Introduction to Peds Flashcards
Dosing
Know how to calculate pediatric doses for medications
Usually mg/kg/day or mg/kg/dose (wt in lbs/2.2= wt in kg)
Dosing should be written in mg and mL on the prescriptions
EX: Pediatric ibuprofen dose is 10 mg/kg/dose q 6 hours PRN
2 ½ year old may weigh 14 kg
14 x 10 = 140 mg q6 hours PRN
Acute Otitis Media
The most common infection for which antibiotics are prescribed for children in the United States. Maximal incidence is in children 6-24 months of age. AOM is also one of the most common reasons a child is taken to the PCP’s office.
Pathophysiology of AOM
Viral Rhinitis &/or Allergic Rhinitis leading to Swelling of the nasal mucosa, nasopharynx, and Eustachian tube leading to Obstruction of the tube leading to Fluid to accumulate (i.e., effusion) leading to Suppuration and inflammation leading to AOM!!
The fluid in the middle ear is secretion from the middle ear leads to effusion.
Why is AOM more common in kids?
The ET in children is more horizontal, shorter, and narrower – making it difficult for fluid to drain and more likely for bacteria to invade.
Etiologies of AOM
Most Common Viral Agents (Viral causes account for 40-75% of cases of AOM): RSV, Rhinovirus, Coronavirus, Influenza, Parainfluenza, Adenovirus, and Enterovirus
Most Common Bacterial Agents: Streptococcus pneumoniae, Haemophilus influenzae (non-typeable), Moraxella catarrhalis
T/F” Strep pneumo is the most common cz of AOM
False, bacterially yes but viral is more common
Diagnosis of AOM
Acute signs and symptoms of AOM,
Pressence of middle ear effusion,
Signs or evidence of middle ear inflammation
Treatment of AOM:
1st line: Amoxicillin
2nd line: Amoxicillin + Clavulanate (Augmentin)
3rd Choice: Oral 3rd generation cephalosporin
Final Resort: IV or IM 3rd generation cephalosporin
For penicillin allergic patients: Cefdinir, cefpodoxime, or cefuroxime
If a severe reaction: Clindamycin or Azithromycin or Sulfamethoxazole-trimethoprim- not effective against Haemophilus.
For children who are vomiting or cannot tolerate PO meds: Ceftriaxone IM/IV 50mg/kg/day for 3 days
Length of Treatment for AOM
10 days for children with severe disease and all children < 2 years of age
5-7 days for children > 6 years with mild to moderate disease
Treating the Pain in AOM
OTC options: Acetaminophen. Ibuprofen. Prescription topical analgesia: Antipyrine/Benzocaine: 2-4 drops in affected ear BID to TID (DO NOT use in children with perforated TMs or Tympanostomy tubes)
Do not use cold or cough meds in children under 2 yo
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Complications of AOM:
Tympanosclerosis, TM perforation, Cholesteatoma
Chronic suppurative OM requiring tympanostomy tubes
Tympanosclerosis
scarring of the TM by hyalinization and granulation tissue deposition usually secondary to inflammation or trauma.
Cholesteatoma
Stratified epithelium that collects in a retracted TM (with possible eventual perforation) that can erode into the middle ear and ossicles and cause conductive hearing loss. They can even erode through the temporal bone and mastoid causing further damage and bone loss.
Pearl *Persistent or recurrent otorrhea should raise concern for a cholesteatoma. Foul smelling otorrhea should, too.
Chronic suppurative OM requiring tympanostomy tubes
When persistent otorrhea occurs in a child with tympanostomy tubes or TM perforations
Treatment usually requires therapy with an antibiotic that covers Pseudomonas and anaerobes (fluoroquinolones – PO or topical)
TM Perforation
Spontaneous. Most secondary to AOM heal within 2 weeks
Mastoiditis
Suppurative infection of the mastoid air cells, which may result in the destruction of the thin bony septae between air cells, followed by the formation of abscess cavities and the dissection of pus into adjacent areas.
Mastoiditis Pathogens:
Strep pneumoniae, Haemophilus Influenza, Strep pyogenes, Staph aureus (including MRSA)
Mastoiditis Clinical presentation:
Ear pain, Fever, Post-auricular tenderness, erythema, edema, fluctuance, or mass and/or Displacement of the auricle
Mastoiditis Diagnosis:
Clinical diagnosis, but imaging may be needed- CT scan
Mastoiditis Treatment:
IV antibiotics
Surgical management: Tympanostomy tubes, myringotomy, and mastoidectomy
Otitis Externa Pathophys:
Inflammation of the skin lining the ear canal and surrounding soft tissue. Most commonly caused by a loss of the protective function of cerumen and a breakdown of the underlying skin.
