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Paeds Flashcards

1
Q

Dose of ondansetron

A

0.15 mg/kg PO/IV

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2
Q

Peds GCS

A

E: 4= Spontaneous, 3 = voice = 2 pain 1 = none

V: 5 = smiles, orients to sounds, interacts, 4 = cries, consolable, inappropriate interactions, 3 = inconsistently inconsolable, moaning, 2 = inconsolable, agitated, 1 = none

M: 6 = moves purposefully, 5 = withdraws touch, 4 = withdraws pain, 3 = flexes (decorticate), 2 = extends (decerebrate), 1 = none

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3
Q

What to send stool for in ED

A
  • Stool for fecal leukocytes (>5/hpf), blood or both, identifies 90% of invasive disease; if neg, may not need to send for culture.
  • C&S, esp. E.coli 0157:H7
  • C.diff
  • O&P
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4
Q

Paeds Dehydration Assessment

A

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5
Q

ORT for Kids

A
  1. Zofran 0.15 mg/kg ODT

Pedialyte (not Gatorade): for mild-moderate dehydration. Calculate desired volume based on dehydration chart, give 25%/h over 4h.
Vx: add 2 mL/kg for each episode during ORT, start again 10 min after vx
Dx: add 10 mL/kg for each episode during ORT
After 4h, if not better, restart for another 4h
After 8h, if not better, admit + IVF

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6
Q

Paeds IV Fluids

A

Shock
20 mL/kg NS over 5-15 minutes, repeat until improvement

CBG, if <2.8 mmol/L:

0-1 month = D10 4 mL/kg
1 month - 8 years/25 kg = D25 2 mL/kg
>8 years = D50 1 mL/kg
CBG Q 30-60 minutes

After initial resuscitation/Rehydration Phase

Total Deficit = %dehydration X kg X 1000 mL
First 9 hours: 1/2 deficit and 1/3 maintenance
9-24h: 1/2 deficit and 2/3 maintenance

Isonatremic/Hypernatremic: D5W 0.45% NS with 20 mmol/L KCl (KCl once voided)
Hyponatremic (<130 mmol/L): D5W 0.9% NS with 20 mmol/L KCl

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7
Q

Dose of PRBC for transfusion in trauma in Kids

A

10 mL/kg

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8
Q

Urine output goals in trauma

Infants

Children

Adults

A

Infants: 2 mL/kg/h

Children: 1 mL/kg/h

Adults: 0.5 mL/kg/h

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9
Q

Hypertonic Saline Dose for IICP in Children

A

3-5 mL/kg 3% Saline

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10
Q

Asthma ICS Dosing

A

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11
Q

Yellow Zone Asthma Therapy

A
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12
Q

Asthma PFT Diagnostic Criteria

A

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13
Q

Asthma Therapy Continuum

A

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14
Q

Asthma Criteria for Good Control

A

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15
Q

Flovent Preparations

A

50 mcgs, 125 mcgs, 250 mcgs

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16
Q

Abnormal Values on WBC for infants

A

WBC <5 or >15

Band/neutrophil > 0.2

Bandemia >1, 500 mm3

ANC > 10, 000

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17
Q

Abnormal UA for infants

A

> 10 WBC or +ve Gram Stain

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18
Q

FWS Algorithm

0-28 days

29 days - 2 months

A

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19
Q

FWS Algorithm

2-3 months

A

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20
Q

FWS Algorithm

3-6 months

A

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21
Q

Accepted Sources of Fever for peds (>3 months)

A

HSV/Gingivostomatitis

Herpangina/Ulcerative stomatitis

RSV

Croup

Flu

Varicella

Viral Exanthem (Rash)

Enterovirus, coxsackie, HFM, echo, rhino, entero

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22
Q

Abx doses for Peds FWS

A

< 28d old: amp + gent or cefotaxime (if >8 days old), vanco (for pneumo resistance), acyclovir (if pleocytosis)

>28d old: cetriaxone +- vanco (for MRSA skin infections/severe infection), +- acyclovir

Amp: 50 mg/kg

Cefotaxime: 50 mg/kg

Vanco: 15-20 mg/kg

Ceftriaxone: 100 mg/kg (meningitis dose), 50 mg/kg (reg dose)

