Acute Pediatric Diseases - Asynch Flashcards
What are the common signs and symptoms of dehydration in children?
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)
What are the common causes of dehydration in children?
most common: vomiting or diarrhea from viral infection (rotavirus, adenovirus)
others:
-Bacteria, parasites
-new onset T1DM, DKA
Hyper and Hypokalemia in children are corrected quickly or slowly?
correct quickly
Hyper and Hyponatremia in children are corrected quickly or slowly?
correct slowly
What is the dose of IV fluids for severe dehydration?
IV bolus of 10-20 ml/kg over 30-60 minutes
oral work as fine as IV in common dehydration
How is mild pain treated in children?
Acetaminophen or ibuprofen
topical anesthetic gels for wound repair
How is moderate pain treated in children?
-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)
Which opioid is absolutely contraindicated for children?
Codeine !!!
How is severe pain treated in children?
IV opioids when needed, changed to oral when possible
-Ketamine (anesthetic) (IV, IM, intranasal, inhaled) can be used too
Which routes of administration are preferred in children?
the least invasive routes
-topical
-intranasal
-inhaled (nitric oxide, laughing gas to calm the child if needed)
What are the risk factors for a higher risk of opioid-related side effects?
-infants less than 6y old
-systemic illnesses
-airway obstruction
-using multiple sedating meds
Which type of headache most commonly causes disability in children?
Migraines
-tension headache (tension of the muscles in the head and neck) is also common, less disability
Differences between Tension headache and Migraine
tension:
-tensing of muscles
-less severe than migraine
-shorter period
Migraine:
-aura before pain
-severe, throbbing pain
Symptoms of Migraine in children
-unilateral
-pulsating
-moderate to severe pain, getting worse with activity
-photophobia
-N/V
children may have migraine with vertigo and less headache
What helps with tension headaches?
-massage tense muscles
-get rest
-Ibuprofen or APAP
What helps with Migraines in children?
-stay at dark and quiet place
-sleep
-migraine meds
Signs for dangerous headaches
-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
What are Lifestyle changes to help with headaches in children?
SMART (sleep, meals (healthy), activity, relaxation, trigger)
Meds to use for headaches in children
APAP, NSAIDs, triptans, ondansetron
for prevention:
Topiramate, gabapentin, verapamil (Calan, CCB)
What are the signs of a UTI in children?
fever
if flanked pain -> usually pyelonephritis
What is the treatment duration of UTI in children?
24 hours
Which pathogen most often causes UTIs in children?
E. coli (90%)
Which IV and oral options are there to treat UTIs in children?
IV: 3rd gen cephalosporins: Cefdinir
oral: Amoxicillin, Amoxicillin/clavulanate, cephalosporins, Bactrim
Signs of Croup in Children
-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
Which pathogen causes Croup?
Parainfluenza types 1, 2, 3
Which part of the respiratory tract is most often affected with Croup?
-subglottis (lower part of the larynx)
-trachea
Non-pharm treatment for Croup
-sit in the bathroom filled with steam
-go outside for 10 minutes
How are children treated for Croup?
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
Varicella Zoster virus (VZV) causes which disease?
Chicken pox
often spread through contact with an infected person
How does VZV spread?
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
Symptoms of chickenpox
-mild headache
-fever
-malaise
-blisters on the skin
-Rash !! (face, limbs, chest, stomach - very itchy)
-nausea, loss of appetite
What helps against the rash caused by chickenpox?
oatmeal bath
hydration
do not scratch
