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ISCE BOOST PAEDIATRICS Devon Ward M E N T I : What is your biggest 3 5 1 0 4 9 8 1 concern about a paediatric station?Our Series and Rough Timeline Menti: 3510 4981 W/B 20 Nov – Introduction and CBDs W/B 27 Nov – SBAR and Important Conditions th W/B 4 Dec – Pharmacology (how to explain and which ones?) W/B 11 Dec – Paeds W/B 18 Dec – O+G ------- W/B 1 Jan – Data interpretation (ABGs, FBC, LFTs, TFTs) th W/B 26 Feb – Neuro W/B 11 Mar – Psych W/B 25 Mar – Imaging (CXR, CT head, MSK) th W/B 8 Apr – Common and Important Presentations Menti: 3510 4981 CBD Review We heard you! CBDs are difficult to know if you’ve picked the right topic and if you’ve got the right content Email us and we can review your topic and/or CBD document! Email: wardde1@cardiff.ac.uk Menti: 3510 4981 Overview Today, we will look at: • How to structure a paediatric history • Important conditions to know • Example stations Any questions put them in the chat and we’ll get to them as we can!PAEDIATRIC HISTORY Menti: 3510 4981 Where does paediatrics fit in? Acute 4 min data station 4 min history 2 min summary 4 min skill interpretation + and DDx Qs x2 SBAR 4 min data station 4 min history 1 min write up 4 min SBAR interpretation + x1 Qs Comms 4 min data 7 min history 2 min summary interpretation + station and DDx Qs x1 Menti: 3510 4981 Advice for a Paeds Station Very similar to other histories, but with a few extra steps Ask where the Ask Qs to make Explain and ask parents are, Safeguard! them comfortable questions simply consent! Developmental Check they’re Birth history (if <5y) Vaccination status leaving to a safe history place now Menti: 3510 4981 Paediatric Histories Introduction Introduce yourself using name and role Greet child and confirm identity Ask where their parents are, and if they’d like to wait for them first Explain what’s going to happen Example th Hi, my name is Devon and I’m a 5 year medical student.What’s your name? When were you born? Today, I’ve been asked to have a bit of a chat with you about what’s been going on, but I know your parents aren’t here.Where are they? Are you okay to have a chat by yourself or would you like to wait? Menti: 3510 4981 Paediatric Histories Past Medical History Ask generally Ask about surgery Ask about developmental and birth history (or have a backup plan) Example Do you have any other conditions? Do you see your doctor for anything regularly? Have you ever had surgery? Any concerns during the birth/labour? Any concerns about their development? [I’d like to ask a bit about when you were born, but your parents aren’t here so I’ll ask that when they get here.] Menti: 3510 4981 Paediatric Histories Drug History Ask generally Ask about allergies Ask immunisations (or have backup plan) Example Do you take any medications? Do you have any allergies? Have you had all of your vaccines? I’ll ask your parents when they get here about vaccines as a baby Menti: 3510 4981 Paediatric Histories Social History Home Education Activities Drugs Example Who lives at home with you? Do you feel safe at home? Are you in school? How are you getting on at school? [What’s your favourite subject?] How do you spend your spare time? Many people start using drugs/cigarettes/alcohol around your age, have you tried any? Menti: 3510 4981 Paediatric Histories Closing Home Education Activities Drugs Example Well thank you so much for having this chat with me today.I’ll speak with my supervisor and we’ll see how we can help you going forwards.Your parents still aren’t here yet, would you like me to wait with you until they arrive? Not an exhaustive list! Conditions to consider Asthma Bronchiolitis Croup Whooping cough Cystic fibrosis Coeliac disease GORD Type I diabetes Meningitis Seizures Eczema Otitis media Menti: 3510 4981 Conditions to consider Asthma Bronchiolitis Croup Whooping cough Cystic fibrosis Coeliac disease GORD Type I diabetes Meningitis Seizures Eczema Otitis media Menti: 3510 4981 Conditions to consider Asthma ACUTE ASTHMA Bronchiolitis Croup Whooping cough EXACERBATION Type I diabetes Cystic fibrosis Coeliac disease GORD DIABETIC KETOACIDOSIS Meningitis Seizures SEPSIS STATUS EPILEPTICUS Eczema Otitis mediaSTATIONS Menti: 3510 4981 Case 1 8-year-old Mr Thompson is brought into primary care with a cough. You are the medical student that reviews him. Menti: 3510 4981 Case 1 – History 8yo M Recurrent episodes of coughing and shortness of breath Worse after exercise Worse at night Not productive, no blood No developmental concerns Fully immunised No PMHx or DHx, NKDA No family history of anything similar Menti: 3510 4981 Case 1 8-year-old Mr Thompson is brought into primary care with a cough. What are your top differentials now? What skills might they ask you to do? What