Module exam feedback: Pedia / Hema Flashcards
most common sites of internal bleeding
intracranial?
when circulating levels decrease to below 10,000 to 20,000/mm3, the risk of spontaneous bleeding becomes concerning, particularly for intracranial hemorrhage (1469)
remarks on treatment of VTE
LMW heparin for at least 6 months is recommended in the treatment of VTE in patients with active cancer
Dalteparin
100 IU/kg SC every 12 h or
200 IU/kg SC every day
Enoxaparin
1 mg/kg SC every 12 h, or
1.5 mg/kg SC every day
treatment of elevated INR and presence of life-threatening or serious bleeding
high-risk bleeding:
-75 years of age
-concurrent antiplatelet drug use
-polypharmacy
-liver or renal disease
-alcoholism
-recent surgery or trauma
administer Vitamin K1 5-10 mg SIVP
For INR >6, give 4-factor PCC 50 units/kg (max 5000 units)
for INR 4-6, give 4-factor PCC 35 units/kg (max 3500 units)
for INR <4, 25 units/kg (max 2500 units)
alternatively, may use 3-factor PCC 50 units/kg IV, FFP 10-15mL/kg IV infusion, or rFVIIa 80 mcg/kg SIVP
additional doses of PCC, FFP, or rFVIIa may be required depending on degree of coagulopathy
define massive transfusion
- replacement of 1 blood volume (approx 10 units prbc within a 24-hour period)
- replacement of 50% of blood volume within 3 hours
- ongoing transfusion during a period of rapi bleeding, such a >150 mL/min
Treatment of malignant hypercalcemia
PNSS IV infusion + zolendronate
+ furosemide if with concurrent heart failure or kidney insufficiency
remarks on pRBC transfusion in children
In children, 10-15mL/kg of PRBC will raise the hematocrit by 6-9% and the hemoglobin levels by approximately 2-3 g/dL (20-30g/L)
remarks on HUS
Hemolytic Uremic syndrome
-associated with Shiga toxin-producing E. coli O157:H7
“ART”
1. Anemia - MAHA
2. Renal failure
3. Thrombocytopenia
typica HUS (>90%) occurs bet 1 and 4 y/o, presenting about 1 week into a case of infectious diarrhea that’s often bloody and without associated fever
-e coli serotype O15:H&
most common hereditary hemolytic anemia among people of northern European descent
Hereditary sphrocytosis
-most commonly due to mutations in genes for spectrin and ankyrin
-not pliable enough to pass through the spleen
remarks on reticulocytes
as a result of tissue hypoxia or blood loss, reticulocytes appear in the blood within 3-7 days
remarks on tracheal suctioning in neonatal resuscitation
no longer recommended bec it can cause reflex bradycardia and apnea
what are epstein pearls
epstein pearls are remnants of embryonic development that present as white, slightly raised nodules seen most commonly midline at the junction of the soft and hard palates of neonates
most resolve spontaneously
2nd most common benign neck mass
thyroglossal duct cysts
-account for ~70% of congenital neck masses
-result from the persistence of any segment of the thyroglossal duct along its course from the foramen cecum of the tongue to the pyramidal lobe of the thyroid
-most are infrahyoid
gold standard for assessment of volume status
weight loss
goals of treatment in inborn errors of metabolism
- remove the inciting metabolic substrate (formula or breast milk)
- provide energy substrate to halt catabolism and toxin production and help eliminate toxic metabolites
- improve circulatory status by restroring circulatory volume as well as electrolyte balance
major life-threateing diagnoses in young infants (0-3 months)
- necrotizing enterocolitis
- malrotation with midgut volvolus
- incarcerated hernias
- nonaccidental trauma
