PICU Flashcards
Fluid calculation in kiddos?
While there may be a few different methods to calculating maintenance fluid rates in children, the most commonly used formula utilizes the “4-2-1 rule”:
4 mL/kg/hour for the first 10 kg;
2 mL/kg/hour for the next 10 kg
1 mL/kg/hour for every kg after 20 kg.
CNS infections in kids what typically causes brain abscess? Shunt infections? Meningitis?
Of note, fever, headache, and vomiting are common signs of a shunt infection. However, a patient with an infected shunt may also be asymptomatic if
the shunt is working as it disrupts the communication between the infected ventricles and the meninges. In the question above, the boy’s shunt is likely blocked by infection as he has symptoms concerning for rising intracranial pressure.
Most common pathogens for CNS pathology:
Brain abscess: Viridans streptococci and Staphylococcus aureus
Shunts: Staphylococcus epidermidis
Meningitis: Group B Strep (19 years), N. meningitidis (10 years - 19 years)
Discuss Kawasaki Disease: findings, treatments, diagnosis?
presenting with fever, cervical adenopathy, a polymorphous (multiple-morphologies) rash, hand and foot edema (these are early signs, before the desquamation occurs), cracked lips and bilateral conjunctivitis. All of these findings together are highly suspicious for Kawasaki disease. High-dose aspirin therapy with the addition of IVIG is indicated for the treatment of Kawasaki disease. Although the etiology of Kawasaki disease is currently unknown, there has been no evidence suggesting that antibiotic or antiviral therapy impacts the disease course. Sometimes, the disease can be preceded by a viral or bacterial illness.
Kawasaki disease (previously called mucocutaneous lymph node syndrome) is one of the most common vasculitides of childhood, second only to Henoch-Schonlein purpura. It is an inflammatory condition of the small- and medium-sized blood vessels and is preferentially seen in children under the age of 5. The small- and medium-vessel vasculitis can notably affect the coronary arteries which can result in aneurysm and dissection and is one of the most feared complications and causes of death due to this condition. This complication is significantly less likely with appropriate treatment.
The diagnosis of Kawasaki disease requires the presence of fever lasting at least 5 days without any other explanation, combined with at least 4 of the 5 following criteria. Not all of these will be present in every child nor even at the same time. Some may appear and vanish before the others appear making the diagnosis challenging at times:
Bilateral bulbar conjunctival injection
Oral mucous membrane changes, including injected or fissured lips, injected pharynx, or strawberry tongue
Peripheral extremity changes, including erythema of palms or soles, edema of hands or feet (acute phase), and periungual desquamation (convalescent phase)
Polymorphous rash
Cervical lymphadenopathy (at least 1 lymph node >1.5 cm in diameter)
