Paediatrics

practical

IMMUNISATION
IAP IMMUNIZATION SCHEDULE
TETANUS
 RABIES VACCINE
Vaccines
1. Cell Culture Vaccines
Human Diploid Cell Vaccine (HDCV)
Purified Chick Embryo Cell Vaccine (PCEC)
Purified Vero Cell Rabies Vaccine (PVRV)
2. Purified Duck Embryo Vaccine:

INTRA-MUSCULAR (IM) REGIMEN

Essen Schedule:
This is a five dose intramuscular regimen.
The course for post-exposure prophylaxis should consist of intramuscular
administration of five injections on days 0, 3, 7, 14 and 28.
-deltoid region.

INTRA-DERMAL (ID) REGIMEN

Updated Thai Red Cross Schedule (2-2-2-0-2).
This involves injection of 0.1ml of reconstituted vaccine per ID site
and on two such ID sites per visit (one on each deltoid area, an inch
above the insertion of deltoid muscle) on days 0, 3, 7 and 28. The day
0 is the day of first dose administration of IDRV and may not be the
day of rabies exposure/animal bite.
 VITAMIN A SOLUTION

Vitamin A (VA) is an essential nutrient needed in small amounts for

the normal functioning of the visual system, growth and
development, maintenance of epithelial cellular integrity, immune
function and reproduction.

Severe deficiency of VA is known to produce corneal

xerophthalmia, keratomalacia and blindness in children.

Vitamin A solution should be administered using only the

spoon/dispenser provided with each bottle. The half mark in
the
spoon indicates 100,000 IU and a level full spoon contains
200,000
IU of Vitamin A.
100000 IU at 9 months with measles immunization,
200000 IU at16-18 months, with DPT booster and
200000 IU every 6 months, up to the age of 5 years.
DRUGS
 INJ PHENYTOIN SODIUM
• Anticonvulsant (especially IV
•What are the clinical uses of
phenytoin is the drug of
Phenytoin?
• choice in status epilepticus
•How do you administer IV
beyond neonatal age group),
phenytoin?
antiarrhythmic action is also
•What is the serious side effect if
there.
administered rapidly?
• It should be diluted and given at
•What are the 2 important side
a rate not more than
effects following long
• 1mg/kg/minute
term use of phenytoin which can
• Cardiac Arrhythmia, Gum
be prevented?
hypertrophy, hirsutism.
 INJ PHENOBARBITONE

• Anticonvulsant
• What is the clinical use? • Monitor respirations while
•What clinical parameter is to be giving it IV.
monitored while giving • It can increase the excretion of
this medicine intravenously? bilirubin by increasing liver
•Is there any other clinical use metabolism, so used in
for the same oral neonatal jaundice as well as
medicine? some cholestatic liver diseases
like neonatal hepatitis
syndrome.
 INJ ADRENALINE

•What are the clinical uses? Anaphylaxis, cardiac arrest,

•What are the doses? shock, croup
•What are the possible routes of syndrome, as local
administration? vasoconstrictor.
Doses & routes
Usual dose: 0.01ml/kg subcut
in anaphylactic shock, give IM,
in croup: < 6 months 2.5ml and
> 6 months 5ml
undiluted adrenaline
nebulized.
In cardiac arrest use IV
0.01ml/kg (diluted 1:10)or
intra tracheally
0.1ml/kg(undiluted)
 INJ HYDROCORTISONE

What are the clinical uses? •Acute severe asthma

•Anaphylaxis
•Hypo adrenalism
•Shock
INJ DEXAMETHASONE
 INJ DIAZEPAM

•What is the dose of IV •0.3 mg/kg/dose

diazepam? •Risk for respiratory
•What care should be taken depression is there ,so it
while giving iv diazepam? should be
monitored. The rate of IV push
should not be more
than 4 mg/minute.
MIDAZOLAM
 DIGOXIN

1. What are the indications? 1. Congestive cardiac failure

2. What are the Supraventricular tachycardia
contraindications? 2. Constrictive pericarditis,
3. Common side effects? Hyperkalemia
3. Vomiting, Cardiac arrythmias
 INJ SODIUM BICARBONATE
1. Available in 7.5% and 8.4%
strengths
2. Indications
1. What all strengths are available? Severe metabolic acidosis( inborn
2. What are the clinical indications for errors of metabolism, diabetic
IV ketoacidosis, salicylate
sodium bicarbonate? poisoning) TOF with cyanotic spell
3. How do you administer this drug? Hyperkalemia 3.

Dilute 1:1 with sterile water or Normal

saline and
administer as slow IV(1
meq/kg/minute).
 INJ CALCIUM GLUCONATE

1. What are the clinical 1. Clinical indications

indications for IV Ca gluconate? • 1. Symptomatic hypocalcemia
2. What precautions should be (tetany/seizures)
taken while giving IV ? • 2. Hyperkalemia: Protects the heart
from the
• arrhythmogenicity of potassium
2. It is a vesicant drug. So patency of IV
line should be verified before giving it.
Also, it should be given very slowly after
dilution with normal saline, monitoring
heart rate. Stop infusion if there is
bradycardia < 60/min.
 INJ POTASSIUM CHLORIDE

What are the clinical situations in Severe vomiting, diarrhea,

which a patient may continuous naso- gastric
get hypokalemia? aspiration, during treatment
•What is the danger of IV for diabetic ketoacidosis.
potassium chloride? Sudden IV push can cause
cardiac arrest.
 INJ DEXTROSE

