Paeds Flashcards
(98 cards)
1
Q
Dose of ondansetron
A
0.15 mg/kg PO/IV
2
Q
Peds GCS
A
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
Q
What to send stool for in ED
A
- 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
5
Q
ORT for Kids
A
- 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
Q
Paeds IV Fluids
A
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
Q
Dose of PRBC for transfusion in trauma in Kids
A
10 mL/kg
8
Q
Urine output goals in trauma
Infants
Children
Adults
A
Infants: 2 mL/kg/h
Children: 1 mL/kg/h
Adults: 0.5 mL/kg/h
9
Q
Hypertonic Saline Dose for IICP in Children
A
3-5 mL/kg 3% Saline
11
Q
Yellow Zone Asthma Therapy
A
15
Q
Flovent Preparations
A
50 mcgs, 125 mcgs, 250 mcgs
16
Q
Abnormal Values on WBC for infants
A
WBC <5 or >15
Band/neutrophil > 0.2
Bandemia >1, 500 mm3
ANC > 10, 000
17
Q
Abnormal UA for infants
A
> 10 WBC or +ve Gram Stain
21
Q
Accepted Sources of Fever for peds (>3 months)
A
HSV/Gingivostomatitis
Herpangina/Ulcerative stomatitis
RSV
Croup
Flu
Varicella
Viral Exanthem (Rash)
Enterovirus, coxsackie, HFM, echo, rhino, entero
22
Q
Abx doses for Peds FWS
A
< 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
Q
FWS Algorithm
6 months - 3 years
A
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
Q
Prevalence of SBI in peds FWS (for a well-appearing child)
A
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
31
Atrovent Dosing
Atrovent has shown to work within 1st hour of tx in children but not beyond
- 250-500 mcg nebs Q20 min X 3
- 4-8 puffs Q20 min PRN
32
Steroid Dosing Asthma
* Dex 0.6 mg/kg (max 16 mg) daily x 2 days (peds only)
* Prednisolone 2 mg/kg day 1, 1 mg/kg days 2-5 (max 50 mg)
* Prednisone 1 mg/kg daily x 5 days (max 50 mg)
33
IV MgSO4 dose for Asthma
If no response in first 1-2h of therapy, 75 mg/kg, max 2.5 g IV. Monitor for bradycardia and hypotension. In adults, use liberally, 2 g IV NNT 2-3 in mod-severe asthma to prevent admission.
34
Andy Sloas' Four Groups of Asthmatics
**Group 1:** ran out of meds/mild cold - home with Rx or 1 treatment with ventolin, steroids, and home.
**Group 2:** Mild (CRS \<3), RR increased to 50, SpO2 92% or one thing off. 6 puffs ventolin + atrovent, steroids. If needs 1-2 sets of this, watch for 1 hour, send home.
