Inpatient Flashcards
(32 cards)
For which age group does a fever count as 100.4 or 38C?
Children less than 3yrs (per academy ER docs)
Otherwise, fever is > 38.5
What are the criteria for home O2 for children with bronchiolitis/viral pneumonitis?
- 3-18 months (if premature), min of 48weeks corrected age
- First episode of wheezing
- RA sat of 87% or less
- Reliable transport, social situation, and phone number
- Lives at altitude 6000 ft or less
- Lives with in 30 min from ER facility
- No apnea
- Follow up in 24 hrs with PCP or return o ED
- Caretakers comfortable with going home on O2
- No smokers at home
What is the benefit of HFNC?
Incorporates higher flows to generate pressure thus improving lung volumes and decreasing WOB
What anticipatory guidance should you give a family going home with home oxygen?
- Keep child away from heat sources (kitchen, etc)
- No smoking.
- Don’t put petroleum based products like vasoline on the child
- Be careful with tubing o not trip over. Taping to back of shirt helps
What are the best 3 clinical predictors of pneumonia (ie cxr shows pneumonia)?
- Fever
- Tachypnea (also its absence is best negative predictor)
- Hypoxemia (less than 90% on RA)
What is the rule of thumb for antibiotics and pneumonia?
If they are sick enough to be admitted to the hospital with a suspected bacterial CAP, then they should be on IV antibiotics
How long should you treat with antibiotics in CAP? When should you expect to see improvement?
- Treat for 7-10 days
2. Expect improvement in the first 48-72 hours
Name 7 common bacterial causes of pneumonia
- Strep pneumo
- Staph aureus
- Haemophilus influenzae
- Group A strep
- Bordetella pertussis
- Chlamydia pneumoniae (school aged)
- Mycoplasma pneumoniae (school aged)
Name 6 common viral causes of pneumonia
- Influenza A & b
- RSV
- Parainfluenza
- Human metapneumovirus
- Adenovirus
- Rhinovirus
What is the first line oral agent for CAP? IV agents?
Oral agent= amoxicillin 90 mg/kg/day divided into 2-3 doses
IV agents= ampicillin, ceftriaxone, cefotaxime
If suspect atypical pneumonia, use azithromycin
True or false: pneumonia is a common complication of hospitalized children with influenza
True
Can be primary pneumonia from influenza or secondary pneumonia from superimposed bacterial infection
What are the indications for hospitalization with pneumonia?
- Cannot take Oral antibiotics
- Dehydration requiring IVF
- O2 requirement
- Concern for or risk of complicated pneumonia
- Underlying comorbidity
What are the discharge criteria for pneumonia?
- Stable and improving O2 requirement, meets home O2 cutoffs
- Improved clinical status
- RR approaching normal for age
- Normal WOB
- Able to maintain adequate oral intake
- Able to take oral prescribed meds
- Reliable follow up and social situation
What are the maximum amount (in liters) of oxygen can be discharged home on for:
- Less than 24 months
- Older than 24 months
Less than 24 months: 1/2 liter or less
Older than 24 months: 1 liter or less
Define diabetic ketoacidosis
= insulin deficient state characterized by:
- Hyperglycemia (BG > 200)
- Acidosis (pH < 7.3, bicarb < 15)
- Ketoacids accumulate in blood ( measurable serum or urine ketones)
Give a problem list for DKA
- Insulin deficiency
- Hyperglycemia
- Dehydration
- Electrolyte loss
- Hyperosmolarity
What is the most common cause of DKA in a known diabetic?
Missed insulin doses (compliance, pump failure, not enough insulin given during sickness/poor PO intake
What are the main principles of management for DKA?
- Give insulin
- Rehydrate
- Correct electrolyte abnormalities
- Monitor for ongoing clinical or lab abnormalities
True or false: bicarb administration for DKA is helpful
False. No evidence it makes a difference
When can you wean the continuous insulin infusion in DKA?
When acidosis resolves (pH > 7.3, bicarb > 15)
What’s a quick rule to pick size of ET tube?
Age/4 + 4
What’s a quick rule for depth of ET tube insertion?
ETT size x3
What should you think about when an intubated patient suddenly develops respiratory failure?
DOPE
D=displacement of ETT
O= obstruction
P= pneumothorax
E= equipment failure
You think a patient is in anaphylaxis. What should you do?
- Epinephrine 0.01 ml/kg of (1:1000) IM, max 0.5 ml, repeat q5 min as needed
- Secure airway and monitor breathing
- IV access, fluid boluses as needed to maintain BP and perfusion
- Benadryl 1-2 mg/kg
- Methylpred 2 mg/kg IV bolus
