By Tim Barrett, A Lander, V Diwakar

An entire revision of this profitable pocketbook, the fourteenth variation of A Paediatric Vade-Mecum presents the junior surgeon and trainee grade paediatrician with important details at the analysis and administration of ailment in kids, and with functional evidence-based recommendation for the secure and potent administration of the ill child.

Retaining the easy-to-digest variety that has made prior variations so renowned, the content material has been restructed into 5 significant sections: acute paediatric difficulties, outpatient paediatrics, formulary, general values and thesaurus of phrases, with entries in sections 1 and a pair of organised alphabetically for ease of reference. Pre-registration residence officials, SHOs and SpRs in Paediatrics, and GPs in education shouldn't be with out a own replica.

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Ventricular tachycardia always has a wide QRS, usually dissociated from P-waves. It is uncommon but serious, having the potential to progress to VF. Treatment is by DC countershock. Discuss with a paediatric cardiologist, who may advise the use of IV lignocaine, amiodarone, disopyramide or magnesium. Congenital heart block usually occurs without other cardiac abnormality, or may be associated with congenitally corrected transposition. The following points should be noted. • It may cause cardiac failure in early infancy, and will then require cardiac pacing.

Human bite marks. Acute paediatrics 4. Ultrasound • Cranial USS may not detect subdural haemorrhage. Highresolution cranial USS may show shear clefts in the brain sustained in shaking injury if MRI is not available. • Abdominal USS is indicated when abdominal trauma is suspected. qxd 9/6/02 5:37 PM Page 36 Acute paediatrics 36 • CHILD ABUSE AND PROTECTION AWARENESS • Undiagnosed coma (drug or carbon monoxide poisoning). • Salt poisoning and water intoxication. • Recurrent apparent life-threatening episodes always occurring in the presence of one person and not witnessed by a third party.

Qxd 9/6/02 5:37 PM Page 39 SEXUAL ABUSE • 39 • Children who have signs of penetration even in the absence of a clear history. • Children who are symptomatic. • Children with anogenital warts or genital herpes. It is better to screen than not, if the procedure is acceptable. Gonorrhoea The isolation of N. gonorrhoeae in children over the age of one year is highly suggestive of abuse. Fomite transmission has not been reported. The commonest symptom is vaginal discharge but up to 45% of children may be asymptomatic.

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