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Respiratory rate in a 0 to 6 month old?
30-50 breaths per minute
Respiratory rate in a 6 month to 12 month old?
20 to 40 breaths per minute
Respiratory rate in a child aged 1 to 5 years?
20 to 30 breaths per minute
pulse in a child aged 6 to 12 months?
95 to 120 beats per minute
Repiratory rate in a child aged 6 to 10 years of age?
18 to 25 breaths per minute
Respiratory rate in a child greater than 10 years?
12 to 25 breaths per minute
Pulse in a child aged one to five years?
90 to 110 beats per minute
pulse in a child aged 6 to 10 years?
pulse in a child aged greater than 10 years?
60 to 100 beats per minute
blood pressure in a child aged 0 to 6 years ?
range 80/50 to 115/80
Blood pressure in a child aged ten years?
range 90/55 to 130/85
Bp in a child aged 15 years?
range 110/60 to 145/90
Where is the pulmonic valve?
second intercostal space, to the left of the sternum
Where is the aortic valve area?
second intercostal space to the right of the sternum
where is the tricuspid valve?
fourth intercostal space over the sternum
abnormality with ASD?
pulmonic valve area- fixed splitting is found with asd
mitral valve prolapse?
apex-third sound is heard at the apex also with asd.
in congestive heart failure
change inconsistency and freq of stools with enough loss of fluid and electrolytes to cause illness
acute diarrhoea - causes?
- infective gastroenteritis
- non-enteric infection e.g. resp tract
- food hypersensitivity reactions
- drugs e.g. antibiotics
- pseudomembranous coilitis
presentation of diarrhoea
- diarrhoea and or bloody stools
- fever and or vomiting (infectious gastroenteritis)
- dehydration and decreased conciousness
management of diarrhoea
assess hydration and vital signs, pallor (blood loss), abdominal tenderness, signs of associated illness (e.g. classical petechial rash in HSP)
management of mild/mod dehydration?
replace fluid and electrolyte losses with oral glucose- electrolyte based rehydration fluid e.g. dioralyte
severe dehydration management?
INV--> U and E, creatinine, FBC, blood gas, stool MC+S and virology, double contrast enema if suspect intussusception.
IV fluid nad electrolyte replacement
definition of chronic diarrhoea?
diarrhoea persisting for>14 days
pathophysiology of chronic diarrhoea?
- decreased gastrointestinal absorptive capacity e.g. coeliac
- osmotic diarrhoea e.g. lactase deficiency
- secretory diarrhoea (rare) vasoactive intestinal peptide producing tumour
Causes of chronic diarrhoea in ages 0 to 24months?
- malabsorption e.g. post enteritis syndrome due to lactose intolerance, CF, coeliac disease;
- food hypersensitivity e.g. to cows milk protein
- toddler diarrhoea
- excesssive fluid intake
- protracted infectious gastroenteritis
- immunodeficiencies e.g. HIV
- hirschsprungs disease
- tumours ( secretory diarrhoea)
- fabricated illness
- autoimmune enteropathy
older children - causes oif diarrhoea?
- irritable bowel syndrome
- infection inc bacterial overgrowth and pseudomembranous coilitis
- laxative abuse
- excesive fluid intake
Important things to ask in a history of diarrhoea?
- 1) nature and frequency of stool
- 2) presence of undigested food
- 3)relationship to diet changes e.g. weaning
- 4) travel
- 5) stool blood or mucus
- 6) weight loss ****
Investigations for chronic diarrhoea - stool tests?
- microscopy for bacteria or parasites, leucocytes, fat globules (pancreatic diseases), fatty acid crystals (diffuse mucosal defects)
- PH (<5.5 = carbohydrate malabsorption)
- reducing substances (>0.5%= carbohydrate malabsorption)
- faecal occult blood (coilitis)
- electrolytes (inc sodium and K= secretory diarrhoea; inc chloride = cong chloridorrhoea)