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Pediatrics > Meningococcemia > Flashcards

Meningococcemia Flashcards

1
Q

Giving advice over phone

A
  • physician dependent
  • don’t prescribe without having seen patient
  • advise to make appointment
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2
Q

Infants less than 6-8 weeks with fever?

A

EMERGENCY!!!!

- all other fevers are context specific and need more info

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3
Q

Asking about severity of illness

A

be careful not to use medical terms that confuse parents

- don’t lead with questions, ask what they think is going on

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4
Q

Determining severity of illness

A

Is there any end-organ hypoperfusion?

Any underlying conditions that could complicate things?

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5
Q

Emergency conditions causing altered mental status

A

Hypoxia - organs and tissues need oxygen
Shock - end-organ perfusion
Hypoglycemia - glucose is critical substrate
Poisoning

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6
Q

Causes of altered mental status

A

1-4 can cause shock and/or acidosis

  1. Intussusception
  2. Sepsis
  3. DKA
  4. Renal failure
  5. CNS problems
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7
Q

CNS causes of altered mental status

A 
Seizure - decreased LOC
Tumor - increased ICP
Intracranial bleed - increased ICP (headache)
Infection - increased ICP
Trauma
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8
Q

DDx of lethargy in teenager

A

Sepsis - fever, lethargy, decreased activity/appetite
Meningitis - fever, headache, stiff neck, AMS
Encephalitis - viral (fever and AMS)
Toxins - overdose
Pneumonia - fever, tachypnea and hypoxic

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9
Q

Assessing Circulation

A
  1. heart rate = very sensitive for volume status (DON’T OVERLOOK)
  2. Capillary refill time = sensitive for hypovolemia
  3. BP = not sensitive for circulation, body can compensate
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10
Q

Airway positioning

A

Infant = towels/pillow under shoulders
1-3 ys = neutral position
3-10 yrs = extend neck
10+ = hyperextend neck

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11
Q

Assess airway and breathing

A
  • describe effort and rate
  • listen and check oxygenation
  • if not doing well, try jaw thrust
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12
Q

Disability and environment

A 
Disability/dextose
- quick neuro assessment for increased ICP
- assess mental status
- pupils
Exposure/Environment
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13
Q

PE of bacterial meningitis

A 
Neck stiffness - 57-92%
Fever - 66-100%
Brudzinski's or Kernig's - 61%
 Altered mental status - 46-95%
INFANTS? - bulging fontanel (harder to examine)
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14
Q

Definition of Shock

A

inadequate delivery of substrates and oxygen to meet metabolic needs of tissue

  • no longer aerobic metabolism
  • disruption of cellular membranes and ion pumps
  • cells swell and break down
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15
Q

Compensation of Shock in Kids

A

kids can maintain their blood pressure much longer during shock than adults
- tachycardia and increased contractility
- increased venous tone and respiratory rate
HYPOTENSION = BAD SHIT

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16
Q

Hypovolemic Shock

A

most common type

  • inadequate fluid intake to compensate for loss
  • AMS, tachypnea, tachycardia, hypotension, cool extremities
17
Q

Distributive Shock

A

Neurogenic and anaphylactic

  • intravascular hypovolemia
  • vasodilation, increased capillary permeability, 3rd space loss
18
Q

Cardiogenic Shock

A

Severe heart disease, dysrhythmia, cardiomyopathy, tamponade

- low cap refill, absent pulses, tachypnea, tachycardia, low UO

19
Q

Septic Shock

A

infectious organism releases toxins that affects fluid distribution and CO
- require repeated boluses of fluid and vasopressors

20
Q

Administration of Fluids in Shock

A

maintaining fluid status trumps everything in shock

- isotonic (normal saline) as fast as possible

21
Q

Intraosseus access

A

easy, fast and can replace IV if trouble starting IV

  • can give any fluid thru it that you would IV
  • distal femur, tibial plateau, proximal humerus
  • don’t place into a fracture or infection
22
Q

DDx for fever and petechiae

A 
Menningococcoal Sepsis
Kawasaki Disease
Toxic Shock Syndrome
RMSF
Scarlet Fever
23
Q

Meningococcal Sepsis

A

fever, petechiae –> MUST BE ON LIST
- patient otherwise looks well
- blood cultures taken and then ABx started
Neisseria meningitidis

24
Q

Toxic Shock Syndrome

A

fever and sun-burn appearing rash

- from staph toxin –> leads to shock

25
Q

Risks for meningococcal sepsis

A 
Close quarters (military/college)
Complement deficiency
Asplenia
26
Q

Transmission of meningococcal

A

Air and respiratory droplets

incubation 1-10 days

27
Q

Disease course of meningococcal

A
  1. Fever, chills, prostration, malaise, myalgias, rash

2. Purpura, ischemia, coagulopathy, pulmonary edema, shock

28
Q

Mortality of meningococcal

A

10% –> higher if longer before treatment

29
Q

Sequelae of meningococcal

A

hearing loss, neuro disability, loss of digits, scarring

30
Q

Treating meningococcemia

A

IV Penicillin (penicillin G)

  • pediatrics = 250,000-300,000 units/kg/day (divided every 4-6 hrs)
  • adults = 12-24 million units a day (divided every 4-6 hrs)
31
Q

Initial treatment

A

as soon as cultures are drawn –> start vanco, ceftriaxone and if in endemic areas doxycycline

  • vanco = gram (+) and MRSA
  • ceftriaxone = gram (-)
  • doxy = tick
32
Q

Meningococcal Prophylaxis

A

Adults - ciprofloxacin
Kids - rifampin or ceftriaxone
*can’t use rifampin or ciprofloxacin for pregnant

33
Q

Pre-renal failure

A

due to hypoperfusion = elevated BUN and Cr

34
Q

Meningococcal vaccine

A

Tetravalent
Given to 11-18 year olds
- given IM at 11 year old
- booster at 16

Pediatrics (36 decks)

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