Acute Pediatric Diseases - Asynch

Question 1

What are the common signs and symptoms of dehydration in children?

Answer 1

often caused by vomiting, diarrhea
they have a cold and not eating well

-number of wet diapers (6 per day is normal; 1-2 diapers -> see a doctor)
-concentrated urine in the diapers
-play less, irritable
-dry mouth
-asking for drink
-not as many tears when they cry
-soft spots of the head become sunken (wrinkled skin, sunken eyes)
-loose stools in diarrhea
-excessive fussiness (difficult to please)

Question 2

What are the common causes of dehydration in children?

Answer 2

most common: vomiting or diarrhea from viral infection (rotavirus, adenovirus)

others:
-Bacteria, parasites
-new onset T1DM, DKA

Question 3

Hyper and Hypokalemia in children are corrected quickly or slowly?

Answer 3

correct quickly

Question 4

Hyper and Hyponatremia in children are corrected quickly or slowly?

Answer 4

correct slowly

Question 5

What is the dose of IV fluids for severe dehydration?

Answer 5

IV bolus of 10-20 ml/kg over 30-60 minutes

oral work as fine as IV in common dehydration

Question 6

How is mild pain treated in children?

Answer 6

Acetaminophen or ibuprofen

topical anesthetic gels for wound repair

Question 7

How is moderate pain treated in children?

Answer 7

-fixed interval NSAID or APAP and PRN or

-fixed interval opioids like Lortab liquid or tablets
caution when using APA if the child is on Lortab (contains APAP)

Question 8

Which opioid is absolutely contraindicated for children?

Answer 8

Codeine !!!

Question 9

How is severe pain treated in children?

Answer 9

IV opioids when needed, changed to oral when possible

-Ketamine (anesthetic) (IV, IM, intranasal, inhaled) can be used too

Question 10

Which routes of administration are preferred in children?

Answer 10

the least invasive routes

-topical
-intranasal
-inhaled (nitric oxide, laughing gas to calm the child if needed)

Question 11

What are the risk factors for a higher risk of opioid-related side effects?

Answer 11

-infants less than 6y old

-systemic illnesses
-airway obstruction
-using multiple sedating meds

Question 12

Which type of headache most commonly causes disability in children?

Answer 12

Migraines

-tension headache (tension of the muscles in the head and neck) is also common, less disability

Question 13

Differences between Tension headache and Migraine

Answer 13

tension:
-tensing of muscles
-less severe than migraine
-shorter period

Migraine:
-aura before pain
-severe, throbbing pain

Question 14

Symptoms of Migraine in children

Answer 14

-unilateral
-pulsating
-moderate to severe pain, getting worse with activity
-photophobia
-N/V

children may have migraine with vertigo and less headache

Question 15

What helps with tension headaches?

Answer 15

-massage tense muscles
-get rest
-Ibuprofen or APAP

Question 16

What helps with Migraines in children?

Answer 16

-stay at dark and quiet place
-sleep
-migraine meds

Question 17

Signs for dangerous headaches

Answer 17

-worsening headaches
-age 3y or younger
-sudden onset and the worst headache of my life
-waking up from a headache
-pain from the posterior of the head
-vomiting at night or in the morning
-vision changes

Question 18

What are Lifestyle changes to help with headaches in children?

Answer 18

SMART (sleep, meals (healthy), activity, relaxation, trigger)

Question 19

Meds to use for headaches in children

Answer 19

APAP, NSAIDs, triptans, ondansetron

for prevention:
Topiramate, gabapentin, verapamil (Calan, CCB)

Question 20

What are the signs of a UTI in children?

Answer 20

fever

if flanked pain -> usually pyelonephritis

Question 21

What is the treatment duration of UTI in children?

Answer 21

24 hours

Question 22

Which pathogen most often causes UTIs in children?

Answer 22

E. coli (90%)

Question 23

Which IV and oral options are there to treat UTIs in children?

Answer 23

IV: 3rd gen cephalosporins: Cefdinir

oral: Amoxicillin, Amoxicillin/clavulanate, cephalosporins, Bactrim

Question 24

Signs of Croup in Children

Answer 24

-inspiratory stridor
-hoarseness
-barking “seal-like” cough

it starts with a low-grade fever and upper respiratory infection -> progresses to airway obstruction and respiratory distress

Question 25

Which pathogen causes Croup?

Answer 25

Parainfluenza types 1, 2, 3

Question 26

Which part of the respiratory tract is most often affected with Croup?

Answer 26

-subglottis (lower part of the larynx)

-trachea

Question 27

Non-pharm treatment for Croup

Answer 27

-sit in the bathroom filled with steam
-go outside for 10 minutes

Question 28

How are children treated for Croup?

Answer 28

if the child is struggling to breathe:

-Oxygen
-Racemic epinephrine (reduces the upper airway swelling)
-single dose of Dexamethasone: 0.6 mg/kg, max of 16 mg

Question 29

Varicella Zoster virus (VZV) causes which disease?

Answer 29

Chicken pox

often spread through contact with an infected person

Question 30

How does VZV spread?

Answer 30

often spread through contact with an infected person
-saliva, sneezing, coughing, fluids of the blisters

-contagious starting 2 days before blisters appear until the blisters have crusted over

Question 31

Symptoms of chickenpox

Answer 31

-mild headache
-fever
-malaise
-blisters on the skin
-Rash !! (face, limbs, chest, stomach - very itchy)
-nausea, loss of appetite

Question 32

What helps against the rash caused by chickenpox?

Answer 32

oatmeal bath
hydration
do not scratch