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Flashcards in Introduction to Peds Deck (43)
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1

Dosing

Know how to calculate pediatric doses for medications
Usually mg/kg/day or mg/kg/dose (wt in lbs/2.2= wt in kg)

Dosing should be written in mg and mL on the prescriptions
EX: Pediatric ibuprofen dose is 10 mg/kg/dose q 6 hours PRN
2 ½ year old may weigh 14 kg
14 x 10 = 140 mg q6 hours PRN

2

Acute Otitis Media

The most common infection for which antibiotics are prescribed for children in the United States. Maximal incidence is in children 6-24 months of age. AOM is also one of the most common reasons a child is taken to the PCP’s office.

3

Pathophysiology of AOM

Viral Rhinitis &/or Allergic Rhinitis leading to Swelling of the nasal mucosa, nasopharynx, and Eustachian tube leading to Obstruction of the tube leading to Fluid to accumulate (i.e., effusion) leading to Suppuration and inflammation leading to AOM!!

The fluid in the middle ear is secretion from the middle ear leads to effusion.

4

Why is AOM more common in kids?

The ET in children is more horizontal, shorter, and narrower – making it difficult for fluid to drain and more likely for bacteria to invade.

5

Etiologies of AOM

Most Common Viral Agents (Viral causes account for 40-75% of cases of AOM): RSV, Rhinovirus, Coronavirus, Influenza, Parainfluenza, Adenovirus, and Enterovirus

Most Common Bacterial Agents: Streptococcus pneumoniae, Haemophilus influenzae (non-typeable), Moraxella catarrhalis

6

T/F" Strep pneumo is the most common cz of AOM

False, bacterially yes but viral is more common

7

Diagnosis of AOM

Acute signs and symptoms of AOM,
Pressence of middle ear effusion,
Signs or evidence of middle ear inflammation

8

Treatment of AOM:

1st line: Amoxicillin
2nd line: Amoxicillin + Clavulanate (Augmentin)
3rd Choice: Oral 3rd generation cephalosporin
Final Resort: IV or IM 3rd generation cephalosporin

For penicillin allergic patients: Cefdinir, cefpodoxime, or cefuroxime
If a severe reaction: Clindamycin or Azithromycin or Sulfamethoxazole-trimethoprim- not effective against Haemophilus.

For children who are vomiting or cannot tolerate PO meds: Ceftriaxone IM/IV 50mg/kg/day for 3 days

9

Length of Treatment for AOM

10 days for children with severe disease and all children < 2 years of age

5-7 days for children > 6 years with mild to moderate disease

10

Treating the Pain in AOM

OTC options: Acetaminophen. Ibuprofen. Prescription topical analgesia: Antipyrine/Benzocaine: 2-4 drops in affected ear BID to TID (DO NOT use in children with perforated TMs or Tympanostomy tubes)

11

Do not use cold or cough meds in children under 2 yo

ok

12

Complications of AOM:

Tympanosclerosis, TM perforation, Cholesteatoma
Chronic suppurative OM requiring tympanostomy tubes

13

Tympanosclerosis

scarring of the TM by hyalinization and granulation tissue deposition usually secondary to inflammation or trauma.

14

Cholesteatoma

Stratified epithelium that collects in a retracted TM (with possible eventual perforation) that can erode into the middle ear and ossicles and cause conductive hearing loss. They can even erode through the temporal bone and mastoid causing further damage and bone loss.
Pearl *Persistent or recurrent otorrhea should raise concern for a cholesteatoma. Foul smelling otorrhea should, too.

15

Chronic suppurative OM requiring tympanostomy tubes

When persistent otorrhea occurs in a child with tympanostomy tubes or TM perforations
Treatment usually requires therapy with an antibiotic that covers Pseudomonas and anaerobes (fluoroquinolones – PO or topical)

16

TM Perforation

Spontaneous. Most secondary to AOM heal within 2 weeks

17

Mastoiditis

Suppurative infection of the mastoid air cells, which may result in the destruction of the thin bony septae between air cells, followed by the formation of abscess cavities and the dissection of pus into adjacent areas.

18

Mastoiditis Pathogens:

Strep pneumoniae, Haemophilus Influenza, Strep pyogenes, Staph aureus (including MRSA)

19

Mastoiditis Clinical presentation:

Ear pain, Fever, Post-auricular tenderness, erythema, edema, fluctuance, or mass and/or Displacement of the auricle

20

Mastoiditis Diagnosis:

Clinical diagnosis, but imaging may be needed- CT scan

21

Mastoiditis Treatment:

IV antibiotics
Surgical management: Tympanostomy tubes, myringotomy, and mastoidectomy

22

Otitis Externa Pathophys:

Inflammation of the skin lining the ear canal and surrounding soft tissue. Most commonly caused by a loss of the protective function of cerumen and a breakdown of the underlying skin.

23

Common Causes of Otitis Externa

Most common bacterial cause: Staph aureus or Pseudomonas

24

Presentation of Otitis Externa

Pain with movement of the outer ear. May have discharge from the ear. White debris within the ear canal on otoscopy

25

Treatment and Prevention of Otitis Externa

No swimming during the acute phase. Don’t use cotton balls!

Treat with topical antibiotic for 10 days. Flouroquinolones. Use oral antibiotics if systemic symptoms are present

Prevention: Use 2-3 drops of a 1:1 mixture of 70% ethyl alcohol and white vinegar after swimming (in kids whose TMs are intact)

26

Foreign Bodies Signs/Symptoms

Foul odor, Purulent Drainage, Pain, Bleeding, Halitosis

27

FB Management:

Gator Clips, Dermabond or Suction.
If you can’t see it, let the professional get it! May have to treat the inflammation first.

Batteries-must be removed emergently!

28

Allergic Rhinitis

Prevalence: 10-20%. IgE mediated reaction to allergens in the nasal mucosa.

29

Most common allergens of Allergic Rhinitis:

Dust mites, pet dander, cockroaches, molds, and pollen

30

Symptoms of Allergic Rhinitis

Nasal itching, clear nasal discharge, sneezing, postnasal drainage, and congestion