CPS High Yield Statements Flashcards
Lab findings in patient with ITP
Low platelets (<100, can be <20)
Normal Hb + other cell lines
Large plts on smear
Patient with ITP, no active bleeding, petechial rash - how to treat?
Observation 1st line, can discuss steroids/IVIG with parents, consider if child is young or very active
Patient with ITP and mucosal bleeding- how to treat?
Steroids- PO pred x4d-2wks (increase plts in 48hrs)
OR
IVIG 1g/kg once (increase plts in 24hr)
Patient with ITP + ICH: how to treat?
IVIG +methylpred +consider TXA (clotting risk so discuss with Heme 1st) + platelet transfusion (only give plts in ITP if life threatening bleed)
Counselling for pts with ITP? How many relapse?
-Avoid sports/activities with injury risk
- Avoid NSAIDS
- Even if treated with steroids or IVIG, 1/3 will relapse in 2-6 weeks
Vit K prophylaxis dosing (<1500g, >1500g, prems)? Timing of administration?
0.5mg if <1500g
1mg if >1500g
0.2-0.5mg if prem (give IM even if they have an IV)
GIVE BY 6HRS OF LIFE
What to do if parents decline IM Vit K?
- Tell them there is a serious risk of IVH!!!
- Give 2mg PO Vit K now, at 2-4 weeks and at 6-8 weeks (3 doses)
RF for early hemmorhagic disease of the newborn?
Maternal warfarin, antiepileptics
RF for late hemmorhagic disease of the newborn?
Oral Vit K
CF
Cholestatic disease
** present primarily as ICH
Patient with SCD is travelling, what should they receive?
Salmonella Typhi vaccine
Malaria prophylaxis
Abx prophylaxis for SCD (what, when?)
- 2mo-> 5yrs (longer if splenectomy (should get for at least 2yrs post splenectomy), if unimmunized or if history of invasive bacterial infections)
- Daily Amox or Penicillin
When to start hydroxyurea in SCD?
> 9mo
(hold if patient is cytopenic, otherwise give every day)
VOC Management
- IN fentanyl within 30 mins then PO morphine
- Observe x 2-3hrs in ED
- If pain improved-> d/c with oral morph
- If pain not improved -> Admit, morphine infusion with PCA, PEG, incentive spirometry, hydration at 1x maint (PO or IV), O2 with target sats >95
Transfusions in the setting of splenic sequestration for SCD
5-10ml/kg
Do not want Hb to rise above 100
ACS SCD workup and management?
- CXR
- Blood culture
- CBC
- Retics
- Cross match
- NP swab + mycoplasma
TX EMPIRICALLY WITH CTX + AZITHRO
Fever in SCD patient -> workup and initial management?
Oral temp >38, rectal temp >38.5
ALL FEBRILE PTS GET
- CBC, retics, bili, blood culture, type and screen, CXR
AND empiric CTX within 30 minutes
Low risk criteria for SCD + fever?
- well appearing
- Temp <40
- Age >6mo
- WBC 5-30
- Plts >100
- Hb >60 and not 20 less than baseline
- No specific features concerning for severe infection (meningitis, osteo, SA etc)
- First presentation for this illness
CAN D/C HOME WITH F/U IN 24HR
Screening for stroke in SCD patients?
TCD yearly age 2-16
Stroke prevention for SCD patients?
Exchange transfusion program
Risks for kids associated with second hand smoke?
-Prematurity
- SIDS
- Asthma
- Pneumonia
- Recurrent AOMs
- Becoming a smoker
Nicotine can induce epigenetic changes that sensitize the brain to other drugs - True or False?
True!!
Also impacts impulsitivity and attention and teens develop addiction at lower levels of nicotine than adults
Interventions that work to reduce smoking
Education and counselling
School based interventions
Legislation
(community interventions do not work well)
Factors that make you more likely to quit smoking?
Older age
Male
Pregnancy/Parenthood
Academic Success
Team sports
Peer and family support
Slow metabolizer
Side effects of nicotine replacement therapy?
skin irritation
tachycardia
hypertension