Dr Sandeep Kumar
Associate Professor
Department of Paediatrics
KMC Manipal
INSTRUMENTS
DRUGS AND VACCINES
NUTRITION SPECIMENS
Infant feeding Tube
Red rubber catheter
Oral airway
Nasopharyngeal airway
Endotracheal tube
Laryngoscope
AMBU Bag with reservoir
LP needle
Bone marrow needles-aspiration, biopsy
Trucut biopsy needle
Gun biopsy needle
How to determine the correct length? (size 5-
12).
How to confirm its position in the gut?
Indications:
Diagnostic- TEF, upper GI bleed, gastric lavage-
AFB, choanal atresia, MCU.
Therapeutic- Feeding, drugs, Intestinal obstrn,
gastric lavage-poisoning. Can be used as urinary
catheter. ET tube suctioning. Rarely as oxygen
catheter.
Contraindication- ?
Uses: soft, non traumatic
Urinary-
Diagnostic: Sterile urine collection, diff b/w
anuria or retention, radiological evaluation.
Therapeutic- Acute retention, bladder
irrigation, intermittent catheterization.
Non urinary: As flatus tube, enema, bowel
wash, oral/nasal suctioning, as tourniquet-IV
line, Snake bite.
To maintain patency of airway
-Comatose patients
-Seizures.
Technique of insertion.
Nasopharyngeal airway
In conscious/
Semiconscious patients.
2 types- Self inflating bag
Flow
inflating/Anaesthesia bag.
Advantage of reservoir- 100% O2.
Size- 250cc,500cc,1000cc,1500cc.
Pressure- 30-40cm H20, preterms-1finger pressure,
2kg-2 finger, >3kg-4 finger..
Masks: Anatomical shaped/rounded
E & C technique.
Indications-PPV
Contraindications-
Diaphragmatic hernia
? Meconium aspiration
Parts- Adaptor, tube,
murphy’s eye, balloon,
balloon inflating tip, vocal
cord guide.
Cuffed tube preferred in >8yrs
Size- Internal diameter- Age/4 + 4 (size 2.5 to 7).
For cuffed tube- Age/4+3.5
Length/Depth of insertion- Age / 2 + 12, ET size
x3
Technique of intubation.
Sellick’s maneuver- applying cricoid pressure
How to confirm the position?
Indications: PPV, resuscitation, GA.
Complications- Trauma, infection, bleed,
pneumothorax
Technique of sterilization- EO.
Parts- Blade: Straight- Miller, Curved-Macintosh. Light
source.
Age group Size of
Size- 0- preterm
the blade
1- term neonate and infants
Preterm and LBW 0
2 & 3- older children. neonates
Learn the technique of fixation Term and para 1
neonates
2-10 yrs old 2
> 10 yrs old 3
LP needle
Parts- needle, stylet
Site- L3-L4/L4-L5
Indications-
Diagnostic- CNS infections, SAH, GBS, MS
Therapeutic- spinal anesthesia, chemotherapy,
antibiotics, Tetanus Immunoglobulin, decrease raised ICT.
Contraindications-Papilledema, local site infection.
Post LP care- Head low position
? Guarded LP
CSF normal and abnormal values
BM aspiration needle
Salah’s / Klima’s
Parts- needle, side screw guard- 2 cm from the tip., stylet.
Site- PSIS, Iliac crest, tibia, sternum.
Indications- Diagnostic-
Anaemias- Dimorphic, Megaloblastic,
Sideroblastic
Pancytopenia- Aplastic anaemia
ITP
Malignancies- Leukaemias, Lymphoma
Infections: PUO, Enteric fever, Kalazar
Storage disorders-Gaucher’s, Neimann Pick
Myelofibrosis
Therapeutic- BMT, Intraosseous line
Contraindications-
Jamshidi’s trephine biopsy needle.
Indications- “Dry tap”
Liver biopsy needle-Trucut biopsy
needle
Site- 9th or 10th intercostal space in the mid
axillary line.
Indications- Chronic hepatitis, cirrhosis,
unexplained jaundice, metabolic liver disease,
malignancy.