Acyclovir: 60 mg/kg/day divided q8h

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23
Q

FWS Algorithm

6 months - 3 years

A

UA + culture for circumsized boys up to 6 months, uncircumsized boys up to 12 months, and girls up to 24 months. Offer UA to all children up to 24 month with T >39 deg C

>3 y, no routine workup necessary for well-appearing

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24
Q

Prevalence of SBI in peds FWS (for a well-appearing child)

A

0-14 days: 1/10

14-28d: 1/20

28-60 d (pre-vaccine): 1/100

28-60 d (post vaccine): 1/1000

60-90d: 1/1000 - 10, 000

>90 d: > 1/10, 000

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25
Q

Criteria for simple febrile seizure

A
  • age 6 months - 5 years
  • generalized
  • <15 min
  • 1 time/24h
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26
Q

Pertinent Asthma Hx

A
  • past ED visits/admissions/intubations
  • home meds
  • fam hx asthma/eczema
  • environmental factors
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27
Q

Asthma Exam

A
  1. WOB
  2. SpO2
    1. >94% awake
    2. >89% asleep
  3. PO intake
    1. diapers
    2. IVC
    3. US bladder (if full, don’t need to wait for pee)
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28
Q

At what age can you give a provisional diagnosis of asthma based on presentation and response to bronchodilators?

A

3 years

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29
Q

At what age would you get a peak flow?

A

6 years

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30
Q

Ventolin Dosing

A

Ventolin (MDI with spacer preferred over nebulizer)

  • 0.15 mg/kg (min 2.5 mg) Q 20 min x 3 then 15-40 mg/h continuous as needed
  • 4-8 puffs q 20 min then Q1-4h PRN
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31
Q

Atrovent Dosing

A

Atrovent has shown to work within 1st hour of tx in children but not beyond

  • 250-500 mcg nebs Q20 min X 3
  • 4-8 puffs Q20 min PRN
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32
Q

Steroid Dosing Asthma

A
  • Dex 0.6 mg/kg (max 16 mg) daily x 2 days (peds only)
  • Prednisolone 2 mg/kg day 1, 1 mg/kg days 2-5 (max 50 mg)
  • Prednisone 1 mg/kg daily x 5 days (max 50 mg)
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33
Q

IV MgSO4 dose for Asthma

A

If no response in first 1-2h of therapy, 75 mg/kg, max 2.5 g IV. Monitor for bradycardia and hypotension. In adults, use liberally, 2 g IV NNT 2-3 in mod-severe asthma to prevent admission.

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34
Q

Andy Sloas’ Four Groups of Asthmatics

A

Group 1: ran out of meds/mild cold - home with Rx or 1 treatment with ventolin, steroids, and home.

Group 2: Mild (CRS <3), RR increased to 50, SpO2 92% or one thing off. 6 puffs ventolin + atrovent, steroids. If needs 1-2 sets of this, watch for 1 hour, send home.

Group 3: if needed 3 back to back nebs or sets of puffs, that is equal to 1h continuous nebulized ventolin —> 3:2:1 rule

  • if needing treatments Q3h, home
  • if needing treatments Q2h, admit to general peds ward
  • if needing treatments Q1h, admit to step-down
  • if needing continuous, PICU

Group 4: de-sat, tripoding, CRS >6

  • continuous nebs, IVSCS, IV MgSO4
  • if needed 2h continuous neb –> IV epi or terbuteline
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35
Q

Bronchiolitis Pertinent History

A

Infants - 2 years

RSV

Lasts 7-14 days, peaks on days 3-5

Ask about apneic episodes –> admit

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36
Q

Bronchiolitis Treatment

A

Hydration

Nasal suctioning with saline nasal drops QID

May try ventolin/racemic/hypertonic saline PRN

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37
Q

Amoxil Dosing & Amox/Clav Dosing for kids

A
  • max Amoxil 3-4 g/day
  • Amox/Clav only available in 7:1 ratio in Canada (14:1) in states
  • to reduce diarrhea, rx (for AOM)
    • 45 mg/kg Amox/Clav (7:1)
    • 45 mg/kg Amox
    • for total 90 mg/kg Amoxil with 14:1 clavulin ratio
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38
Q

