Minor Illnesses & Common Pediatric Procedures
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This document discusses common minor illnesses and pediatric procedures related to anesthesia. It covers issues related to canceling surgeries and reasons for postponing procedures, such as optimizing a patient's clinical condition. Common illnesses that may impact anesthesia include respiratory issues like colds, ear infections, and asthma. The document provides guidance on murmurs, noting most in children are innocent, and outlines considerations for general anesthesia with upper respiratory tract infections. It also addresses the effect of general anesthesia on immunity and vaccination.
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This document provides an overview of congenital heart disease (CHD) in children, including:
- The incidence of CHD is 7-10 per 1000 live births, with some forms being more common in premature infants. The most common types are ventricular septal defects and atrial septal defects.
- CHD can be classified based on the direction of blood shunting (left-to-right or right-to-left), presence of mixing lesions, or obstructive lesions. Examples of different types of CHD are provided with diagrams.
- Management of CHD depends on whether the heart defect is uncorrected, partially corrected, or completely corrected. A multidisciplinary approach is needed and
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The document discusses the effects of diabetes mellitus on lung health and function. Diabetes can damage the lungs through microvascular complications and cause structural changes in the lungs over time. It increases risks of various pulmonary infections due to impaired immune function in diabetics. Lung function tests often show reduced volumes, elasticity, gas exchange and diffusion in diabetic patients compared to healthy individuals.
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This document summarizes the health effects of smoking. It states that smoking is a learned habit that is culturally established, and is the leading cause of avoidable illness and death worldwide. Smoking causes over 60 million deaths between 1950-2000 in developed countries, and tobacco-caused deaths are expected to increase to 10 million per year by 2030, most occurring in developing countries. Half of regular smokers will eventually be killed by their habit.
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The document compares mechanical ventilation strategies for acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD). For ARDS, the strategies aim to prevent volutrauma and barotrauma by limiting tidal volumes and airway pressures. Positive end-expiratory pressure (PEEP) is used to recruit alveoli and keep airways open. For COPD, the goal is to increase oxygen levels while allowing longer expiration to prevent auto-PEEP. Non-invasive ventilation can help both conditions but invasive ventilation may be needed for severe COPD exacerbations or if non-invasive methods fail.
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This document describes the case of a 2-month-old male infant who presented with respiratory distress after being referred from another hospital. The child had experienced a seizure the previous day involving all four limbs and became unresponsive, requiring CPR and intubation. On admission, the child was irritable with inspiratory stridor and a fever. Initial workup showed laryngomalacia and bronchiolitis. During hospitalization, the child had two additional cardiac arrests and was treated with ventilation and antibiotics. Further workup including imaging, lumbar puncture, EEG and echocardiogram was negative. The child remained hospitalized for management and observation.
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This case report describes a 17-year-old male college student presenting with occipital headache, blurred vision, and vomiting for two days. His history revealed similar complaints three months prior when he was diagnosed with hypertension but did not take medications regularly. On examination, his blood pressure was elevated at 210/120 mmHg and fundoscopy showed grade 1 hypertensive retinopathy. Investigations showed abnormal renal function and echocardiogram revealed left ventricular hypertrophy. CT brain showed findings suggestive of posterior reversible encephalopathy syndrome. Based on his history of poorly controlled hypertension, family history, examination findings, and investigation results, he was diagnosed with secondary hypertension likely due to chronic kidney disease.
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This document provides guidance for medical interns on case sheet writing and obtaining patient consent. It outlines the necessary components of a case sheet including demographics, history of present illness, past medical history, examination findings, diagnostic testing, treatment plan, and discharge instructions. Tips are provided for taking a patient's history such as introducing oneself, speaking softly, and avoiding hurtful language. The different types of consent are defined including informed consent, written consent, and high risk consent. Obtaining proper consent is emphasized as an important part of hospital practice.
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1. The document outlines the essential components of taking a history for cardiovascular issues, including the presenting complaint, past medical history, drug history, family history, and social history.
2. Key symptoms to inquire about include chest pain, shortness of breath, fatigue, palpitations, syncope, and edema. Additional symptoms like cough and limb pain may also indicate cardiovascular problems.
3. When evaluating the presenting complaint, details like onset, duration, severity, and exacerbating/relieving factors provide important clues to the diagnosis. A systems review helps identify any related symptoms.
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This document provides guidance on performing a history and physical examination for patients with potential cardiovascular issues. It outlines key components of the history, including presenting complaint, past medical history, medications, family history, and lifestyle. The physical exam section describes inspecting the patient for clues like cyanosis, edema, and clubbing, as well as examining vital signs, pulse, jugular veins, heart, and edema. Taking a thorough history and performing a detailed physical exam are important for accurately diagnosing cardiovascular conditions.
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- 1. MINOR ILLNESSES AND COMMON PAEDIATRIC PROCEDURES Interac6ve Discussion Dr Moataz Abdelrahman Consultant Paediatric Anaesthe2st Central Manchester University Hospitals Royal Manchester Children’s Hospital, UK
- 2. CANCELLATION • Problems with cancella6on of surgery – Pa,ent – Family – System • Why postpone – Op,mise clinical condi,on • Individual basis – Be?er resources/equipment – ICU – Monitoring – Inves,ga,on – Other
- 3. COMMON ILLNESSES • CVS – Murmurs • Respiratory – Cold – Cough – Laryngi,s/tonsilli,s middle ear – Asthma • Infec6ons – Rashes – Temperature – Diarrhoea and or vomi,ng – Local eye infec,on – Urinary tract infec,on
- 4. • Miscellaneous – Immuniza,on – Child on an,bio,cs – Child on an,epilep,c medica,ons
- 5. Murmurs The vast majority of children found to have a murmur pre‐opera7vely have an innocent murmur • Innocent murmurs – SoK – Early systolic – No thrill or abnormal cardiac impulses – Not associated with cardiac signs or symptoms • Pathological murmurs – All diastolic murmurs – All pansystolic murmurs – Late systolic – Cardiac signs or symptoms
- 6. Murmurs • If a child is found to have a murmur prior to elec6ve surgery a history and cardiac examina6on should be performed and an ECG done • In the presence of a murmur an echocardiogram and cardiac opinion is indicated prior to surgery if: – The child is younger than a year – The murmur fits pathological criteria – There are cardiac signs or symptoms – Evidence of LVH or RVH
- 7. Upper Respiratory Tract Infec6on • GA in URTI is associated with: – Hypoxaemia – Laryngospasm – Bronchospasm – Death Overall risk of events 2‐7 ,mes With ETT risk of events 10 ,mes
- 8. • Consider GA in URTI (mild) – Not unwell – Clear nasal discharge – Clear chest – Age ≥ 5 years – Age 1‐5 years assess risk/benefit • Postpone Surgery in URTI – Fever ≥ 38°C (37.5°C) – Mucopurulent nasal secre,ons – Lower repiratory symptoms/signs – WCC – Age < 1 year even with mild URTI ?
- 9. VACCINATION • Effect of GA on immunity • Symptoms and signs interfering with post‐opera,ve complica,ons clinical picture • Recent DOH opinion Paeds guidelines/vaccina,on.pdf – Imminent GA – Imminent Surgery " NOT A CONTRAINDICATION TO VACCINATION
- 10. THANK YOU