Contraindications- PT
Semi-automatic disposable/Bard Biopsy gun needle.
Site- USG guided, below 12th rib, lateral to the
sacrospinalis muscle.
Indications-
Acute Glomerulonephritis-RPGN, Delayed resolution- Oliguria,
hypertension, azotemia persisting beyond 2 weeks
Nephrotic syndrome- atypical, Steroid resistant, low C3, prior
to Cyclosporin therapy.
Acute kidney injury- Unremitting acute kidney injury lasting
more than 2 to 3 weeks
Systemic diseases- SLE, HSP
Contraindications- Uncontrolled HTN,Bleeding
diathesis, local infection
Antibiotics: Group, MOA, dose, spectrum,
indications, adverse effects
Crystalline/Benzyl penicillin-
Dose-1-2 lakh u/kg/day q4-6hrs.
Indications- Pneumo, strepto,meningo,gono.
Diphtheria, Tetanus, Plague, syphilis. Leptospira.
Amoxycillin/Co-amoxyclav- Semisynthetic-extended
spectrum. Clavulenic acid-beta lactamase inhibitor.
Oral- 30-50mg/kg/day q 6-8h.
IV- 80-100mg/kg/day q 6-8h.
Cloxacillin, Ampilox- Anti staphylococcal.
Piperacillin- tazobactam- Antipseudomonal.
Ceftriaxone- 3rd gen cephalosporin.
Cefoperazone-sulbactam
Amikacin- 15-20mg/kg/d, nosocomial
infections, ATT.
Gentamicin- 4-5mg/kg/d.
Hydrocortisone: 2-5 mg/kg.
-Status asthmaticus, anaphylaxis, Addison’s
disease, CAH.
In shock- 10mg/kg or 50-100mg/m2 BSA.
Dexamethasone: 0.1-0.3mg/kg/dose.
- Cerebral edema, shock, dexamethasone
suppression test
Adrenaline – Ind-Cardiac arrest,
bronchospasm, anaphylaxis, shock, Croup,
hypoglycemia, local as vasoconstrictor.
1mg-1ml, 0.01mg/kg,1:1000, IM in
anaphylaxis, IV/IO/Endotracheal in CPR.
Shock- 0.05-1mic/kg/min
Atropine- ind- Bradycardia, preanaesthetic,
antidote for OP poisoning,
OP poisoning-0.02-0.05mg/kg/dose
Calcium gluconate: 10%, 1ml of 10% =9mg of
elemental calcium (0.45mEq)
1-2ml/kg IV infusion over 10-15min
Ind- Hypocalcaemia, Hyperkalemia, antidote
to Verapamil, Mgso4
Adv- Rapid administration-bradycardia,
cardiac arrest, subcutaneous extravasation.
Sodium Bicarbonate- dose 1-2ml/kg/dose of
7.5%. To correct metabolic acidosis,
resuscitation post cardiac arrest,
hypercyanotic spell in TOF, hyperkalemia
Adv- respiratory acidosis, extravasation
Potassium Chloride: 15%, 1ml=2mEq K
Ind- Hypokalemia, Malnutrition, Euthanasia
Dopamine & Dobutamine
Anticonvuslants-Diazepam, Midazolam,
Phenobarbitone, Phenytoin
OPV/IPV
MMR
Hep B
Td vac/dTaP/TT
DPT/DTaP
BCG
Rotavirus
Hib
Pneumococcal
Item Calories/100g Protein/100g
Rice 350 (175) 7 (4)
Egg 173 13.3
Rice
wheat 350 10-11
Ragi 330 7
Bengal gram(Channa 360 17
dal)
Black gram (urad dal) 340 24
Green gram (Moong 340 24
dal)
Red gram (Toor dal) 340 22
Ground nut 560 25
Banana 110 1.2
Drumstick leaves 90 6
Jaggery 350 0.4
Sugar 398 0.1
Mustard 540 20
Ragi-
Supplementary action of proteins
Parboiling
Reference protein
NPU
Amylase Rich Food
Energy Dense Food
MALNUTRITION “MALL”NUTRITION