Perforated TM with AOM or TM tube with purulent otorrhea

A
  • ciprodex better than PO Abx
  • swab & send for C&S
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39
Q

Definition of peds UTI

A

100, 000 CFU’s per mL for clean catch or 50, 000 CFU per mL for catheterized sample of single organism + 10 WBC/mL from unspun or 5 WBC/mL from centrifuged specimen or culture or leuks/nitrites in a symptomatic child

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40
Q

Additional investigations for peds UTI

A
  • 1st febrile UTI 2-24 months –> KUB U/S
    • peds if +ve (for VCUG)
    • peds if second febrile UTI (even if US -ve) for VCUG
  • VUR Grades 1-3 no change in treatment, no prophylaxis, Grades 4, 5, refer to peds urology, consider sx
41
Q

1st line Abx for febrile peds UTI

A
  • cefixime (Suprax) 8 mg/kg PO daily x 7-14 d
42
Q

Measles

A
  • Rubeola
  • incubation: 10 days
  • infectivity: 2 days before rash until 5 days after onset of rash
  • symptoms: cough, coryza, conjunctivitis, high fever, Koplik spots, rash starting from ears, spreading all over
  • diagnosis: measles IgM
  • complications: AOM, pneumonitis, encephalitis (0.1%)
43
Q

Mumps

A
  • Paramyxovirus
  • incubation: 6 days
  • infectivity: 1 day before swelling until 5 days after onset of swelling
  • symptoms: myalgias, fever, headache, swelling of parotid/submandibular glands
  • complications: orchitis (30%, usually does not lead to infertility), meningoencephalitis (10%)
  • droplet precautions
  • testing:
    • throat swab
    • buccal swab (massage parotid gland x 30 s first)
    • urine
    • IgG/IgM (serology)
  • most can manage as outpatient (avoid school/work for 2-5 days, live in separate room)
44
Q

Rubella

A
  • incubation: 14-21 days
  • infectivity: 2 days before onset of rash until 7 days after onset of rash
  • symptoms: URI, posterior auricular, posterior cervical, occipital LAN, MP rash starts on face, spreads over body for 3 days
  • complications: congenital rubella syndrome (infection in first 4 months of pregnancy –> cataracts, glaucoma, CHD, dev delay, etc.)
    • pregnancy
      • IgG + IgM
        • if IgG +ve at time of exposure, reassure
        • if IgM +ve, IgG -ve, counsel for termination if in 1st trimester
45
Q

Fifth Disease/Erythema Infectiosum/Slapped Cheek

A
  • Parvovirus B19
  • incubation: 5-10 days
  • infectivity: prior to onset of rash
  • symptoms: URI, waxing/waning rash (red cheeks, eyelid + circumoral sparing first then 4d later reticular rash), arthralgias (Ag/Ab deposition), transient aplastic anemia (infects erythroid progenitor cells)
  • complications:
    • 15% risk hydrops and fetal death if infected before 20 wks GA, <3% after 20 weeks.
    • pregnancy
      • risk of fetal death after household exposure <2.5%, workplace <1.5%
        • draw IgG
          • detectable by 7th day, persists lifelong
        • draw IgM
          • detectable by 3rd day, persist 30-60 days
      • if susceptible or +ve IgM, weekly US x 4-8 weeks after exposure to r/o hydrops
46
Q

Chicken Pox

A
  • Varicella Zoster
  • incubation: 10-20 days
  • infectivity: 2 days before rash until all lesions crusted over
  • symptoms: fever, HA, malaise, then itchy painful rash, lasts 7-10 days
  • complications: sepsis, cerebellar ataxia, encephalitis, pneumonia, nec fasc
    • pregnancy
      • 30% varicella pneumonia, mortality 40%
      • maternal HZV not harmful but exposure to HZV without varicella immunity is
      • congenital varicella syndrome
        • usually in first 20 weeks of pregnancy
        • <2% risk at < 20 weeks, lower after
      • diagnosis
        • clinical
        • 4x rise in varicella-specific IgG Ab over 14-21d period
      • management
        • if history of chickenpox –> reassure
        • if unknown, and able to get results within 96h, draw VZV IgG Ab
        • if unable to get labs within 96h or if no immunity
        • give VZIG 625 units IM
        • if develops severe disease
          • acyclovir 10 mg/kg IV Q8h or 800 mg PO QID x 5 d
47
Q

Hand-Foot-Mouth Disease

A
  • coxsackie virus
  • complications:
    • myocarditis
    • diarrhea 10 d after onset
48
Q

Formula to estimate normal lower limit BP in children > 1 year

A

SBP = 70 + [2X(age in years)]

49
Q

NRP: The three questions to ask to decide whether to give baby to mom or to resuscitate.

