Other Flashcards
Parkland formula
For burns >15%
Fluid resuscitation 4mL/kg x TBSA burned = 24 hour total
-give first half over 8 hours and rest over 16 hours
Pyloric stenosis
- pre repair children develop hypochloremic hypokalemic hyperbilirubinemia and metabolic alkalosis
Bilirubin and liver disease
- high total bilirubin with presence of conjugated or direct bilirubin likely indicates cholestatic liver disease
- physiologic jaundice of the newborn has an associated elevated unconjugated bilirubin level
Mallampati score
- an assessment of the airway prior to intubation
- score of class 3 or 4 or higher is associated with a more difficult airway and intubation
Contraindication to lung transplant
- malignancy within past 2 years, immunodeficiency syndrome, hepatitis B or C with liver disease, severe neuromuscular disease, multiorgan system dysfunction.
- relative contraindications include pleurodesis, renal insufficiency, markedly abnormal BMI, chronic airway infection with specified organisms, severe scoliosis, active collagen disease, mechanical ventilation,
Normal QTc
- normal value is 0.44 m/second or less
Tumor lysis syndrome
- elevated potassium, phosphorus and uric acid
- elevated BUN and creatinine
- low calcium
neurofibromatosis
- Type I is usually diagnosed in infancy or at least prior to age 10 and involves the presence of café au lait spots and Lisch nodules (hamartomas of the iris), the defining characteristic.
- Type II occurs in patients in adult years and findings include glioma, meningioma, and hearing loss
SCFE ( slipped capital femoral epiphysis)
- obese adolescent who presents with a limp.
- pain to the hip, knee, or thigh and holding the leg in an externally rotated position are other findings.
- requires urgent intervention, and surgical correction is necessary to prevent further slippage
Legg–Calvé–Perthes disease
- caused by poor blood supply to the femoral head causing avascular necrosis.
- occurs in prepubertal, immature children and it affects males more than females
- discomfort with internal rotation and abduction and no external signs
- initial therapy includes rest and slow restoration back to use. If not identified early and managed, may require surgical intervention.
transient synovitis or septic arthritis
- inflammatory process often following a viral illness
- acute or gradual onset
- usually unilateral
hypomagnesemia causes
-GI losses (Pancreatitis, celiac disease, short gut syndrome, and inflammatory bowel disease)
CHARGE syndrome
- genetic pattern of birth defects which include coloboma of the eyes, choanal atresia or stenosis, cranial nerve involvement, outer, inner, and middle ear abnormalities, cardiac defects, cleft lip and palate, and several others that are not typically associated with other patterned abnormalities.
- includes hearing loss and outer ear abnormalities, such as the outer ear appearing wide, low, and with no earlobe.
Iron overload following chemotherapy
-prolonged elevated ferritin level can lead to liver dysfunction, endocrine disorders, and altered cardiac function
diarrhea-associated (D+) hemolytic uremic syndrome (HUS)
- bloody diarrhea versus non-bloody
- anemia, decreased or no urine output, and signs of bleeding (e.g., petechiae).
- anemia is normochromic, normocytic, with an elevated reticulocyte count.
- results in Hyperkalemia and hyperphosphatemia, uremia, metabolic acidosis, Fluid overload secondary to lack of glomerular filtration resulting in hemodilution and relative hyponatremia
- cause E.coli 0157 (produces a toxin and is contracted through contaminated water, meat, fruits, and vegetables).
- results in damage to endothelial cells and erythrocytes, producing a prodrome of hemorrhagic enterocolitis.
- Endothelial swelling of the glomerular arterioles in the kidneys results in decreased glomerular filtration rate, proteinuria, and hematuria with hemolytic anemia, thrombocytopenia, and acute renal failure.
Diamond–Blackfan anemia
-increased percentage of fetal hemoglobin (Hgb F)
Bowel obstruction or perforation in an infant
-emesis, poor feeding, distended abdomen, metabolic acidosis
Use of magnesium citrate as a laxative results in
-hypokalemia, hyponatremia, hypomagnesia
Pulmonary hypertension
- presents with hypotension, tachycardia, and then bradycardia, irritability, hypoxia, chest pain, seizures, decreased exercise tolerance
- treatment focused on managing the acute events by providing a stable environment and lowering pulmonary vascular resistance through stabilizing hemodynamics and treating acidosis and hypercarbia
- use of vasodilating agents is appropriate in both acute and chronic settings of pulmonary hypertension. Milrinone is a nonspecific vasodilating agent like sildenafil and prostaglandin which would be used first line in the treatment of pulmonary hypertension.
