Paediatrics - Queensland Health - Queensland Government

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Respiratory problems 562 - - palpate the head and neck for enlarged lymph glands - - auscultate the chest for air entry and any added sounds - crackles or wheezes - - 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 • Check vaccination status. See Immunisation program 4. Management • Consult MO if - - < 3 months of age - - < 1 year with respiratory rate more than 40 respirations per minute (rpm) ○ 1 - 2 years more than 35 rpm ○ 2 - 5 years more than 30 rpm ○ 5 - 12 years more than 25 rpm ○ 12 years and older more than 20 rpm ○ respiratory distress or apnoea -- if child looks sick, not alert or interactive and has temperature over 38°C -- if child still looks sick when temperature reduced - - if child has any rash - - if child has a cough productive of mucopurulent sputum, may need further investigations for possibility of chronic respiratory disease - - if child has tonsillitis and is sick • If child has cough as the main feature; consider other diagnoses. See Pertussis (whooping cough), croup, acute asthma • If child has an increased respiratory rate, or any chest findings consider other diagnoses. See Bronchitis / pneumonia • If child has evidence of secondary ear infection. See Acute otitis media • For the child with URTI, indications for antibiotic treatment are: -- sore throat and red swollen tonsils, with or without pus, with fever (>38°C) and local lymphadenitis -- sore throat with red swollen tonsils in a child with existing rheumatic heart disease -- Scarlet fever - has a characteristic and striking red blanching rash and strawberry tongue due to streptococcal infection; rash usually starts after the sore throat and lasts a week -- Quinsy (severe infection of the tonsils causing massive enlargement). If quinsy is present, consult MO (may need evacuation / hospitalisation for IV penicillin and / or surgical drainage of pus) • For the child with uncomplicated URTI, treatment is symptomatic [1]: - - encourage rest and increase fluid intake - - paracetamol for analgesia if uncomfortable (do not use aspirin in children) - - topical nasal decongestants can be helpful for sleeping and eating particularly in young infants; however their use should be limited to short periods of time (5 days max.). Nose drops of normal saline or cool boiled water can also be helpful and are safe - - other symptomatic treatments, nebulised saline, and lemon and honey drinks may have some subjective benefit in some children See Simple analgesia back cover Controlled copy V1.0 Primary Clinical Care Manual 2011
Respiratory problems • For the child with indicators for antibiotic treatment present and if not allergic treat with oral penicillin: Schedule 4 Phenoxymethylpenicillin DTP IHW / SM R&IP / IPAP Authorised Indigenous <strong>Health</strong> Workers and Isolated Practice Area Paramedic must consult MO / NP Scheduled Medicines Rural & Isolated Practice Registered Nurses may proceed Form Strength Route of administration Capsule 250 mg 500 mg Oral Suspension 150 mg / 5 mL Recommended dosage Child 15 mg / kg / dose bd to a max. of 500 mg bd Duration 10 days Provide Consumer Medicine Information: should be taken on an empty stomach; ½ to 1 hour before meals. Ensure full course is completed Management of associated emergency: as for severe allergic reactions See Anaphylaxis [1] • If a lack of observance with oral medication is anticipated or those intolerant of oral therapy treat with IM penicillin: Schedule 4 Benzathine penicillin (Bicillin LA) DTP IHW / SM R&IP / IPAP Authorised Indigenous <strong>Health</strong> Workers and Isolated Practice Area Paramedic must consult MO / NP Scheduled Medicines Rural & Isolated Practice Registered Nurses may proceed Form Strength Route of administration Recommended dosage 3 kg - < 6 kg 225 mg Duration Disposable syringe 900 mg IM 6 kg - < 10 kg 337.5 mg 10 kg - < 15 kg 450 mg 15 kg - < 20 kg 675 mg >20 kg 900 mg Stat Use a concentration of 442 mg / mL when measuring part doses. Refer to product information Provide Consumer Medicine Information Management of associated emergency: as for severe allergic reactions See Anaphylaxis Administration tips - as per patient preference: -- apply EMLA cream to the injection site 30 - 60 minutes prior to injection and allow medication to warm up to room temperature or -- allow medication to warm up to room temperature, apply pressure with thumb (to the exact injection site) 30 seconds prior to the injection, use 21 gauge needle and deliver injection very slowly (2 minutes) [1] • If allergic to penicillin, treat with roxithromycin: Primary Clinical Care Manual 2011 Controlled copy V 1.0 563
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 and 18: Meningitis Meningitis Recommend Co
Page 19: 6. Referral / consultation Consult
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
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Paediatrics - Queensland Health - Queensland Government

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