A
  1. Is it term?
  2. Is it crying & breathing?
  3. Does it have good tone?
50
Q

Rule of three’s for Colic

A

3 weeks to 3 months

At least 3 h of crying at least 3d/wk

Usually after 3 PM

51
Q

Age of incidence: Croup

A

3 months - 6 years

52
Q

Dose of Dex: Croup

Dose of Racemic Epi neb: Croup

Dose of IM Epi: Croup

A

Dex: 0.6 mg/kg (max: 10 mg) PO X 1

Racemic epi: 0.25 mL mixed with 3-5 mL saline, watch for 2h

IM Epi: 0.01 mL/kg of 1:1000 (max: 0.3 mL)

53
Q

Peds Vitals

A

Review Evernote

Correct HR by 10 and RR for 5 per 1 deg C increase

54
Q

AAP Guidelines for UTI testing in 2 mo. - 2 yrs age

A
  • girls, test if 2 or more of:
    • nonblack
    • < 12 mo.
    • T >= 39
    • fx >= 2 d
    • no other source
  • uncircumcised boys
    • test if no apparent focus of infection present
    • circumcised boys, test if 2 or more of:
    • nonblack
    • T >= 39
    • fx >= 24h
    • no other source
  • circumcised boys, test if 2 or more of:
    • nonblack
    • T >= 39
    • fx >= 24h
    • no other source
55
Q

Necrotizing Enterocolitis

Age, pathophys, clinical features, dx, tx.

A
  • neonatal disease
  • immune overreaction, coagulation necrosis
  • mean age 2-9 days of life, but think up to 3 months
  • poor feeding, abdo distension, bilious vomiting, fever +- BRBPR/melena
  • labs
    • 3V Abdo
    • pneumatosis intestinalis
    • portal venous gas
  • tx
    • NPO, g-tube, abx, IVF
56
Q

Hirschprung’s Disease

History, clinical features, age of onset

A
  • Hx Delayed first stool passage (>24-48h)
  • Needs suppository for every stool.
  • 1-2 months old.
  • On rectal exam, stool and gas is explosive.
57
Q

Volvulus (peds)

age of onset

clinical features

dx

A
  • Malrotation is abnormal position, volvulus is twisting/ischemia of bowel.
  • 80% presents in 1st month of life, 90% within 1st year
  • abrupt onset bilious vx, abdo distention
    • may be intermittent
  • lab
    • upper GI series
    • sx consult without waiting for result
58
Q

Intususseption

Age of onset

causes

clinical features

dx

A
  • 3 months - 3 years
  • causes
    • Peyer’s patches, Meckel’s, HSP
  • lethargy, intermittent pain
    • legs drawn to chest
  • normal exam in-between
    • sausage mass RUQ
    • occult blood (70%), gross blood (50%)
  • US ~100% sensitive
  • If high suspicion, direct to air-contrast enema
    • not if FA on xray, or in shock
59
Q

Peds Umbilical vs. inguinal hernias

A
  • all inguinal need urgent repair
  • umbilical may repair if symptomatic or age > 3
60
Q

How much weight loss is acceptable for a neonate, and when must they regain their birth weight?

A
  • normal to lose up to 10% birth weight during first 3-7 days, but should regain by 10-14 d
  • average gain of 20-30 g/day for first 3 months then 15-20 g for next several months
61
Q

Normal Periodic Breathing vs. Apnea in neonates

A
  • normal periodic breathing: normal/fast alternating with slow + pauses 3-10 seconds
  • apnea: pause in breathing > 20 seconds or with bradycardia/cyanosis/change in muscle tone is abnormal
62
Q

By what age do most infants sleep through the night?