**Group 3:** if needed 3 back to back nebs or sets of puffs, that is equal to 1h continuous nebulized ventolin ---\> 3:2:1 rule
- if needing treatments Q3h, home
- if needing treatments Q2h, admit to general peds ward
- if needing treatments Q1h, admit to step-down
- if needing continuous, PICU
**Group 4:** de-sat, tripoding, CRS \>6
- continuous nebs, IVSCS, IV MgSO4
- if needed 2h continuous neb --\> IV epi or terbuteline
35
Bronchiolitis Pertinent History
Infants - 2 years
RSV
Lasts 7-14 days, peaks on days 3-5
Ask about apneic episodes --\> admit
36
Bronchiolitis Treatment
Hydration
Nasal suctioning with saline nasal drops QID
May try ventolin/racemic/hypertonic saline PRN
37
Amoxil Dosing & Amox/Clav Dosing for kids
* max Amoxil 3-4 g/day
* Amox/Clav only available in 7:1 ratio in Canada (14:1) in states
* to reduce diarrhea, rx (for AOM)
* 45 mg/kg Amox/Clav (7:1)
* 45 mg/kg Amox
* for total 90 mg/kg Amoxil with 14:1 clavulin ratio
38
Perforated TM with AOM or TM tube with purulent otorrhea
* ciprodex better than PO Abx
* swab & send for C&S
39
Definition of peds UTI
100, 000 CFU's per mL for clean catch or 50, 000 CFU per mL for catheterized sample of single organism + 10 WBC/mL from unspun or 5 WBC/mL from centrifuged specimen or culture or leuks/nitrites in a symptomatic child
40
Additional investigations for peds UTI
* 1st febrile UTI 2-24 months --\> KUB U/S
* peds if +ve (for VCUG)
* peds if second febrile UTI (even if US -ve) for VCUG
* VUR Grades 1-3 no change in treatment, no prophylaxis, Grades 4, 5, refer to peds urology, consider sx
41
1st line Abx for febrile peds UTI
* cefixime (Suprax) 8 mg/kg PO daily x 7-14 d
42
Measles
* **Rubeola**
* **incubation:** 10 days
* **infectivity:** 2 days before rash until 5 days after onset of rash
* **symptoms:** cough, coryza, conjunctivitis, high fever, Koplik spots, rash starting from ears, spreading all over
* **diagnosis:** measles IgM
* **complications:** AOM, pneumonitis, encephalitis (0.1%)
43
Mumps
* **Paramyxovirus**
* **incubation:** 6 days
* **infectivity:** 1 day before swelling until 5 days after onset of swelling
* **symptoms:** myalgias, fever, headache, swelling of parotid/submandibular glands
* **complications:** orchitis (30%, usually does not lead to infertility), meningoencephalitis (10%)
* droplet precautions
* testing:
* throat swab
* buccal swab (massage parotid gland x 30 s first)
* urine
* IgG/IgM (serology)
* most can manage as outpatient (avoid school/work for 2-5 days, live in separate room)
44
Rubella
* **incubation:** 14-21 days
* **infectivity:** 2 days before onset of rash until 7 days after onset of rash
* **symptoms:** URI, posterior auricular, posterior cervical, occipital LAN, MP rash starts on face, spreads over body for 3 days
* **complications:** congenital rubella syndrome (infection in first 4 months of pregnancy --\> cataracts, glaucoma, CHD, dev delay, etc.)
* ***pregnancy***
* IgG + IgM
* if IgG +ve at time of exposure, reassure
* if IgM +ve, IgG -ve, counsel for termination if in 1st trimester
45
Fifth Disease/Erythema Infectiosum/Slapped Cheek
* **Parvovirus B19**
* **incubation:** 5-10 days
* **infectivity:** prior to onset of rash
* **symptoms:** URI, waxing/waning rash (red cheeks, eyelid + circumoral sparing first then 4d later reticular rash), arthralgias (Ag/Ab deposition), transient aplastic anemia (infects erythroid progenitor cells)
* **complications:**
* 15% risk hydrops and fetal death if infected before 20 wks GA, \<3% after 20 weeks.
* ***pregnancy***
* risk of fetal death after household exposure \<2.5%, workplace \<1.5%
* draw IgG
* detectable by 7th day, persists lifelong
* draw IgM
* detectable by 3rd day, persist 30-60 days
* if susceptible or +ve IgM, weekly US x 4-8 weeks after exposure to r/o hydrops
46
Chicken Pox
* **Varicella Zoster**
* **incubation:** 10-20 days
* **infectivity:** 2 days before rash until all lesions crusted over
* **symptoms:** fever, HA, malaise, then itchy painful rash, lasts 7-10 days
* **complications:** sepsis, cerebellar ataxia, encephalitis, pneumonia, nec fasc
* ***pregnancy***
* 30% varicella pneumonia, mortality 40%
* maternal HZV not harmful but exposure to HZV without varicella immunity is
* congenital varicella syndrome
* usually in first 20 weeks of pregnancy
* \<2% risk at \< 20 weeks, lower after
* ***diagnosis***
* clinical
* 4x rise in varicella-specific IgG Ab over 14-21d period
* ***management***
* if history of chickenpox --\> reassure
* if unknown, and able to get results within 96h, draw VZV IgG Ab
* if unable to get labs within 96h or if no immunity
* give VZIG 625 units IM
* if develops severe disease
* acyclovir 10 mg/kg IV Q8h or 800 mg PO QID x 5 d
47
Hand-Foot-Mouth Disease
* coxsackie virus
* complications:
* myocarditis
* diarrhea 10 d after onset
48
Formula to estimate normal lower limit BP in children \> 1 year
SBP = 70 + [2X(age in years)]
49
NRP: The three questions to ask to decide whether to give baby to mom or to resuscitate.