AGVHD (acute graft versus host disease)
- a serious complication of allogeneic hematopoietic stem cell transplant which typically occurs in the first 100 days after transplant
- characterized by inflammation of the skin, liver, and gastrointestinal systems as a result of the donor cell’s immune response recognizing the recipient tissue as foreign.
- manifestations of AGVHD include generalized erythematous maculopapular rash which can progress to bullae formation and desquamation, hyperbilirubinemia, transaminitis, vomiting, diarrhea, abdominal pain, anorexia, mucosal sloughing, bloody stools, and ileus.
Cryoprecipitate
-obtained by centrifuging plasma and removing the precipitate. -blood product used to replace low fibrinogen levels and assist in stabilizing coagulation disorders
basilar skull fracture
- linear fracture at the base of the skull, typically occurs as a result of blunt trauma or crush forces to the head, presents with battle sign and raccoon eyes
- Battle sign is bruising noted behind the ears which can show up even a few days after the accident.
- Raccoon eyes include bruising and potential swelling around the eyes, indicative of a frontal basilar skull fracture.
Infants with liver failure
-present with poor feeding, lethargy, hepatomegaly and failure to thrive
VACTERL
- vertebral defects, anal atresia, cardiac defects, TEF, renal anomalies, and limb abnormalities
- 50% to 80% of infants with VACTERL syndrome have a TEF
Switching from a second- to a third-generation cephalosporin
-adds pseudomonal coverage
Septic shock
- state of acute circulatory failure characterized by persistent hypoperfusion despite adequate fluid resuscitation or by tissue hypoperfusion (manifested by a lactate concentration >4 mg/dL) unexplained by other causes.
- Clinical findings include prolonged capillary refill, decreased or absent urine output and potential renal failure, fever, and hypotension along with respiratory compromise
Drug-resistant streptococcal infection
- pneumococcal infection resistant to β-lactams
- primarily involves the respiratory system and includes otitis media, sinusitis, and pneumonia
Meckel diverticulum
- congenital abnormality of the small intestine, caused by an incomplete obliteration of the vitelline duct
- majority present with painless rectal bleeding prior to their second birthday.
- Meckel scan completed in nuclear medicine is the study of choice to best diagnose this problem.
- a complete blood count with differential and metabolic studies should be completed.
Hirschsprung disease
- absence of enteric neurons within the myenteric and submucosal plexus of the rectum and/or colon
- aganglionic segment results in constipation, abdominal distention, and discomfort
Side effects of abuterol
- β2-adrenergic agent
- side effects of inhaled albuterol include tachycardia, hypertension, nausea and vomiting, and hypokalemia
Guillain–Barré syndrome (GBS)
- presents with ascending, symmetric weakness, paralysis with areflexia, meningismus, vomiting, headache, ataxia, and ophthalmoplegia
- symptoms of GBS are typically preceded by an infection or immunization
Pulmonary contusion
- result of chest trauma with damage to the capillaries and resulting fluid and blood collection in the lung tissues
- symptoms include pain and hypoxia
- symptoms peak at 24 to 48 hours and typically resolve within 1 week of injury
botulism
- constipation, poor feeding, and increasing weakness
- weak cry, expressionless face, ptosis, hypotonia, and symmetrical cranial nerve palsies
Cushing triad
- occurs with increased intracranial pressure (ICP)
- bradycardia with hypertension and an abnormal respiratory pattern
Encephalitis
- inflammatory process of the brain parenchyma
- presents very similarly to meningitis and can involve a viral or bacterial process
- Elevated protein, normal glucose and pleocytosis
- elevated opening pressure
cerebral perfusion pressure
- CCP = MAP – ICP
- goal is >50
Myasthenia gravis
- neuromuscular disorder that is characterized by varying degrees of weakness of the voluntary skeletal muscles.
- symptoms include weakness that increases during periods of activity and improves after periods of rest
- therapy for myasthenia gravis includes an anticholinesterase medication (e.g. neostigmine), immunosuppressants (e.g systemic steroids, azothiaprine, cyclophosphamide), intravenous immune globulin, plasmapheresis, and thymectomy
Measles
-high, persistent fever over several days, diffuse red confluent rash, Koplik spots inside the mouth, cough, and coryza
necrotizing enterocolitis
- abdominal radiograph shows pneumatosis-intestinalis, dilated loops of bowel that do not change on repeated abdominal radiographs (fixed loops), intrahepatic portal venous air, and ascites.
- treatment with bowel rest, gastric decompression, and broad spectrum antibiotics
Epidural hematoma
- hemorrhage located between the dura mater and overlying skull often caused by trauma.
- symptoms include headache, vomiting, or irritability and often presents with a lucid interval.
- classic appearance is a biconvex or lentiform mass that pushes the brain away from the skull bone, does NOT cross suture lines.
