Pediatrics Flashcards
Pressors
Dopamine if poor perfusion
Cold shock (hypotensive and vasocontricted) = epinephrine
Warm shock (hypotensive and vasodilator) = norepinephrine (levophed)
If catecholamine resistant = hydrocortisone
Intubation
Avoid etomidate in sepsis (adrenal insufficiency)
Have atropine available for bradycardia and secretions
PALS recommends everyone under 1 year gets atropine
PALS
Reversible causes of asystole/PEA
2-4 J/K in VT/VF
Jaundice
Physiologic (2-3 days) Breastfeeding (relative dehydration) Breast Milk (inhibitor of bili conjugation) Infection Hemolysis
Bad = first 24h or conjugated biliribuin
Bilirubin nomogram
Tx = phototherapy, exchange transfusion
Crying Infant
Hair Tourniquettes Infection Corneal abrasion Testicular torsion Nonaccidental Trauma (Frenulum)
Crashing neonate
Sepsis Cardiac Metabolic (check ammonia) GI catastrophe (NEC, bilious vomiting) NAT
Hypoglycemia
Rule of 50
D10W 5cc/kg neontes
D25W 2cc/kg young kids
D50W 1cc/kg older
Fever abx for neonates
Ampicillin/Cefotaxime (or Gent)
>1 month rocephin
Acyclovir
Vancomycin for UTI or sepsis
Pneumonia
Neonates: GBS, Listeria, Chalmydia, G- enterics
ABX: Tx for sepsis!
Infants/Toddlers: Viral, Strep pneumo, Haemophalus, Staph, atypicals, pertussis
ABX: Amoxicillin (high doses)
> 4-5 yrs: Mycoplasma
ABX: Macrolides
Afebile staccato cough = chlamydia, zithromax
Otitis Media
Treat if bilateral or >48h
High dose Amoxicillin
Augmentin if recent infection or associated bilateral conjunctivitis (H-flu)
Congenital Heart Disease
Bimodal, neonate (ductal dependent) and 2-6 months (CHF)
Ductal dependent
1. pulmonary blood flow = cyanosis/hypoxic
2. systemic blood flow = shock/acidotic
Tx = PGE 1 (intubate, MC side effect = apnea)
TRANSFER!!!
CHF = respiratory symptoms, looks like asthma, difficulty feeding, hepatomegaly
Arrythmias
SVT (>220 infant, >180 child)
Vagals (ice to face)
Acquired heart disease
Myocarditis Pericarditis Endocarditis Kawasaki Cardiomyopathy
Peds EKG
R heart dominant at birth
HR faster
Intervals shorter
Normal to have TWI in V1-3
Croup
Middle of night barky cough and respiratory distress
Steroids, single dose dexamethasone
If severe, epi neb (watch x2h)
DDx = bacterial tracheitis if sick appearing and no improvement with tax’s
Bronchiolitis
Suctioning, O2, PPV if needed
Maybe albuterol, hypertonic saline nebs, epi nebs
No role for steroids or abx
Status Epilepticus
FSBS? Check frequently - can become hypoglycemic
Benzo’s (0.1 mg/kg)
Dilantin/Cerebyx, Phenobarbitol, Keppra
(all 20 mg/kg)
Dilantin if >2 yo (20 mg/kg)
Secure airway if refractory
Versed, propofol, ketamine, pentobarbitol
Causes? Hypoglycemia Hyponatremia Hypocalcemia (DiGeorge) INH toxicity (Pyridoxine)
Febrile Seizures
Simple:
6 months - 6 years
15 min, focal, or recur in 24h
AMS
FSBS Low threshold to tx infection Tox? NAT Intussusception
Stroke in kids
50% hemorrhagic
Risk factors: Infection Arteriopathies Cardiac disease Hematologic disease (sickle cell - exchange transfusion) Drugs Chemo/rads
Management: controversial, officially don’t use TPA in kids
Peds DKA
Less fluid resuscitation!