investigations do you want? Menti: 3510 4981 Case 1 – Interpretation Mr Thompson DOB: XX/XX/XXXX Spirometry Results FVC: 1.2L (1.0-1.5L) FEV1: 0.7L (0.8-1.2) FEV1/FVC: 58%Case 1 8-year-old Mr Thompson is brought into primary care with a cough. How do you manage this patient?Case 1 – Management Menti: 3510 4981 My most likely diagnosis at this point is asthma, so I will describe the management of asthma. To begin, there needs to be a conversation with Mr Thompson and his parents about what asthma is and explain their role in the management of his symptoms.This will include inhaler technique, assessing for and avoiding triggers and how to take peak flow measurements. In terms of medical management, given his age, I would like to give him a SABA and a low dose paediatric ICS, for example as a salbutamol inhaler andbeclametasone inhaler.It is important to explain side effects of this management as well, including increased risk of oral thrush. He will also require referral to the asthma nurse team, who will support him going forwards.He will require regular follow-up and medication review, with a view to increasing his medications if his symptoms are unmanaged. More long-term, he should also be considered for annual influenza vaccines and pneumococcal vaccine every 5 years. Menti: 3510 4981 Case 2 13-year-old Miss Denver is brought into primary care with a rash. You are the medical student that reviews her. Menti: 3510 4981 Case 2 – History 13yo F Rash appeared yesterday, started on her trunk and spread to arms and legs Small red spots, do not blanch Not itchy, no blistering Feeling generally unwell with a fever and a headache No PMHx, DHx, NKDA Had measles as a child FHx – father had ITP Menti: 3510 4981 Case 2 13-year-old Miss Denver is brought into primary care with a rash. What are your top differentials now? What skills might they ask you to do? What investigations do you want? Menti: 3510 4981 Case 2 – Interpretation Mr Bloggs DOB: XX/XX/XXXX Blood test results: Hb: 120 (130-180) WBC: 22.0 (3.6-11.0) Plt: 75 (140-400) MCV: 96 (80-100) Neut: 9.4(1.8-7.5) Lymph: 3.6 (1.0-4.0) Menti: 3510 4981 Case 2 13-year-old Miss Denver is brought into primary care with a rash. How do you manage this patient?Case 2 – Management Menti: 3510 4981 My most likely diagnosis at this point is meningococcal meningitis with potential septicaemia, so I will describe the management of this. This will begin with an explanation of the diagnosis and management to the patient to ensure they are informed, but this is an emergency scenario. First, I would get my senior involved as I’m just a medical student.The likely management will require a referral to hospital.In the meantime, as we are in primary care we can give a STAT dose of IM benzylpenicillin, provided the patient isn’t allergic.We can also see what aspects of the SEPSIS 6 we can start in primary care, for example, taking a blood sample for lactate and blood cultures.We can also consider pain relief for her headache, progressing up the WHO pain ladder starting with paracetamol. Menti: 3510 4981 Case 3 15-year-old Miss Bendo is brought into the emergency department with abdo pain. You are the medical student that reviews her. Menti: 3510 4981 Case 3 – History 15yo F Abdominal pain and bloating for past few months Having diarrhoea over the same time – greasy, frothy Weight loss of 7kg over same time Feeling tired Trying to eat and drink normally, not dieting No trigger, no blood, no vomiting No PMHx, DHx, NKDA FHx – Mum has ulcerative colitis Menti: 3510 4981 Case 3 15-year-old Miss Bendo is brought into the emergency department with abdo pain. What are your top differentials now? What skills might they ask you to do? What investigations do you want?Case 3 – Interpretation Menti: 3510 4981 Normal bowel gas pattern No evidence of obstruction No evidence of dilatation No evidence of fractures in pelvis of vertebral column Menti: 3510 4981 Case 3 15-year-old Miss Bendo is brought into the emergency department with abdo pain. How do you manage this patient?Case 3 – Management Menti: 3510 4981 My most likely diagnosis at this point is Coeliac disease, so I will talk through the management of this. This will begin with an explanation of the diagnosis and management to the patient to ensure they are informed.They will need to start on a gluten-free diet, and therefore need education on what gluten is, and which foods are likely to contain it.For example, they should be advised to avoid wheat and barley, including bread and beer. It would be important to check for and correct any vitamin or iron deficiency that may have contributed to her tiredness. Patients with Coeliac disease have functionalhyposplenism, so will require the pneumococcal vaccine and a booster every 5 years.QUESTIONS Menti: 3510 4981