1. Is it term?
2. Is it crying & breathing?
3. Does it have good tone?
50
Rule of three's for Colic
3 weeks to 3 months
At least 3 h of crying at least 3d/wk
Usually after 3 PM
51
Age of incidence: Croup
3 months - 6 years
52
Dose of Dex: Croup
Dose of Racemic Epi neb: Croup
Dose of IM Epi: Croup
Dex: 0.6 mg/kg (max: 10 mg) PO X 1
Racemic epi: 0.25 mL mixed with 3-5 mL saline, watch for 2h
IM Epi: 0.01 mL/kg of 1:1000 (max: 0.3 mL)
53
Peds Vitals
Review Evernote
Correct HR by 10 and RR for 5 per 1 deg C increase
54
AAP Guidelines for UTI testing in 2 mo. - 2 yrs age
* **girls**, test if 2 or more of:
* nonblack
* \< 12 mo.
* T \>= 39
* fx \>= 2 d
* no other source
* **uncircumcised boys**
* test if no apparent focus of infection present
* circumcised boys, test if 2 or more of:
* nonblack
* T \>= 39
* fx \>= 24h
* no other source
* **circumcised boys**, test if 2 or more of:
* nonblack
* T \>= 39
* fx \>= 24h
* no other source
55
Necrotizing Enterocolitis
Age, pathophys, clinical features, dx, tx.
* neonatal disease
* immune overreaction, coagulation necrosis
* mean age 2-9 days of life, but think up to 3 months
* poor feeding, abdo distension, bilious vomiting, fever +- BRBPR/melena
* labs
* 3V Abdo
* pneumatosis intestinalis
* portal venous gas
* tx
* NPO, g-tube, abx, IVF
56
Hirschprung's Disease
History, clinical features, age of onset
* Hx Delayed first stool passage (\>24-48h)
* Needs suppository for every stool.
* 1-2 months old.
* On rectal exam, stool and gas is explosive.
57
Volvulus (peds)
age of onset
clinical features
dx
* Malrotation is abnormal position, volvulus is twisting/ischemia of bowel.
* 80% presents in 1st month of life, 90% within 1st year
* abrupt onset bilious vx, abdo distention
* may be intermittent
* lab
* upper GI series
* sx consult without waiting for result
58
Intususseption
Age of onset
causes
clinical features
dx
* 3 months - 3 years
* causes
* Peyer's patches, Meckel's, HSP
* lethargy, intermittent pain
* legs drawn to chest
* normal exam in-between
* sausage mass RUQ
* occult blood (70%), gross blood (50%)
* US ~100% sensitive
* If high suspicion, direct to air-contrast enema
* not if FA on xray, or in shock
59
Peds Umbilical vs. inguinal hernias
* all inguinal need urgent repair
* umbilical may repair if symptomatic or age \> 3
60
How much weight loss is acceptable for a neonate, and when must they regain their birth weight?
* normal to lose up to 10% birth weight during first 3-7 days, but should regain by 10-14 d
* average gain of 20-30 g/day for first 3 months then 15-20 g for next several months
61
Normal Periodic Breathing vs. Apnea in neonates
* ***normal periodic breathing:*** normal/fast alternating with slow + pauses 3-10 seconds
* ***apnea:*** pause in breathing \> 20 seconds or with bradycardia/cyanosis/change in muscle tone is abnormal
62
By what age do most infants sleep through the night?