63
Q

TSB levels for severe and critical hyperbilirubinemia in neonates

A
  • Severe hyperbilirubinemia – a total serum bilirubin (TSB) concentration greater than 340 µmol/L at any time during the first 28 days of life
  • Critical hyperbilirubinemia – a TSB concentration greater than 425 µmol/L during the first 28 days of life
64
Q

Neonatal Jaundice

Readthrough, Evernote

65
Q

Mastoiditis

A
  • almost always from AOM
  • highest age 1-3
  • CT mastoid
  • PipTazo + Vanco
66
Q
A
  • Geographic tongue
  • childhood lesions
  • migratory
  • recurrent
  • asymptomatic
  • no treatment necessary, benign
67
Q

Pediatric ABRS

A
  • usually ethmoid & maxillary (frontal don’t develop until late adolescence)
  • don’t do imaging
  • check for FB –> do consider xray if unilateral purulent discharge
  • more or less same criteria as adult, mostly gestalt (unilateral tenderness, prolonged nasal discharge)
  • clavulin/cefuroxime + nasonex, f/u GP
68
Q

Pediatric Assessment Triangle

A
  1. Appearance
  2. Work of Breathing
  3. Circulation
69
Q

NRP Algorithm

A
  • 0-30 Seconds
    • dry, stimulate
    • if no response, suction nose and throat with 8F catheter
  • 30s-60s
    • if HR > 100 but cyanosis/laboured breathing
    • open airway, suction
    • SpO2 from R hand
    • no naloxone
    • if HR <100/apnea
    • BMV PPV @ 40-60 BPM, Pmax ~20-30
      • start with room air
      • Mask seal
      • Reposition
      • Suction
      • Open mouth (jaw thrust)
      • Pressure (increase to max 40)
      • Airway control –> (ETT)
  • 60s-90s
    • if HR < 60, start CPR
    • 3:1 compression:breath ratio
    • if no response give Epi (0.01-0.03 mg/kg IV or 0.05-0.1 mg/kg intratracheal)
    • 10 mL/kg NS bolus over 3-5 min if blood loss suspected
    • 2 mL/kg bolus D10W for glu < 1.38 in first hours of life
70
Q

Dose of e- in Peds Arrest

A

2 J/kg initially –> 4 J/kg all subsequent shocks, may go up to 10 J/kg

71
Q

Dose of e- in Peds Cardioversion

A

0.5 J/kg —> 1 J/kg, up to 2 J/kg

72
Q

SVT vs. ST in Peds

A
  • >220 in infant, >180 in child more likely to be SVT
73
Q

Treatment of Tet Spell

A
  • calm child
  • 100% NRB O2
  • flex knees to chest (to increase preload + SVR)
  • morphine
  • IV NS bolus
74
Q

Approach to Suspected CHD in Sick Neonate

A
  • CXR, ECG
  • R vs. L SpO2
  • UE vs. LE BP’s
  • R brach-femoral pulse delay
  • O2 is pulmonary vasodilator and decreases R–>L flow through PDA + vasoconstricts PDA so be careful
  • IV Prostaglandin E1 0.1 mcg/kg/min
    • titrate to lowest effective dose (typically 0.05 mcg/kg/min)
  • 10 mL/kg NS bolus (may not tolerate if CHF)
  • IV Abx as cannot r/o sepsis
  • +- Lasix 1-2 mg/kg IV
  • +- dopamine, dobutamine
75
Q

