PEDIATRICS
Practical
Pediatric Instruments – Viva Revision Table
Instrument Image Name of Uses, Indications and Complications
Instrument
1 IV Cannula Uses: IV access for fluids, medications,
Yellow (24G - blood transfusion.
infants)
Blue (22G -
children)
Pink (20G -
older children)
By SASWAT ABHIGYANAM
2 IV Set / Used for IV fluid administration in
Pediatric Drip pediatric patients.
Set IV Maintenace
•IV solution bags and syringes are to be
replaced at least every 24 hours
•IV tubing is changed at a minimum of
every 96 hours for continuous infusions
(Intermittent and lipid containing IV
tubing is changed very 24 hours)
Complications:
Infiltration,
Site infection,
hematoma,
phlebitis.
3 Lumbar INDICATIONS:
Puncture Diagnostic
Needle [Link] infections like meningitis,
encephalitis, subarachnoid hemorrhage,
pseudotumor cerebri, Guillain –Barre
syndrome.
II. Instillation of intrathecal dye for
imaging procedures (e.g.: myelography)
III. Measurement of CSF pressure.
Therapeutic
I. Instillation of intrathecal medications
(e.g.: chemotherapeutic CNS prophylaxis
in leukemia, tetanus immunoglobulin
in tetanus , rarely antibiotics in severe
meningitis)
II. Spinal anesthesia
Contraindications
▪ Elevated Intracranial pressure 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
By SASWAT ABHIGYANAM
Complications
• Post LP headache and backache
• Iatrogenic meningitis
• Cerebellar herniation in sudden drop
of elevated intracranial pressure
4 Bone Marrow Indications
Aspiration • Diseases like leukemia, to detect
Needle marrow infiltration in disorders like
(Salah) lymphomas and other non-hematologic
malignancies.
• To rule out malignant process in ITP
before starting steroid therapy
• Bone marrow culture in diseases like
typhoid, malaria
5 Jamshidi Indication: dry tap in BMA suspected
Trephine aplastic anemia, myelofibrosis.
Biopsy Needle Site: posterior iliac spine.
6 Oxygen Hood Oxygen delivery to infants.
Flow: 10–15 L/min.
7 Oxygen Face Short-term oxygen therapy.
Mask Flow: 6–10 L/min.
By SASWAT ABHIGYANAM
8 Nasal Cannula • Offers low flow O2 concentration for
extended periods of time.
• Maximum O2 flow should be 2
Liters/min for newborns and infants.
• Maximum O2 flow for older children
should be 4 Liters/min
9 Bag & Mask Indications:
(Ambu Bag) respiratory failure, apnea, airway
protection, preoxygenation before
intubation.
10 Endotracheal ENDOTRACHEAL INTUBATION
Tube •Indications: Assisted ventilation
•Drugs through ET route: Surfactant
administration in newborn RDS
•Sizes based on age
Preterm: 2.5-3.0,
term: 3.0 –3.5,
6 months: 3.5 –4.0,
1 yr: 4.0 –4.5
•For 2 -10 years –
i). UncuffedETT (mm): (Age/4) + 4,
ii). Cuffed tube (mm): (Age /4) + 3.5
•ETT depth (from lip to mid trachea) in
mm: ETT internal diameter (size) x 3
By SASWAT ABHIGYANAM
11 Laryngoscope Laryngoscope
•Straight i.e. Miller for < 2 years or
difficult airway
Sizes ->
# 00 -1 for premature to 2 months age
# 1 for 3 months to 3 years
# 2 for > 3 years
•Curved i.e. Mac more effective > 2
years
sizes –
Mac #2 for >2 years
Mac # 3 for > 8 years.
12 Nasogastric Indications: gastric aspiration,
Tube poisoning, NG feeding.
1. Different sizes are available No.5‐No
10 are used at various ages for infants
2. The length to be inserted is measured
from the nostril to the tragus of the ear
and then to the xiphisternum. Once
inserted push air through the tube &
auscultate over the epigastrium to check
position
13 MDI with Used for asthma prophylaxis.
Spacer
14 Foley Urinary catheterization and drainage.
Catheter
By SASWAT ABHIGYANAM
Drugs Quick Revision Table
Drug Dose Main Indications Routes Important Viva Side Effects
Points
Paracetamol 10–15 Fever, Pain Oral, IV, IM, Formulations: —
mg/kg/dose Rectal syrup, drops,
tablet,
suppository
Ceftriaxone (Inj.) 50–100 Meningitis, IV 3rd generation —
mg/kg/day Septicemia, Enteric cephalosporin
fever
Ampicillin (Inj.) 50 mg/kg/dose Pneumonia, IV, IM Beta‑lactam Rash, Penicillin
6 hourly Bacterial infections (semisynthetic allergy
penicillin)
Vancomycin 40–60 MRSA, Meningitis, IV — Red Man
mg/kg/day Gram positive Syndrome
infections
Dextrose (inj) _ Symptomatic IV Available: 5%, —
hypoglycemia 10%, 25%;
Upto 10% via
peripheral line;
higher via central
line
Lorazepam 0.1 mg/kg Acute seizures IV, IM Formulation: 2 Respiratory
ml/4 mg injection depression
Midazolam 0.1–0.2 mg/kg Seizures, Sedation IV, IM, _ Respiratory
Intranasal depression
(possible)
Phenytoin (IV) Loading: 20 Anticonvulsant IV Dilute and give Cardiac
mg/kg Status epilepticus not more than arrhythmia; gum
(beyond neonatal hypertrophy;
age) 1 mg/kg/min hirsutism
Phenobarbitone _ Anticonvulsant _ Monitor Respiratory
Neonatal seizures respiration depression
during IV;
also used in
neonatal jaundice
(↑ bilirubin
By Saswat Abhigyanam
metabolism)
Adrenaline Anaphylaxis Anaphylaxis, Cardiac SC, IM, IV, Cardiac arrest —
shock; 0.01 arrest, Shock, Croup Nebulization, dose: 0.1 ml/kg
ml/kg (1:1000) Intratracheal (1:10,000) IV;
Croup
nebulization: <6m
2.5 ml, >6m 5 ml
undiluated
adrenaline
Hydrocortisone _ Acute severe _ Emergency —
asthma, steroid
Anaphylaxis,
Hypoadrenalism,
Shock
IV FLUIDS Quick Revision Table
IV Fluid Type / Clinical Uses Composition / Important Additional
Description Points Viva Points
Ringer Lactate Crystalloid Used as volume expander Sodium 130 mEq/L, Balanced
(RL) solution in severe dehydration, Potassium 4 mEq/L, electrolyte
acute haemorrhage, shock Calcium 3 mEq/L, Chloride solution
109 mEq/L, Lactate 28
mEq/L
Normal Saline Isotonic Same as RL Sodium 150 mEq/L More
(0.9% NS) crystalloid fluid preferred
fluid for
shock
Isolyte-P Neonatal Used when oral intake is Sodium 23 mEq/L (low Used for
maintenance not possible or sodium) neonatal
fluid contraindicated maintenance
DNS (Dextrose Pediatric Given used when oral Calculated by Holliday– Provides
Normal Saline) Maintenance intake is not possible or Segar formula glucose +
Fluid contraindicated sodium
First 10 kg: 100 ml/kg/day
11–20 kg: 1000 ml + 50
ml/kg for each kg above 10
>20 kg: 1500 ml + 20 ml/kg
for each kg above 20
By Saswat Abhigyanam