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      "title": "Asthma in pedatrics",
      "body": "- Asthma is a reversible obstructive airway disease characterized by swelling, secretions and airway spasm.\n- The diagnosis of asthma made using a breathing test called spirometry. As such, it is often difficult to formally diagnose young children who are not able to perform such a test.\n- This makes it difficult to distinguish between viral induced wheeze, bronchiolitis and asthma at a very young age.\n\n- Symptoms include: wheezing (musical sound on expiration), cough, shortness of breath\n- Common triggers include: respiratory tract infections, allergens, exercise, cold air, dust, pollen, medications (aspirin, b-blockers), passive smoking.\n- Risk factors: family history of asthma/atopy, maternal/passive smoking. Atopy - allergic rhinitis, eczema, atopic dermatitis\n\nDiagnosis: spirometry (pre/post bronchodilator), peak expiratory flow\n\nTreatment:\n- Treatment is based on severity of symptoms: mild, intermittent, persistent. This is based on frequency of exacerbations, the presence of interval symptoms, the amount of respiratory distress.\n- A stepwise approach should be consider based on severity:\n\n1. Short acting beta agonist (SABA) as needed\n2. SABA plus low dose inhaled corticosteroid (fluticasone, budesonide)\n3. SABA plus medium dose inhaled corticosteroid\n4. SABA plus medium dose ICS plus montelukast\n5. SABA plus high dose ICS plus montelukast\n6. SABA plus high dose ICS plus montelukast plus oral corticosteroid\n\nNote that LABA (long acting beta 2 agonists) are not recommended in young children (<5 years) due to lack of evidence. In older children LABA can be used to substitute montelukasts\n\nAdditionally, childnre with severe persistent asthma with evidence of allergic sensitisation and elevated IgE - an immunomodulator (omalizumab) may be considered.\n\nAll children with diagnosis or suspected asthma should receive an asthma action plan.",
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      "body": "- Aka laryngotracheobronchitis\n- Common upper respiratory tract infection accompanied with a distinct 'seal like' barking cough and occasionally with stridor, hoarse voice and respiratory distress.\n- The symptoms are a result of upper respiratory tract inflammation resulting in narrowing of the upper respiratory airways.\n- Most commonly occur in those between 6months-6years, male, symptoms usually worse at night\n\n- Croup can be mild (barking cough without any increased work of breathing), moderate (barking cough with stridor and \nmoderated increased work of breathing), severe (barking cough with severly increased work of breathing, lethargy /agitation).\n- Mild/Mod croup can be managed with corticosteroids (dexamethasone, prednisone) and nebulised adrenaline.  Nebulised adrenaline is often given in moderate croup, its effects will last for ~2hrs. Patients may be discharged home after a period of observation.\n- In severe croup the above are required along with supplement oxygen. If the patient does not improve or there is risk of respiratory failure - intubation is considered.\n\n- Diagnosis is clinical. However on chest x-ray the steeple sign (narrowed trachea) is a classical finding on AP view\n- However other diagnoses to consider are:  epiglottitis, bacterial tacheitis, foreign body inhalation, peritonsillar abscess, congenital tracheo/bronchomalaecia.",
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      "title": "Febrile Seizures",
      "body": "- Febrile convulsion is a seizure that usually occurs from 3-6months of age (but can occur in those up to 5 years of age) with associated fever (>38 degrees Celsius) without acute intracranial disease, metabolic disturbance or CNS infection.\n- Most febrile seizures last between 1-3 mins and spontaneously resolve - these patients needs to be monitored in the emergency department and often do not require admission and the condition is self limiting.\n- Diagnosis is clinical. The important thing to the presence of seizures with an associated high temperature. It is important to exclude other possible causes of seizure.\n- Risk factors include: family history of febrile seizures, previous febrile seizures, febrile illness (such as underlying viral or bacterial infection), young age, high temperature .\n\nTypes:\n- Simple febrile seizure: self limiting\n- Complex febrile seizures: focal findings, prolonged >15mins, multiple within 24 hours or multiple without incomplete recovery between each episode.\n- Febrile status epilepticus: prolonged seizure or one that does not recover  - treat as per status - rectal/PO benzo +/- IV diazepam +/- fosphenytoin.\n\n- If seizures are lasting >5 minutes - then medication is required to stop the seizure, this is done to reduce\n- Choice of medication: midazolam (buccal, IN) or rectal diazepam and repeat after 10 mins if required. If still ongoing seizures -> antiepileptics are given including IV fosphenytoin. Consultation with paedatrician is recommended if prolonged seizure without adequate response to antiepileptics.\n\nReasons for hospital admission:\n- uncertain focus of fever\n- uncertain cause of seizure\n- complex febrile seizure\n- prolonged post ictal phase\n- focal neurology\n\nPatient information:\n- Febrile seizures gives 35% of having another febrile seizure\n- Febrile seizures gives patient slightly higher chance of developing epilepsy or non-febrile seizure later in life (5%). This percentage is higher if initial febrile seizure is complex (10-15%)",
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