Kawasaki’s Disease

A
  • late fall through early spring
  • phase 1 (acute): 1-2 weeks
  • phase 2 (subacute): 2-4 weeks
  • phase 3 (convalescent): 4-6 weeks
  • Criteria
  • Classic (Complete)
    • Fever >=5d and at least 4 of:
    • bilateral, nonpurulent, bulbar (not palpebral) conjunctivitis
    • oropharyngeal erythema (any of strawberry tongue, nonexudative erythematous oropharynx, fissured, cracked, erythematous lips)
    • polymorphous rash (diffuse, non-specific, not bullous/vesicular)
    • peripheral extremity changes (any of: erythema of palms/soles, edema of palms/soles, periungal desquamation
    • cervical lymphadenopathy (>1.5 cm, usually unilateral)
  • Incomplete
    • Fever >=5d with only two of above clinical criteria
    • CRP >= 3 or ESR >= 40
    • >= 3 of the following lab findings
      • WBC >= 15
      • Anemia
      • Plt >= 450 (if >=7d fever at presentation)
      • Albumin <= 30
      • high ALT
      • Urine WBC > 10/hpf
  • Atypical
    • meets all clinical criteria for complete but also features not typical of Kawasaki’s (e.g. nephrotic syndrome)
  • infants < 6 mo with 7 d fever without explanation should get lab testing +- 2D echo even if no other criteria met
76
Q

AVPU Score

A

Alert

Verbal (responds to verbal)

Pain

Unresponsive

77
Q

HUS

A

Review on Evernote

78
Q

HSP

A

Review Evernote

79
Q

HUS Triad

A
  • Microangiopathic hemolytic anemia
  • Thrombocytopenia
  • AKI
80
Q

HSP Tetrad

A
  • Palpable purpura in patients with neither thrombocytopenia nor coagulopathy - everyone, although not on presentation in 25%
  • Arthritis/arthralgia ~75%
  • Abdominal pain 50%, GI bleeding in 25%
  • Renal disease ~30%
81
Q

Peds limp

A

Review Evernote

82
Q

Acute Rheumatic Fever

A
  • usually begins 2-6 weeks after GABS strep throat
  • mild migratory polyarthritis
  • contrast with post-strep reactive arthritis
    • ~10 d after strep, more severe mono-oligoarthritis without any Jones features
83
Q

Bullous Impetigo/Staph Scalded Skin Syndrome

A
  • spectrum of disease from staph toxin
  • +ve Nikolsky
  • usually <6 years old
  • often MRSA
  • IV abx + admission if extensive
  • pan-culture
84
Q

Roseola

A
  • high fevers x 3-5 days –> defervescence –> rash
85
Q

HSV Skin Infections Peds

A
  • stain eyes
  • eczema herpeticum
    • HSV over eczema
    • Keflex + acyclovir (80 mg/kg/d divided Q 6h x 10d)
  • herpes gingivostomatitis
    • symptomatic tx
    • PO acyclovir may shorten if given within 48h
  • consult peds if < 2 y for dose
86
Q

Scarlet Fever

87
Q
A

Erythema Toxicum Neonatorum

  • benign, self-limited, 1st-2nd week of life
  • 2-3 cm erythematous macules, sometimes with central pustules
88
Q
A

Transient Neonatal Pustular Melanosis

  • usually black infants
  • small pustules, red macules with surrounding scale, or brown macules
  • also self-limited
89
Q
A

Cradle Cap (Seborrheic Dermatitis)

  • usually starts weeks 2-6, improves by 6 mo.
  • consider atopy if starts at 2-3 months and strong fam hx
  • ddx tinea
  • try Sebulex shampoo or mineral/olive oil followed by washing + removal of scales with comb
90
Q

Diaper Dermatitis

A
  • clotrimazole 1%/hydrocortisone 1% BID then cover with zinc ointment
  • check for oral thrush –> nystatin 100, 000 units/mL 2 mL QID for infants, 4-6 mL QID for children for up to 48h after resolution of lesions
91
Q
A

Erythema Multiforme

  • usually viral from HSV, can be caused by drugs
  • minor if limited and no mucosal, major if mucosal
  • supportive tx for both
92
Q

Croup

A

Review Evernote

93
Q

PALS

A

Review Evernote + Card

94
Q

Mastoiditis

A
  • postauricular erythema, swelling, tenderness
  • protrusion of auricle and obliteration of postauricular crease
  • Contrast CT Scan
  • admission IV Cetriaxone
95
Q

Normal neonatal feeding/voiding

A

2-3 oz every 2-3 h

6 diapers/24h

96
Q

Difference between caput succedaneum and subgaleal hemorrhage

A

See Peds Newborn Exam

97
Q

Measles

A

see Evernote Measles

98
Q

Ultimate BVM

A

See Evernote BVM

EM (27 decks)

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