1. What are the clinical Symptomatic hypoglycemia.

indications? 5%, 10%, 25%. Up to 10%, we
2. What are the concentrations can give through
available and up to peripheral line. Beyond that we
what concentration we can give have to use central line.
through a
peripheral line?
 IV FLUID: RINGER LACTATE

•What are the clinical uses? •It is a crystalloid. Used as

•What is the concentration of volume expander in severe
sodium in this? dehydration, acute
hemorrhage, shock etc.
•Sodium 130meq/l (other
contents are potassium 4,
calcium 3, chloride 109, lactate
28 meq/l)
 ISOLYTE P

What is the use of this fluid? This is the pediatric

•How much fluid you will advice maintenance fluid. Given
for a 15 kg child? when oral intake is not possible
or is contra
indicated.
Calculation is by Holliday Segar
formula.
Up to 10kg: 100ml/kg/day.
11-20kg: 1000ml+ 50ml/kg for
each kg above 10kg.
More than 20kg:
1500ml+20ml/kg for each kg
above
20kg.
 IV FLUID: NORMAL SALINE

• What are the uses? •Uses are same as that of

Ringer Lactate.
• What is the concentration
•More preferred fluid to treat
of sodium in this? shock.
•Sodium 150meq/L
 ARTESUNATE

Artesunate is reconstituted with

sodium bicarbonate.

The dose of ARTESUNATE

is 2.4 mg/kg for patients
weighing >20kg and 3 mg/kg
for <20 kg.

and that of ARTEMETHER 3.2

mg/kg given stat and then
repeated after 12 hr and 24 hr
and then daily.
Quine causes hypoglycemia =>
add with Dextrose.
 SYRUP OSELTAMIVIR

What is the clinical indication? Antiviral drug for H1N1

•How do you diagnose this Definite diagnosis requires
disease? nasal and throat swab viral
culture/PCR. Most of the time
treatment is given
without waiting for the reports
if there is strong clinical
suspicion.
 INJ AMINOPHYLLIN

1. What are the indications ? 1. Acute severe asthma, Apnea

2. What are the side effects? of prematurity
2. Arrhythmia, Convulsions
PARACETAMOL
CHLORPHENIRAMINE
CETRIZINE
IRON
INJ FRUSEMIDE
 ORS
Oral rehydration salt
INSTRUMENTS
MUAC TAPE
AMBU Bag / SIRB- Self Inflating Resuccitation bag

Q. Indications of
AMBU:
• Fish mouth valve
•
•
Pop up Valve
Inlet Valve
Isafer
• Proper pressure
Valve
OXYGEN FACE MASK (PAEDIATRICS)

Q. What is the flow

rate

• Prong- 1-2 L/min

• Mask- 5-6 L/min
• Oxygen hood- 5-10
L/min
NASAL PRONG
NASAL CATHETER/CANNULA
OXYGEN HOOD
ENDOTRACHEAL TUBE
MDI & Spacer

• Used for prophylaxis

• in persistent asthma
• Correct technique is
• to be taught to the
• child and parents
• Parts to be explained
• clearly
Q. Parts of MDI:
S abeasPulses
bean and Pall
07
soya 4
- Ric
Rice
-
lk Banana
Eg
÷
89-

50
/
cal 100
gm
=

F-
gm protein
0.5

and 0.5qu
profen
FEEDING TUBES
Indications
– stomach aspiration – poisoning
etc..
– Nasogastric feeding
• Different sizes are available No.5-
No 10 are used at
various ages for infants

The length to be inserted is

measured from the nostril to the
tragus of the ear and then to the
Xiphi sternum. Once inserted push
air through the tube & auscultate
over the epigastrium to check
position
 UMBILICAL CORD CLAMP

Q. Identify- Cord Clamp

Q. What distance from the
umbilicus, it is attached
Q. On which day after birth, the cord
falls

The umbilical cord should be clamped at 2-3 cm away

from the abdomen using a commercially available
clamp, a clean and autoclaved thread or a sterile rubber
band. The stump should be away from the genitals to
avoid contamination. The cord should be inspected
every 15-30 minutes during initial few hours after birth
for early detection of any oozing.
LUMBAR PUNCTURE NEEDLES

• Instrument
– Sterile spinal needle with stellate, 22 – gauge (black),
length according to age (1.5-3.5 inch)
• Indications
– Diagnostic
• CNS infections like meningitis, encephalitis,
subarachnoid hemorrhage, pseudotumor cerebri,
inflammatory CNS diseases like Guillain – Barre
syndrome
• Instillation of intrathecal dye for imaging
procedures (e.g.: myelography )
• Measurement of CSF pressure.
Therapeutic
• Instillation of intrathecal medications
( e.g.: chemotherapeutic CNS prophylaxis in
leukemia, tetanus immunoglobulin in tetanus ,
rarely antibiotics in severe meningitis)
• Spinal anesthesia
CONTRAINDICATIONS
• Elevated Intracranialpressure owing to a
suspected mass lesion of the brain or spinal
cord.( So fundus examination & head CT are
mandatory)
• Severe respiratory distress & shock etc. as that
may worsen with positioning in flexion.
• Thrombocytopenia. ( ˂ 20,000 cells/mm3 )
• Local infection at the site

COMPLICATIONS
• Post LP headache and backache
• Iatrogenic meningitis
• Cerebral herniation in sudden drop of elevated
intracranial pressure.
Bone Marrow Biopsy needle

Instrument
•Jamshidi trephine biopsy
needle
Site
•Posterior iliac spine
Indication
• Dry tap in BMA
• Suspected Aplastic
anemia and myelofibrosis
I V Canula