Acute Care Flashcards
Croup - epi
<1% severe, <6% presentations to ED need hospitalization
Croup - viruses
mainly parainfluenza type 1 and 3, also influenza, adeno, RSV, HMPV
Croup - symptoms, time course
rapid onset, barky cough, insp stridor, hoarseness, resp distress
symptoms 3-7 days, most cough gone <48h
Croup - ddx & when to consult ENT
bacterial tracheitis, RPA, peritonsillar abscess, epiglottitis, FBA, allergic rxn
ENT if recurrent, severe, or atypical age
Croup - treatment (general)
General - keep comfortable, don’t frighten, don’t use mist tents, antipyretics
Dex 0.6 mg/kg PO or IM for all kids w croup - helps within 2-3h, lasts 24-48h
Epinephrine neb for mod-severe (lasts 1-2h, so watch 2-4h post treatment)
Heliox for severe to avoid ETT
Consult ENT if severe or if recurrent/atypical age
Croup - treatment (by severity)
Mild (no sx at rest) - PO dex and home
Moderate (stridor or indrawing at rest) - PO dex and observe, if no improvement by 4h consider admit
Severe (stridor, indrawing, agitation/lethargy) - minimize intervention, blowby, epi neb, PO dex, if no recurrent sx at 2h then DC home, if recurrent symptoms repeat epi and continue to observe, if poor response PICU consult
MCC of gastro?
Rota + noro
Pharmacologic class of ondansetron, and how long until it reaches peak plasma concentration?
5-HT3 receptor antagonist
1-2h
Should you screen electrolytes/ECG before giving ondansetron?
no evidence for routine screening
Name some antiemetics and their s/e
Promethazine, metoclopramide, dimenhydrinate, domperidone
Drowsiness, hallucinations, EPS, convulsions, NMS
Who should get oral zofran, details of how to give?
6m - 12y with mild-mod dehydration that have failed trial of oral rehydration
single dose
start ORS 15-30 mins after dose of ondansetron
MC side effect of ondans
diarrhea
dosing of ondans?
0.15mg/kg
OR
8-15kg: 2mg
15-30kg: 4mg
>30kg: 6-8mg
ITP triggers
virus
immune cause
usually no trigger found
Classic ITP presentation
Child 2-5 years
Usually mild bruising and petechiae
Mild mucocutaneous lbeeding in 3%
ICH very rare (0.17-0.6%)
Red flags for diagnosis other than ITP with plts <100
History:
- constitutional symptoms
- bone pain
- recurrent thrombocytopenia
- poor response to treatment
Physical:
- LAD
- HSM
- Unwell appearing
- Signs of chronic dx
Labs:
- Low Hb
- Abnormal total WBC or ANC
- High MCV
- abnormal cellular morphology on smear
Treatment for mild ITP (no or mild bleeding)
Observation
2nd line: steroids, IVIG
Consider family opinion, pt activity level, social issues
Treatment for moderate ITP (and definition)
Mucosal lesions, epistaxis, menorrhagia
IVIG 0.8-1.0 g/kg
- s/e: HA, NV, fever, rash, hemolysis, IV placement, in hospital, $$$
- usually plts increase within 24h, peak 2-7d
STEROIDS 4 mg/kg/day div BID-QID x 4 days (max 150mg/day) WITHOUT taper, or 2 mg/kg/day for 1-2wks WITH taper
- s/e: mood changes, increased appetite/weight, gastritis, HTN, poor taste
- increased plts within 48h
anti-D only for Rh+ kids, not considered firstline
Severe bleeding in ITP, definition and treatment
Prolonged epistaxis, GI bleeding, or ICH
- Admit
- IV steroids AND IVIG
- TXA as adjunct: 25 mg/kg/dose TID-QID to max 1500mg/dose
- plt transfusion if acute, life-threatening bleeds or in children requiring immediate surgery
Relapse in ITP (how many and when)
1/3
within 2-6 weeks
Sepsis definition
Systemic inflammatory response to presence of suspected or proven infection
Classic features: Tachycardia, tachypnea, hyperthermia
Septic shock definition
Severe infection leading to cardiovascular dysfunction (hypotension, need for vasoactive medication, or impaired perfusion)
Biochemical signs of adrenal insufficiency
Hyponatremia, hyperkalemia, hypoglycemia
Patients at risk for adrenal insufficiency in the setting of septic shock - and what to do?
Kids with
- Purpura fulminans
- Waterhouse-Friederichsen syndrome
- Steroid therapy for chronic illness
- Pituitary or adrenal abnormalities
Give stress dose - 50 mg/m2, then 100 mg/m2 div TID or QID
