Child with fever Fever is usually a
Page 13 and 14: Child with stridor Stridor is a har
Page 15 and 16: Any history of significant trauma?
Page 17: Meningitis Meningitis Recommend Co
Page 21 and 22: Respiratory problems • For the ch
Page 23 and 24: Respiratory problems 1. May present
Page 25 and 26: Respiratory problems 4. Management
Page 27 and 28: Child < 3 months Contact MO immedia
Page 29 and 30: Immune complications Acute post st
Page 31 and 32: Immune complications Schedule 4 Ben
Page 33 and 34: Immune complications Acute rheumat
Page 35 and 36: Immune complications Australian gui
Page 37 and 38: presence of RHD Place person on Re
Page 39 and 40: Ear problems • Clean the ear usin
Page 41 and 42: Ear problems Acute otitis media (A
Page 43 and 44: Ear problems Schedule 4 Roxithromyc
Page 45 and 46: Ear problems 4. Management • Give
Page 47 and 48: See Simple analgesia back cover Ear
Page 49 and 50: Ear problems 6. Referral / consulta
Page 51 and 52: Ear problems 5. Follow up Children
Page 53 and 54: Ear problems Ear discharge in the p
Page 55 and 56: Ear problems 4. Management • Cons
Page 57 and 58: Ear problems Schedule 4 Flumethason
Page 59 and 60: Ear problems Foreign body / insect
Page 61 and 62: Gastrointestinal problems Acute gas
Page 63 and 64: Gastrointestinal problems 4. Manage
Page 65 and 66: Gastrointestinal problems • Bottl
Page 67 and 68: Gastrointestinal problems Nutrition
Page 69 and 70:
5. Follow up Review 1 - 2 days aft
Page 71 and 72:
Gastrointestinal problems Intestin
Page 73 and 74:
Gastrointestinal problems Schedule
Page 75 and 76:
Gastrointestinal problems 4. Manage
Page 77 and 78:
Gastrointestinal problems Intussusc
Page 79 and 80:
Gastrointestinal problems • Perfo
Page 81 and 82:
Gastrointestinal problems Backgroun
Page 83 and 84:
Schedule 2 Folic Acid Gastrointesti
Page 85 and 86:
Urinary tract problems References 1
Page 87 and 88:
Urinary tract problems ○ where no
Page 89 and 90:
Bone and joint problems 3. Clinical
Page 91 and 92:
Abuse and neglect 2. Immediate mana
show all

Paediatrics - Queensland Health - Queensland Government

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?