* 6 months
63
TSB levels for severe and critical hyperbilirubinemia in neonates
* ***Severe hyperbilirubinemia*** – a total serum bilirubin (TSB) concentration greater than 340 µmol/L at any time during the first 28 days of life
* ***Critical hyperbilirubinemia*** – a TSB concentration greater than 425 µmol/L during the first 28 days of life
64
Neonatal Jaundice
Readthrough, Evernote
65
Mastoiditis
* almost always from AOM
* highest age 1-3
* CT mastoid
* PipTazo + Vanco
66
* Geographic tongue
* childhood lesions
* migratory
* recurrent
* asymptomatic
* no treatment necessary, benign
67
Pediatric ABRS
* usually ethmoid & maxillary (frontal don't develop until late adolescence)
* don't do imaging
* check for FB --\> do consider xray if unilateral purulent discharge
* more or less same criteria as adult, mostly gestalt (unilateral tenderness, prolonged nasal discharge)
* clavulin/cefuroxime + nasonex, f/u GP
68
Pediatric Assessment Triangle
1. **A**ppearance
2. Work of **B**reathing
3. **C**irculation
69
NRP Algorithm
* **0-30 Seconds**
* dry, stimulate
* if no response, suction nose and throat with 8F catheter
* **30s-60s**
* if HR \> 100 but cyanosis/laboured breathing
* open airway, suction
* SpO2 from R hand
* no naloxone
* if HR \<100/apnea
* BMV PPV @ 40-60 BPM, Pmax ~20-30
* start with room air
* **M**ask seal
* **R**eposition
* **S**uction
* **O**pen mouth (jaw thrust)
* **P**ressure (increase to max 40)
* **A**irway control --\> (ETT)
* **60s-90s**
* if HR \< 60, start CPR
* 3:1 compression:breath ratio
* if no response give Epi (0.01-0.03 mg/kg IV or 0.05-0.1 mg/kg intratracheal)
* 10 mL/kg NS bolus over 3-5 min if blood loss suspected
* 2 mL/kg bolus D10W for glu \< 1.38 in first hours of life
70
Dose of e- in Peds Arrest
2 J/kg initially --\> 4 J/kg all subsequent shocks, may go up to 10 J/kg
71
Dose of e- in Peds Cardioversion
0.5 J/kg ---\> 1 J/kg, up to 2 J/kg
72
SVT vs. ST in Peds
* \>220 in infant, \>180 in child more likely to be SVT
73
Treatment of Tet Spell
* calm child
* 100% NRB O2
* flex knees to chest (to increase preload + SVR)
* morphine
* IV NS bolus
74
Approach to Suspected CHD in Sick Neonate
* CXR, ECG
* R vs. L SpO2
* UE vs. LE BP's
* R brach-femoral pulse delay
* O2 is pulmonary vasodilator and decreases R--\>L flow through PDA + vasoconstricts PDA so be careful
* IV Prostaglandin E1 0.1 mcg/kg/min
* titrate to lowest effective dose (typically 0.05 mcg/kg/min)
* 10 mL/kg NS bolus (may not tolerate if CHF)
* IV Abx as cannot r/o sepsis
* +- Lasix 1-2 mg/kg IV
* +- dopamine, dobutamine
75
Kawasaki's Disease
* late fall through early spring
* **phase 1 (acute):** 1-2 weeks
* **phase 2 (subacute):** 2-4 weeks
* **phase 3 (convalescent):** 4-6 weeks
* **_Criteria_**
* **Classic (Complete)**
* Fever \>=5d and at least 4 of:
* bilateral, nonpurulent, bulbar (not palpebral) conjunctivitis
* oropharyngeal erythema (any of strawberry tongue, nonexudative erythematous oropharynx, fissured, cracked, erythematous lips)
* polymorphous rash (diffuse, non-specific, not bullous/vesicular)
* peripheral extremity changes (any of: erythema of palms/soles, edema of palms/soles, periungal desquamation
