Paediatrics - Queensland Health - Queensland Government

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Immune complications Upper limits of normal BP levels for girls at 50th percentile for height and weight [1] BP upper level systolic 104 105 108 111 115 119 123 126 128 129 of normal diastolic 58 63 70 74 76 78 80 82 84 84 572 1 years 2 years 4 years Diagnostic features of APSGN [2] This illness usually features oedema and / or hypertension (BP greater than levels in tables for age and gender). Other features include: 1. Haematuria - often macroscopic but can be microscopic • A urine dipstick reading of ≥ 2+ red blood cells is adequate to define haematuria • Microscopic haematuria is defined as >10 x 106 red blood cells on microscopy of fresh urine; red cells casts should also be seen. If microscopy is not readily available 2. Reduced serum complement: C 200 international units or, • anti-DNase B >300 U / mL • These serological titres are often high at baseline in Aboriginal and Torres Strait Islander community children because of repeated skin infections with GAS. So acceptable evidence for recent GAS infection is either: -- titres of > 2 x reference e.g. ASOT > 400 international units / mL or -- anti-DNase B > 600 units / mL or -- a rising titre when repeated after 10 - 14 days 4. Management • Consult MO who: - - will advise to treat streptococcal infection with IM benzathine penicillin [3] regardless of whether skin sores / sore throat are present at the time of presentation or not; or if allergic to penicillin a full 10 day course of oral roxithromycin [3] -- may advise to treat hypertension and / or heart failure (initial treatment is usually frusemide) • All cases with hypertension should be evacuated / hospitalised • Restrict fluids and salt intake (usually patient is fluid overloaded) • Notify all cases of APSGN to the Public Health Unit 6 years Controlled copy V1.0 8 years 10 years 12 years 14 years 16 years > 17years Primary Clinical Care Manual 2011
Immune complications Schedule 4 Benzathine penicillin (Bicillin LA) DTP IHW / SM R&IP / IPAP Authorised Indigenous Health 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, give oral roxithromycin [3] Schedule 4 Roxithromycin DTP IHW / SM R&IP / IPAP Authorised Indigenous Health Workers and Isolated Practice Area Paramedic must consult MO / NP Scheduled Medicines Rural & Isolated Practice Registered Nurses may proceed Form Strength Tablet for suspension Tablet 50 mg 150 mg 300 mg Route of administration Oral Recommended dosage Child 4 mg / kg / dose bd to a max. of 150 mg bd Duration 10 days Provide Consumer Medicine Information: should be taken on an empty stomach, 15 minutes before food. Ensure full course is completed Management of associated emergency: consult MO [1] • If treatment for hypertension and / or heart failure required, contact MO immediately Primary Clinical Care Manual 2011 Controlled copy V 1.0 573
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 and 20: 6. Referral / consultation Consult
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: Immune complications Acute post st
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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