peds80 Flashcards
management of dog bite wounds
sutured; also give antibiotics like amoxicillin-clavulanic acid; tetanus prophylaxis if needed
victims of cat bites have a high risk of infection of what orgnism?
P. multicoda
cat scratch disease
regional lymphadenitis
metcarpophalyngeal joint
remember three phalanges and then the metacarpal
infections in human bites
infecton rate is high! Mixed bacterial infection is often present; other systemic infections like hep B, HIV, and syphillis may be transmitted
black widow spider- what does it look like
red or orange hour glass marking on its ventral surface
clinical features of a black widow spider bite
few local sx except for burning or a sharp pinprick; pathognomonic sx are severe htn and muscle cramps
management of black widow spider bite
local wound care (tetanus if needed); benzos or narcotics to relieve muscle cramps; lactrodectus antivenin is given for signs and sx suggestng severe envenomation
brown recluse spider- what does it look like?
brown violin shaped marking on the dorsum of the thorax
brown recluse spider bite clinical features
cytotoxic compound that destroys the tissues; bite initially little pain then 1-8 hrs later, a painful itchy papule that increases in size and discolors during the course of 3-4 days develops
systemic symptoms in brown recluse spider bite
may develop 24-48 hours after the bite
management of recluse spider bite
wound care and tetanus prophylaxis if needed; there is no antivenom
pit viper snake bite
venom is a mixture o proteolytic enzymes; local puncture marks and progressive swelling and ecchymosis
systemic effects of pit viper snakes
paresthesias of the scalp, periorbital fasciculations, weakness, diaphoresis, dizziness, nausea, and a metallic taste in the mouth; coagulopathy, thrombocytpenia, hypotension, and shock also
management of pit viper snake bite
immediate transport to closest Er; use crotalidae polyvalen antivenin within 4-6 hours; kids need more
complications of the pit snake antivenin
common; serum sickness and anaphylaxis
coral snake venom
neurotoxic venum; mild local swelling and severe systemic sx (paresthesias, vomiting, weakness, diplopia, fasciculations, confusion, resp distress)
management of coral snake bite
antivenon, local wound care, and supportive care
Ziehl-Neelson stain
for acid-fast bacili
silver stain
for funghi
Wright stain
stool white blood cells
intradermal tests
for TB and coccidioides immitis
antibody testing
for vruses (EBV, CMV, VZV, and HIV), toxoplasma gondii, bartonella henselae, and mycoplasma pneumonia
fever is defined as what?
rectal temp of 100.4 (38 deg) or higher
what are high risk groups that should be evaluated for serious infection?
infants less than 28 days because of immaturity of immune sys; older infants with fecers over 39 deg who appear ill; infants and kids who are immunodef, have SS disease, or chronic liver, renal, pulm, or cardiac dz
toxic appearance
child appearing extremely ill with diminished interactivity or poor peripheral perfusion
normal band count
a band is a young neutrophil; less than 3% is normal
normal urinalysis
less than 10 WBCs per HPF
normal stool analysis WBC count
less than 5 WBCs per hpf on stool Wright stain
when do you hospitalize a kid with a fever?
all infants less than 28 days; infants between 29 days and 3 months with any of the following: toxic appearance, suspected meningitis, pneumonia, pyeloneph, or bone or soft tissue infections unrespons to oral antibiotics; patients in social circumstances in which there is uncertain follow up
antibiotic management for infants less than 28 days
IV in the hospital until cultures of blood, urine, CSF, and stool, if diarrhea is present, are neg
antibiotic management of infants 29days to 3 mos
empiric outpatient parenteral antibiotic therapy on a daily basis while cultures are pending; unless they are high risk, and those need to be hospitalized
most common bacterial pathogens in 0-1 month olds
Group B strep, E. coli, listeria
most common bacteria in 1-3 month olds
group B strep, strep pneumonia, listeria
most common bacteria in 3 months-3 years
strep pneumonia, Haemophilus influenza type B, neisseria meningitidis
most common bacteria in 3 years to adults
strep pneumoniae, neisseria meningitidis
empiric IV antibiotics for 0-1 month old
Ampciillin + gentamycin or cefotaxime; IV acyclovir if kid has apnea, seizures, or cutaneous vesicles for HSV
empiric IV antibiotics for 1-3 month olds
ampciillin + cefotoxamine (+ vanc if bacterial meningitis suspected, given that strep pneumo can be resistant to cef)
empiric IV antibiotics for 3 months to 3 yeasr
cefotoxamine (+vanc if bacterial mening suspected)
empiric IV antibiotics for 3 years to adults
cefotoxamine (+vanc if bacterial meningitis suspected)
definition of fever of unknown origin
greater than 8 days in length; prior history, physical exam,a dna prelim lab eval all fail to lead to diagnosis
when is the highest incidence of bacterial meningitis?
first month of life
what could potentially meningitis do to a fontanelle?
bulging fontanelle
signs suggestive of meningeal irritation
alteration in level of consciousness; nuchal rigidity (pos Kernig’s sign and Brudzinski’s sign); seizures; photophobia; emesis; headache
kernig’s sign
severe stiffness of the hamstrings causes inability to straighten the leg when the hip is flexed
brudzinski sign
severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
LP of meningitis has a predom of what type of cell?
neutrophils
blood culture in bacterial meningitis?
yes, do it; because usually positive
do you need to do a brain CT scan with contrast for suspected meningitis?
yes, because you might have a brain abscess