Common Causes of Otitis Externa
Most common bacterial cause: Staph aureus or Pseudomonas
Presentation of Otitis Externa
Pain with movement of the outer ear. May have discharge from the ear. White debris within the ear canal on otoscopy
Treatment and Prevention of Otitis Externa
No swimming during the acute phase. Don’t use cotton balls!
Treat with topical antibiotic for 10 days. Flouroquinolones. Use oral antibiotics if systemic symptoms are present
Prevention: Use 2-3 drops of a 1:1 mixture of 70% ethyl alcohol and white vinegar after swimming (in kids whose TMs are intact)
Foreign Bodies Signs/Symptoms
Foul odor, Purulent Drainage, Pain, Bleeding, Halitosis
FB Management:
Gator Clips, Dermabond or Suction.
If you can’t see it, let the professional get it! May have to treat the inflammation first.
Batteries-must be removed emergently!
Allergic Rhinitis
Prevalence: 10-20%. IgE mediated reaction to allergens in the nasal mucosa.
Most common allergens of Allergic Rhinitis:
Dust mites, pet dander, cockroaches, molds, and pollen
Symptoms of Allergic Rhinitis
Nasal itching, clear nasal discharge, sneezing, postnasal drainage, and congestion
Physical Findings of Allergic Rhinitis
Shiners are secondary to venous congestion
Dennie lines are creases under the eyes (Infraorbital folds from venous congestion and edema)
Nasal crease is from rubbing the nose
Pale boggy turbinates secondary to edema
Cobblestoning is secondary to follicular hypertrophy of mucosal lymphoid tissue secondary to chronic nasal congestion and postnasal drainage.
Treatment of Allergic Rhinitis
INTRANASAL: Steroids are the Gold Standard (Ex -Nasonex, Flonase, etc…)
ORAL: Anti-leukotrienes (Ex-Singulair (montelukast)) or Oral (and intranasal) antihistamines (Ex- Benadryl, Claritin, Zyrtec, Astelin)
Atopic Dermatitis (THE ITCH THAT RASHES)
Chronic relapsing inflammation of the skin due to faulty epidermal barrier.
Many patients experience 3 phases
o Infantile
o Childhood or Flexural
o Adolescent
Pathophysiology of Atopic Dermatitis
Faulty epidermal barrier predisposes the patient with atopic dermatitis to dry, itchy skin. Inability to hold water within the stratum corneum results in rapid evaporation of water, shrinking of the stratum corneum, and cracks in the epidermal barrier
Infantile Phase of Atopic Dermatitis
Begins on the cheeks and scalp and then as oval patches on the trunk, and later the extensor surfaces of the extremities (–age at onset is 2–3 months, usually lasting to 18 -24 mos)
Childhood/Flexural Phase of Atopic Dermatitis
1/3 of kids progress to this phase (–usually affects antecubital and popliteal fossae, neck, wrists, hands, feet.)
Adolescent Phase of Atopic Dermatitis
Only 1/3 of the above progress to this
usually just chronic flexural dermatitis and hand dermatitis.
Atopic Triad of Atopic Dermatitis
AR, asthma, and AD. Children with asthma or AR have a 30-50% incidence of having atopic derm
Treatment of Atopic Dermatitis
Goal: avoid irritants and restore hydration
Use mild soaps and shampoos , Avoid rough clothing, Limit baths, Occlusive emollients should be applied just after bathing (only pat dry), Wet dressings for flare ups
Medical Therapy: Topical steroids are gold standard.
Mild cases: with low potency steroids (Ex-hydrocortisone or desonide).
Moderate cases: medium potency steroids (Ex-triamcinolone or mometasone)
Remember – only low potency steroids on face, axilla, groin, and intertriginous areas ONCE DAILY
Complications of Atopic Dermatitis
Most common: Secondary infection is Impetigo
Usually caused by Staph or Strep
Treat topically if possible. Oral- Cephalosporin (Keflex), Clindamycin, Amoxicillin-Clavulinic Acid
Rarer: Vesicular eruption caused by HSV, then Treat with acyclovir
Fungal Infections: Candida Albicans
Two forms: Dermatitis: 1)Diaper region, neck folds, axillae 2)Oral: Thrush
Appearance
Treatment: Topical imidazole, such as Nystatin, Oral Fluconazole if severe
Fungal Infections: Tinea
Multiple forms: Capitis, Corporis, Cruris, Pedis
Treatment: If hair is involved give Griseofulvin
If skin give Topical imidazole
The most common infection for which antibiotics are prescribed for children in the United States.
AOM
