Pediatrics Flash Cards - Case 23 - 15yo lethargy & F
Hallmark s/sx of meningitis?
fever, headache, stiff neck, altered mental status, and photophobia
Encephalitis in pediatrics is often due to what class of organisms?
Viruses
What is the first and most subtle sign of possible inadequate perfusion?
tachycardia
Emergency assessment mnemonic?
CABD(D)E: circulation -> airway -> breathing -> disability/dextrose (neuro ∆s/ICP s/sx) -> environment/exposure (expose everything, make sure pt is warm)
Brief definition of “shock”?
inadequate delivery of substrates and oxygen to meet the metabolic needs of tissues
Early signs of shock in peds?
incr HR & RR, periph BV constriction (-> cool, clammy extremities and delayed cap refill), and decr pulses (d/t vasoconstriction and decr stroke volume). The vasoconstriction can lead to difficulty w/ pulse ox reading.
Four categories of shock? Which are most common in kiddos?
distributive (neurogenic & anaphylactic), **septic, hypovolemic, cardiogenic [ = most common in kiddos]
Consider starting an IO line in a shocky patient after how many failed peripheral IV attempts?
after 3 failed in 90 secs
When you see fever and petechial rash think …?
meningococcal sepsis; also could be: RMSF, TSS, Kawasaki’s disease, scarlet fever
Rash and fever seen in RMSF?
classically: rash on palms and soles; maculopapular to petechial; usu starts on wrists/ankles and moves centraly; palms and soles may be late finding
Rash and fever seen in TSS?
rash is sandpaper-y and sunburn-looking
Rash and fever seen in Kawasaki’s dz?
polymorphic truncal rash -> later periungal peeling of hands and feet; mucocutaneous changes (“strawberry” tongue, red-cracked lips, oral erythema); conjunctivitis; swollen feet/hands; unilateral cerv lymph > 1.5cm
Rash and fever seen in scarlet fever?
Rash appears on upper trunk 12-48 hrs after fever onset; becomes confluent/sandpaper-y as it spreads to extremities; fades 4-5 days -> desquamation; Linear petechiae in body folds (Pastia’s sign); pharynx is beefy red and tongue is initially white and rough (strawberry tongue); w/in 4-5 days white coating sloughs off and tongue becomes bright red.
Tx w/ pediatric dosing for meningococcemia/ meningococcal meningitis?
Penicilin G: 250,000-300,000 units/kg/day divided every 4-6 hours
Adult PenG dosing for meningococcal meningitis?
Penicilin G: 12-24 million units daily divided every 4-6 hours
Empiric tx for “sick” patient w/ fever and a rash? What is each antibiotic covering?
Vanco (MRSA) AND Ceftriaxone (Gm-neg and Gm-pos bugs, e.g. Staph and Strep) ADD doxy in RMSF endemic areas
Eliminating carrier state of menigococcus?
at end of PenG, pt needs either rifampin (children/young adults) or cipro (adults). Alternatively, a pt can be treated 5 to 7 days w/ ceftriaxone, which also eliminates the carrier state.
Prophylaxis choices for close contacts of a pt w/ meningococcal disease? Ped option? Adult?
< 18 y/o: PO rifampin or IM ceftriaxone; > 18 y/o: cipro is drug of choice. Rifampin, ceftriaxone, and azithromycin are alternatives. (No rifampin or cipro for preg women.)
In the general population, at what age do we recommend MCV4 vaccination?
Children ages 11-18 (usually one at 11/12 and booster at 16); if they get it at 13-15, boost at 18; if they get it at 16+, no need to boost
Fatality rate from meningococcal disease overall? In adolscents?
All ages: 10-15%; Adolscents: 20%
Bad outcomes, besides death, from pts w/ meningococcal meningitis?
Hearing loss, Neuro disability, Digit or limb amputations, Skin scarring
Classic clinical presentation of RMSF?
abdominal pain, headaches, myalgias, fever, and nausea, followed by blanching erythematous macules, which may be transitioning to petechiae and purpura
Initial w/u and mgmt of suspected RMSF?
Admit, CBC, blood and CSF cultures, then give loading doses of doxycycline 2.2 mg/kg and ceftriaxone 100 mg/kg/day (the latter for N. meningitides coverage d/t rash also c/w meningococcal disease)
