Paediatric as HO

Paediatric books to study in HO

In our hospital when I am in paediatric department posting, mainly using the paediatric protocol book. It is quite important as we use it when we have presentations in department. 

Other than paed protocol, I found that the following other books and website is also useful. 

Neonate Paediatric / Oncology paediatric:

Paediatric Protocol

MOH Paediatric Protocols for Malaysian Hospitals, 4th edition

General Paediatric:

 Ampang guideline

https://myhow.files.wordpress.com/2013/11/hoguidepeds1.pdf

Physical examination:

MRCPH website

https://mrcpch.paediatrics.co.uk/

Medications

Frank Shan book

**highly recommend to get the physical copy, as some alignment in the ebook is not as accurate. 

Things to prepare:

• Pens
• Measuring tape
• Mini calculator (either those pocket size or the ones that you can hang on your landyard)
• Scissors
• Durapore

Notes to bring along

• Fluid requirements 
• Growth development
• Growth chart
• Normal readings of blood test
• Normal values for vital signs (RR, BP percentile) 
•  it is quite challenging and difficult to memorise the whole chart, easier to bring it around and refer when needed. 
• mini toy/ cute things 
• (to help kids to calm down before any procedures, eg: taking blood/ punctures)
• I have a mini duck with me most of the time, and i find it very useful in making the kids happy and cooperate. However later on I realise they just like anything that is in bright colour, not necessarily toys.  Even a cute plaster could make them feel so happy. 

Good Attitude

• kids are often affected by our mood/ emotions, so do make sure you are treating them with joy, patience and love.

* Always stay vigilant, observant and a good attitude helps you get through paediatric posting. 

You might enjoy it in the end too!

Abdominal examination for paeds

Abdominal examination:

 

General Examination

• General surroundings
• equipments : NG tube/ PEG tube
• nutrition: milk, food
• Growth chart
• Hand
• finger clubbing
• crt, pulse volume, warm/cold peripheries
• rashes? 
• Face
• eyes: anemia? edema?
• mouth: gum bleed/ hydration
• cyanosis
• overall inspection
• Neck
• spider naevi
• inflammation/ edema on the neck
• lymph node
• Abdomen
• Inspection
• shape
• distension
• masses
• rashes/scar/striae/stoma 
• Palpation
• pt should be in supine position, gently ask if it is comfortable to lie down if having abdominal distension
• superficial, deep palpation
• liver/ spleen/ kidney palpation/ abdominal mass
• Percussion
• shifting dullness/ fluid thrill
• Auscultation
• resonance/ dull
• Lower back
• sacral edema?
• Lower limbs
• pedal edema

Sample video

Special cases

• Nephrotic syndrome : ascites/ periorbital edema/ pedal edema/ sacral adema/ pleural effusion

Causes of hepatomegaly

• 1.  Structural: Extrahepatic biliary atresia, choledochal cyst, intrahepatic biliary hypoplasia, congenital hepatic fibrosis, polycystic disease

  2 . Storage/ metabolic:

    – Carbohydrate- glycogen storage disease (Type 1,3,4,6), hereditary fructose intolerance, galactosaemia,, mucopolysaccaridoses-

  – Mineral: Wilson’s disease, juvenile haemachromatoses

  -Nutrition: Protein calorie malnutrition, TPN-Bile flow: progressive familial intrahepatic cholestaisis syndrome

  -Protease: Alpha-1-antitripsin

  -Electrolyte: CF

  – Amino acid: Tyrosinaemia type 1, urea cycle disorder

  -Lipid – Gaucher, Nieman-Pick diease, cholesteryl ester storage disease

  3. Haematological: Thalassaemia, sickle cell disease, ALL, AML CML

  4. Heart/ Vascular: Congestive heart failure, constrictive pericarditis, obstructive IVC, Budd-Chiari syndrome

  5. Infection: Viral – rubella, CMV, coxsackie virus, echovirus, hepatitis ABCDE, EBV  ; Bacteria – E.coli TI, TB, syphilis ; Parasite – Malaria, toxoplasmosis, Schistosomiasis

Reference: 

1. https://mrcpch.paediatrics.co.uk/abdominal/abdominal-examination-guide/