Inpatient Flashcards
For which age group does a fever count as 100.4 or 38C?
Children less than 3yrs (per academy ER docs)
Otherwise, fever is > 38.5
What are the criteria for home O2 for children with bronchiolitis/viral pneumonitis?
- 3-18 months (if premature), min of 48weeks corrected age
- First episode of wheezing
- RA sat of 87% or less
- Reliable transport, social situation, and phone number
- Lives at altitude 6000 ft or less
- Lives with in 30 min from ER facility
- No apnea
- Follow up in 24 hrs with PCP or return o ED
- Caretakers comfortable with going home on O2
- No smokers at home
What is the benefit of HFNC?
Incorporates higher flows to generate pressure thus improving lung volumes and decreasing WOB
What anticipatory guidance should you give a family going home with home oxygen?
- Keep child away from heat sources (kitchen, etc)
- No smoking.
- Don’t put petroleum based products like vasoline on the child
- Be careful with tubing o not trip over. Taping to back of shirt helps
What are the best 3 clinical predictors of pneumonia (ie cxr shows pneumonia)?
- Fever
- Tachypnea (also its absence is best negative predictor)
- Hypoxemia (less than 90% on RA)
What is the rule of thumb for antibiotics and pneumonia?
If they are sick enough to be admitted to the hospital with a suspected bacterial CAP, then they should be on IV antibiotics
How long should you treat with antibiotics in CAP? When should you expect to see improvement?
- Treat for 7-10 days
2. Expect improvement in the first 48-72 hours
Name 7 common bacterial causes of pneumonia
- Strep pneumo
- Staph aureus
- Haemophilus influenzae
- Group A strep
- Bordetella pertussis
- Chlamydia pneumoniae (school aged)
- Mycoplasma pneumoniae (school aged)
Name 6 common viral causes of pneumonia
- Influenza A & b
- RSV
- Parainfluenza
- Human metapneumovirus
- Adenovirus
- Rhinovirus
What is the first line oral agent for CAP? IV agents?
Oral agent= amoxicillin 90 mg/kg/day divided into 2-3 doses
IV agents= ampicillin, ceftriaxone, cefotaxime
If suspect atypical pneumonia, use azithromycin
True or false: pneumonia is a common complication of hospitalized children with influenza
True
Can be primary pneumonia from influenza or secondary pneumonia from superimposed bacterial infection
What are the indications for hospitalization with pneumonia?
- Cannot take Oral antibiotics
- Dehydration requiring IVF
- O2 requirement
- Concern for or risk of complicated pneumonia
- Underlying comorbidity
What are the discharge criteria for pneumonia?
- Stable and improving O2 requirement, meets home O2 cutoffs
- Improved clinical status
- RR approaching normal for age
- Normal WOB
- Able to maintain adequate oral intake
- Able to take oral prescribed meds
- Reliable follow up and social situation
What are the maximum amount (in liters) of oxygen can be discharged home on for:
- Less than 24 months
- Older than 24 months
Less than 24 months: 1/2 liter or less
Older than 24 months: 1 liter or less
Define diabetic ketoacidosis
= insulin deficient state characterized by:
- Hyperglycemia (BG > 200)
- Acidosis (pH < 7.3, bicarb < 15)
- Ketoacids accumulate in blood ( measurable serum or urine ketones)
Give a problem list for DKA
- Insulin deficiency
- Hyperglycemia
- Dehydration
- Electrolyte loss
- Hyperosmolarity
What is the most common cause of DKA in a known diabetic?
Missed insulin doses (compliance, pump failure, not enough insulin given during sickness/poor PO intake
What are the main principles of management for DKA?
- Give insulin
- Rehydrate
- Correct electrolyte abnormalities
- Monitor for ongoing clinical or lab abnormalities
True or false: bicarb administration for DKA is helpful
False. No evidence it makes a difference
When can you wean the continuous insulin infusion in DKA?
When acidosis resolves (pH > 7.3, bicarb > 15)
What’s a quick rule to pick size of ET tube?
Age/4 + 4
What’s a quick rule for depth of ET tube insertion?
ETT size x3
What should you think about when an intubated patient suddenly develops respiratory failure?
DOPE
D=displacement of ETT
O= obstruction
P= pneumothorax
E= equipment failure
You think a patient is in anaphylaxis. What should you do?
- Epinephrine 0.01 ml/kg of (1:1000) IM, max 0.5 ml, repeat q5 min as needed
- Secure airway and monitor breathing
- IV access, fluid boluses as needed to maintain BP and perfusion
- Benadryl 1-2 mg/kg
- Methylpred 2 mg/kg IV bolus
What are the 3 pathological features underlying asthma exacerbation?
- Inflammation
- Bronchospasm
- Increased secretions
What is the action of ipratropium bromide in asthma exacerbation when given as duoneb?
When given with albuterol atrovent decreases respiratory secretions
What is the mechanism of action of magnesium sulfate for asthma exacerbation?
Smooth muscle relaxant that can relieve Bronchospasm
Side effect: hypotension
Compare and contrast upper airway obstruction vs lower airway obstruction
Upper: stridor, O2 sat usu fine unless completely obstructed
Lower: wheezing, poor air movement, hypoxemia
How long does the effect of dexamethasone for croup last?
2-3 days
What is the differential dx for AMS?
- Anoxia
- Metabolic-DKA, hypoglycemia, uremia, hyperammonemia, inborn error of metabolism, electrolyte abnormality
- Infection-sepsis, meningitis, encephalitis
- Seizure, postictal
- Toxins, ingestions
- Psychiatric
- Trauma
- ICP
- Vascular-cva
What is the numerical scale for GCS? How many categories
3 major categories:
- Eye opening
- Verbal
- Speech
15 pointstotal
Name the — types of inborn errors of metabolism
- Disorders carbohydrate metabolism
- Disorders amino acid metabolism
- Fatty acid oxidation defects
- Organic acidemias
- Disorders of energy metabolism
- Carnitine disorders
- Purine disorders
- Lysosomal disorders
- Peroxisomal disorders
- Congenital disorders of glycosylation
- Disorders cholesterol metabolism
- Disorders of cholesterol synthesis
- Disorders of neurotransmitter metabolism
