Archive for the ‘Paediatrics’ Category

Paediatric RSI Drug Dosages (KKH)   Leave a comment

please note that these dosages are recommended for an Asian population residing in Singapore.
 

Age weight Atropine Succinylcholine Midazolam Etomidate Ketamine
dose 0.01-0.02mg/kg 1mg/kg* 0.1-0.3mg/kg 0.3mg/kg 1-2mg/kg
2m 5kg 0.1mg NA 0.5-1.5mg 1.5mg 5-10mg
6m 8kg 0.16mg 12mg 0.8-2.4mg 2.4mg 8-16mg
1y 10kg 0.2mg 15mg 1-3mg 3mg 10-20mg
3y 15kg 0.2mg 15mg 1.5-4.5mg 4.5mg 15-30mg
5y 19kg 0.4mg 19mg 2-6mg 5.7mg 19-38mg
7y 23kg 0.5mg 23mg 2.5-7mg 6.9mg 23-46mg
9y 29kg 0.6mg 29mg 3-9mg 8.7mg 29-58mg
11y 36kg 0.6mg 36mg 3.5-11mg 10.8mg 36-72mg
12y 44kg 0.6mg 44mg 4.5-13mg 13.2mg 44-88mg
14y 50kg 0.6mg 50mg 5-15mg 15mg 50-100mg
16y 58kg 0.6mg 58mg 15mg 17.4mg 58-116mg
Adult 65kg 0.6mg 65mg 15mg 19.5mg 65-130mg

*succinylcholine: dose 1.5mg/kg for <10kg; second dose is contraindicated in infants and young children (increased risk of bradycardia, asystole)

Atropine pre-medication is required in:

  • all <1y/o
  • bradycardic
  • children receiving succinylcholine
  • adolescents and adults receiving 2nd dose of succinylcholine
  • when ketamine is used

 
Special indications:

  • head injury with no hypotension: use midazolam/thiopental
  • hypotension: use ketamine or not at all
  • status asthmaticus: use ketamine; thiopentone contraindicated
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Which are some genetic syndromes associated with behavioural psychological abnormalities?   Leave a comment

  • Down syndrome
  • Fragile-X syndreom
  • Rett syndrome
  • Prader-Willi syndrome
  • Williams syndrome
  • Angelman syndrome
  • Smith-Magenis syndrome
  • fetal alcohol spectrum disorders
  • autism spectrum disorders

Blueberry Muffin Baby: Differentials   Leave a comment

Generalised non-blanching, blue-red macules or firm dome-shaped papules on a neonate’s skin, mostly over the head, neck, trunk: a sign of extramedullary dermal haematopoiesis persisting beyond what normally occurs up to the fifth month of gestation. In the strictest sense the term describes the appearance of congenital TORCH infections; but nowadays may also refer to similar lesions in some haematologic dyscrasias and vascular malformations.

blueberry muffin baby


Link to article in the Nov 2007 issue of Archives of Paediatric and Adolescent Medicine.

Congenital Infections

  • rubella — for which this term was first coined
  • CMV (cytomegalovirus) — most common cause
  • rarely, other TORCH infections

Haemolytic diseases (Coombs positive haemolytic anaemia, unconjugated hyper-bilirubin-aemia, hydrops)

  • haemolytic disease of the newborn
  • hereditary spherocytosis

Malignancies

  • neuroblastoma (blanchable lesions, raccoon eyes, heterochromia irides)
  • AML (acute myeloid leukaemia) with leukaemia cutis (chloromas, pallor, lethargy, hepatosplenomegaly, fever, leukocytosis)

  • Langerhans cell histiocytosis (yellow-brown papules with central ulceration, multiple petechiae)

Vascular malformations

  • multiple haemangiomas of infancy
  • multifocal lymphangioendotheliomatosis
  • blue rubber bleb naevus syndrome
  • multiple glomangiomas

others

  • neonatal lupus erythematosus (occasionally)

 

Ref:

  1. Mehta V, Balachandran C, Lonikar V. Blueberry Muffin Baby: A Pictoral Differential Diagnosis. Dermatol Online J [Internet]. 2008 [cited 3 Mar 2010];14(2). Available from:
    http://dermatology.cdlib.org/142/case_reports/blueberry/mehta.html

  2. Gaffin JM, Gallagher PG. Picture of the Month & Diagnosis. Arch Pediatr Adolesc Med [Internet]. 2007 [cited 3 Mar 2010];161(11):1102-3. Available from:
    http://archpedi.ama-assn.org/cgi/reprint/161/11/1102 (Pictures)
    http://archpedi.ama-assn.org/cgi/reprint/161/11/1103
    (Denouement and Discussion)