Cerebral edema
10mg/kg bolus over 1 hour
2nd bolus over hour 2 if circulation compromised
1.5-2x maintenance fluids
Have mannitol at bedside
Risk factors for cerebral edema:
Age
First time episode
Degree of acidosis
Congenital Adrenal Hyperplasia
Hyperkalemic, Hyponatremic, Hypoglycemic
N/V/D
Arrythmias (due to elevated K)
Hypoglycemia can cause seizures
IVF, glucose, hydrocortisone
Inborn Errors of Metabolism
Enzyme deficiency leads to toxic metabolite
Metabolic Acidosis
Hypoglycemia
**Hyperammonemia
Supportive, make NPO
Replete glucose
Control seizures
Correct electrolyte abnormalities
Tx for sepsis, these are higher risk
Bilious Vomiting
Surgical emergency
Malrotation with midgut volvulus until proven otherwise
Call surgery, if stable may get upper GI as well.
Hirschsprung’s Disease
No meconium in neonates
Lesser form: Infants/children with chronic constipation
Pyloric Stenosis
Hypertrophy of gastric outlet, hungry but vomiting
US diagnostic
Olive mass at epigastrium
Correct dehydration or metabolic deficiency
Intussusception
Abdominal pain
Palpable sausage mass
Red currant jelly stool
Lethargy, N/V, paroxysms of pain
3 months - 2 years
Surgical emergency
Diagnosed with US or air/barium enema (dx and therapeutic, but perf risk)
10% recurrence, usually early
Meckel’s Diverticulum
Painless rectal bleeding
Can be nidus for volvulus or intussusception
Hemolytic Uremic Syndrome
Follows diarrhea (Ecoli, bloody) Abx with bloody diarrhea increase risk of HUS
Acute Renal Failure
Thrombocytopenia
MAHA (schistocytes)
If neuro findings as well consider TTP
Tx = supportive, dialysis
Leukemia
Presents like viral syndrome Fever Petechiae Bone pain, limp HSM Lymphadenopathy
Lymphoma
Night sweats Fever Pruritis Respiratory distress (if mediastinal mass) Lymphadenopathy
Limping Kids
Fracture
Discitis
Abdominal pain
Transient Synovitis
Septic Joint (fever, elevated CRP/ESR/WBC, effusion on XR/US, decreased ROM)
AVN (Legg-Calve-Perthes) - NWB
SCFE - frog leg view, chubby 13 year old, Klein’s line - NWB
Malignancy
Arthritis (ANA»_space; RF)
Apophysitis (overuse injuries)
Nonaccidental Trauma
Posterior rib fractures Multiple injuries Skull fractures Serious injuries Recurrent visits Metaphyseal lesions (bucket fractures) Frenulum tears
5th’s disease
Parvovirus B19, slapped cheek
Worry in pregnancy (hydrops) and sickle cell (aplastic crisis)
Varicella
Vesicles in different stages = varicella
Acyclovir, VZIG
Can happen in vaccinated kids
Scarlet Fever
Scarlet Fever - pastia’s line, sandpaper, strawberry tongue, desquamation (toxin mediated)
Staph Scaled Skin
Desquamination
More well defined than TEN
ABx
Nikolsky positive
Henoch Schonlein Purpura
Palpable Purpura (dependent, symmetric, edema)
Arthritis/Arthralgias (>50%)
Abdominal pain (can lead to intussusception)
Renal disease
If normal urine dip can f/u outpatient with kids, all adults should have Cr checked as well
Supportive tx with NSAIDs
Erythema Multiforme
Minor = no mucosal involvement
Major = mucosal involvement
Negative Nikolsky sign
90% a/w infection (HSV usually)
Symptomatic tx
Stevens Jonhsons Syndrome
Postive Nikolsky
On TEN spectrum
Prior abx usually
Mucous membrane involvement
IVF, supportive care
Kawasaki
5 days of fever PLUS 4/5 criteria
Mucosal changes Conjunctivitis Extremity changes Cervical LAD Polymorphous rash
ASA, IVIG
Concern for coronary artery aneurysm
Neonatal Resuscitation
PPV if HR under 100
Compressions if HR under 60
120 bpm if intubated
Otherwise 3:1 with thumb compressions
With hold support if under 23wks or 400g
DC if after 10 min with no HR