* cervical lymphadenopathy (\>1.5 cm, usually unilateral)
* **Incomplete**
* Fever \>=5d with only two of above clinical criteria
* CRP \>= 3 or ESR \>= 40
* \>= 3 of the following lab findings
* WBC \>= 15
* Anemia
* Plt \>= 450 (if \>=7d fever at presentation)
* Albumin \<= 30
* high ALT
* Urine WBC \> 10/hpf
* **Atypical**
* meets all clinical criteria for complete but also features not typical of Kawasaki's (e.g. nephrotic syndrome)
* infants \< 6 mo with 7 d fever without explanation should get lab testing +- 2D echo even if no other criteria met
76
AVPU Score
**A**lert
**V**erbal (responds to verbal)
**P**ain
**U**nresponsive
77
HUS
Review on Evernote
78
HSP
Review Evernote
79
HUS Triad
* Microangiopathic hemolytic anemia
* Thrombocytopenia
* AKI
80
HSP Tetrad
* Palpable purpura in patients with neither thrombocytopenia nor coagulopathy - everyone, although not on presentation in 25%
* Arthritis/arthralgia ~75%
* Abdominal pain 50%, GI bleeding in 25%
* Renal disease ~30%
81
Peds limp
Review Evernote
82
Acute Rheumatic Fever
* usually begins 2-6 weeks after GABS strep throat
* mild migratory polyarthritis
* contrast with post-strep reactive arthritis
* ~10 d after strep, more severe mono-oligoarthritis without any Jones features
83
Bullous Impetigo/Staph Scalded Skin Syndrome
* spectrum of disease from staph toxin
* +ve Nikolsky
* usually \<6 years old
* often MRSA
* IV abx + admission if extensive
* pan-culture
84
Roseola
* high fevers x 3-5 days --\> defervescence --\> rash
85
HSV Skin Infections Peds
* **stain eyes**
* **eczema herpeticum**
* HSV over eczema
* Keflex + acyclovir (80 mg/kg/d divided Q 6h x 10d)
* **herpes gingivostomatitis**
* symptomatic tx
* PO acyclovir may shorten if given within 48h
* consult peds if \< 2 y for dose
86
Scarlet Fever
* GABS
87
Erythema Toxicum Neonatorum
* benign, self-limited, 1st-2nd week of life
* 2-3 cm erythematous macules, sometimes with central pustules
88
Transient Neonatal Pustular Melanosis
* usually black infants
* small pustules, red macules with surrounding scale, or brown macules
* also self-limited
89
Cradle Cap (Seborrheic Dermatitis)
* usually starts weeks 2-6, improves by 6 mo.
* consider atopy if starts at 2-3 months and strong fam hx
* ddx tinea
* try Sebulex shampoo or mineral/olive oil followed by washing + removal of scales with comb
90
Diaper Dermatitis
* clotrimazole 1%/hydrocortisone 1% BID then cover with zinc ointment
* check for oral thrush --\> nystatin 100, 000 units/mL 2 mL QID for infants, 4-6 mL QID for children for up to 48h after resolution of lesions
91
Erythema Multiforme
* usually viral from HSV, can be caused by drugs
* minor if limited and no mucosal, major if mucosal
* supportive tx for both
92
Croup
Review Evernote
93
PALS
Review Evernote + Card
94
Mastoiditis
* postauricular erythema, swelling, tenderness
* protrusion of auricle and obliteration of postauricular crease
* Contrast CT Scan
* admission IV Cetriaxone
95
Normal neonatal feeding/voiding
2-3 oz every 2-3 h
6 diapers/24h
96
Difference between caput succedaneum and subgaleal hemorrhage
See Peds Newborn Exam
97
Measles
see Evernote Measles
98
Ultimate BVM
See Evernote BVM
