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1

Dose of ondansetron

0.15 mg/kg PO/IV

2

Peds GCS

E: 4= Spontaneous, 3 = voice = 2 pain 1 = none

V: 5 = smiles, orients to sounds, interacts, 4 = cries, consolable, inappropriate interactions, 3 = inconsistently inconsolable, moaning, 2 = inconsolable, agitated, 1 = none

M: 6 = moves purposefully, 5 = withdraws touch, 4 = withdraws pain, 3 = flexes (decorticate), 2 = extends (decerebrate), 1 = none

3

What to send stool for in ED

- Stool for fecal leukocytes (>5/hpf), blood or both, identifies 90% of invasive disease; if neg, may not need to send for culture.

- C&S, esp. E.coli 0157:H7

- C.diff

- O&P

4

Paeds Dehydration Assessment

5

ORT for Kids

1. Zofran 0.15 mg/kg ODT

Pedialyte (not Gatorade): for mild-moderate dehydration. Calculate desired volume based on dehydration chart, give 25%/h over 4h.
Vx: add 2 mL/kg for each episode during ORT, start again 10 min after vx
Dx: add 10 mL/kg for each episode during ORT
After 4h, if not better, restart for another 4h
After 8h, if not better, admit + IVF

6

Paeds IV Fluids

Shock
20 mL/kg NS over 5-15 minutes, repeat until improvement

CBG, if <2.8 mmol/L:

0-1 month = D10 4 mL/kg
1 month - 8 years/25 kg = D25 2 mL/kg
>8 years = D50 1 mL/kg
CBG Q 30-60 minutes

 

After initial resuscitation/Rehydration Phase

Total Deficit = %dehydration X kg X 1000 mL
First 9 hours: 1/2 deficit and 1/3 maintenance
9-24h: 1/2 deficit and 2/3 maintenance


Isonatremic/Hypernatremic: D5W 0.45% NS with 20 mmol/L KCl (KCl once voided)
Hyponatremic (<130 mmol/L): D5W 0.9% NS with 20 mmol/L KCl


 

7

Dose of PRBC for transfusion in trauma in Kids

10 mL/kg

8

Urine output goals in trauma

Infants

Children

Adults

Infants: 2 mL/kg/h

Children: 1 mL/kg/h

Adults: 0.5 mL/kg/h

9

Hypertonic Saline Dose for IICP in Children

3-5 mL/kg 3% Saline

10

Asthma ICS Dosing

11

Yellow Zone Asthma Therapy

12

Asthma PFT Diagnostic Criteria

13

Asthma Therapy Continuum

14

Asthma Criteria for Good Control

15

Flovent Preparations

50 mcgs, 125 mcgs, 250 mcgs

16

Abnormal Values on WBC for infants

WBC <5 or >15

Band/neutrophil > 0.2

Bandemia >1, 500 mm3

ANC > 10, 000

17

Abnormal UA for infants

> 10 WBC or +ve Gram Stain

18

FWS Algorithm 

0-28 days

29 days - 2 months

19

FWS Algorithm

2-3 months

20

FWS Algorithm

3-6 months

21

Accepted Sources of Fever for peds (>3 months)

HSV/Gingivostomatitis

Herpangina/Ulcerative stomatitis

RSV

Croup

Flu

Varicella

Viral Exanthem (Rash)

Enterovirus, coxsackie, HFM, echo, rhino, entero

22

Abx doses for Peds FWS

< 28d old: amp + gent or cefotaxime (if >8 days old), vanco (for pneumo resistance), acyclovir (if pleocytosis)

>28d old: cetriaxone +- vanco (for MRSA skin infections/severe infection), +- acyclovir

Amp: 50 mg/kg

Cefotaxime: 50 mg/kg

Vanco: 15-20 mg/kg

Ceftriaxone: 100 mg/kg (meningitis dose), 50 mg/kg (reg dose)

Acyclovir: 60 mg/kg/day divided q8h

 

23

FWS Algorithm

6 months - 3 years

UA + culture for circumsized boys up to 6 months, uncircumsized boys up to 12 months, and girls up to 24 months. Offer UA to all children up to 24 month with T >39 deg C

>3 y, no routine workup necessary for well-appearing

24

Prevalence of SBI in peds FWS (for a well-appearing child)

0-14 days: 1/10

14-28d: 1/20

28-60 d (pre-vaccine): 1/100

28-60 d (post vaccine): 1/1000

60-90d: 1/1000 - 10, 000

>90 d: > 1/10, 000

25

Criteria for simple febrile seizure

  • age 6 months - 5 years
  • generalized
  • <15 min
  • 1 time/24h

26

Pertinent Asthma Hx

  • past ED visits/admissions/intubations
  • home meds
  • fam hx asthma/eczema
  • environmental factors

27

Asthma Exam

  1. WOB
  2. SpO2
    1. >94% awake
    2. >89% asleep
  3. PO intake
    1. diapers
    2. IVC
    3. US bladder (if full, don't need to wait for pee)

28

At what age can you give a provisional diagnosis of asthma based on presentation and response to bronchodilators?

3 years

29

At what age would you get a peak flow?

6 years

30

Ventolin Dosing

Ventolin (MDI with spacer preferred over nebulizer)

     - 0.15 mg/kg (min 2.5 mg) Q 20 min x 3 then 15-40 mg/h continuous as needed

     - 4-8 puffs q 20 min then Q1-4h PRN