Professional Documents
Culture Documents
APGAR
LENGTH / HEIGHT
(50 cm) Age Transverse-AP 0 1 2
Inches Blue / Pink body/ Blue Completely
Diameter ratio A
Age Centimeters Inches At Birth 1.0 Transverse = AP Pale extremities pink
At Birth 50 20 1y 1.25 Transverse > AP P Absent Slow (<100) > 100
1y 75 30 6y 1.35 Transverse >>> AP Coughs,
(-)
2-12 mo Age x 6 + 77 Age x 2.5 + 30 G Grimaces Sneezes,
Response
Cries
FONTANELS (-) Some flexion / Active
A
Age Gain in 1st Year is ~ 25cm Movement extension movement
0-3 mo + 9 cm 3 cm per mo Appropriate size at birth: 2 x 2 cm (anterior) Good,
R Absent Slow / Irregular
3-6 mo + 8 cm 2.67 per mo Closes at: Anterior = 18 months, or as early strong cry
6-9 mo + 5 cm 1.6 cm per mo as 9-12 months
Posterior = 6 – 8 weeks or 8 – 10: Normal
9-12 mo + 3 cm 1 cm per mo 4 – 7: Mild / Moderate Asphyxia
2 – 4 months
0 – 3: Severe asphyxia
Habit 1: Be Proactive
Habit 2: Begin with the end in mind
Habit 3: Put First Things First
Habit 4: Think Win-Win
Habit 5: Seek first to understand and
then to be understood
Habit 6: Synergize
Habit 7: Sharpen the saw
EXPECTED LA SALLIAN
GRADUATE ATTRIBUTES
(ELGA)
Up to 6 mo: 1 half tab per day for 10-14 days ◦ reassess after 6 hrs (infant) & 3 hrs (child)
6 months or more: 1 tab or 20mg
OD x 10-14 days
3. Continue feeding
4. Know when to return
TREATMENT PLAN B
CHILDS WT (kg) x 25
◦ if the child wants more ORS than shown, give more
◦ give frequent small sips from a cup
◦ if the child vomits, wait for 10 min then resume
◦ continue breastfeeding whenever the child wants
AFTER 4 HOURS
◦ reassess the child & classify dehydration status
◦ select the appropriate plan to continue treatment
◦ begin feeding the child while at the clinic
ORS
• Glucolyte 60 • Pedialyte 45 0r 90
ETIOLOGY OF PNEUMONIA
Bacterial
- Streptococcus pneumoniae
- Group B streptococci (neonates)
ARI PROTOCOL (PROGRAM FOR THE CONTROL OF ARI)
- Group A streptococci
- Mycoplasma pnemoniae (adolescents)
- Chlamydia trachomatis (infants)
- Mixed anearobes (aspiration pneumonia)
- Gram negative enteric (nosocomial pneumonia)
Viral
- Respiratory syncitial virus
- Parainfluenza type 1-3 (Croup)
- Influenza types A, B
- Adenovirus
- Metapneumovirus
Fungal
- Histoplasma capsulatum (bird, bat contact)
- Cryptococcus neoformans (bird contact)
Child Age 2months up to 5years
- Mucormycosis (immunosuppressed)
- Coccidioides immitis
- Blastomyces dermatitides
- Pneumocystis carinii (immunosuppressed,
HIV, steroids)
SMR GIRLS
LUDAN’S METHOD (HYDRATION THERAPY) Stage Pubic Hair Breasts
1 Preadolescent Preadolescent
MILD MODERATE SEVERE Sparse, lightly pigmented, straight, Breast & papilla elevated, as small
DEHYDRATION DEHYRATION DEHYDRATION 2
medial border of labia mound, areola diameter increased
< 15 kg, < 2 y/o 50 cc/kg 100 cc/kg 150 cc/kg Breast & areola enlarged, no contour
3 Darker, beginning to curl, ▲amount
> 15 kg, 2 y/o 30 cc/kg 60 cc/kg 90 cc/kg separation
D5 0.3% in st
1 hr: ¼ Plain LR 1st hr: ⅓ Plain LR Course, curly, abundant but amount < Areola & papilla formed secondary
4
6-8 hours Next 5-7 hrs: Next 5-7 hrs: adult mound
¾ D5 0.3% in ⅔ D5 0.3% in Adult, feminine triangle, spread to Mature, nipple projects, areola part of
5
5-7 hours 5-7 hours medial surface of thigh general breast contour
DENGUE PATHOPHYSIOLOGY
> Neonates (<1mo) - RSV
- GBS - Other respiratory viruses
- E. coli - Streptococcus pneumoniae
- other gram (-) bacilli - Haemophilus influenzae (Type B)
- Streptococcus pneumoniae - C. trachomatis
- Haemophilus influenza (Type B) - M. pneumoniae
- Group A Streptococcus
> 1-3 months - Staph aureus
* Febrile pneumonia
- RSV > 2-5 yrs
- Other respiratory viruses - Streptococcus pneumoniae
- Streptococcus pneumoniae - Haemophilus influenzae (Type B)
- Haemophilus influenza (Type B) - C. trachomatis
- M. pneumoniae
* Afebrile pneumonia - Group A Streptococcus
- Chlamydia trachomatis - Staph aureus
- Mycoplasma homilis
- CMV
> MOT: mosquito bite (man as reservior) Biphasic fever (2-7 days) with 2 or more of the ff: Manifestations of DHF plus signs of circulatory failure
1. rapid & weak pulse
> Vector: Aedes aegypti 1. headache 2. narrow pulse pressure (<20mmHg)
2. myalgia or arthralgia 3. hypotension for age
> Factors affecting transmission: 3. retroorbital pain 4. cold, clammy skin & irritability / restlessness
- breeding sites, high human population density, 4. hemorrhagic manifestations
mobile viremic human beings [petechiae, purpura, (+) torniquet test]
5. leukopenia DANGER SIGNS OF DHF
> Age incidence peaks at 4-6 yrs
1. abdominal pain (intense & sustained)
> Incubation period: 4-6 days Dengue Hemorrhagic Fever (DHF) 2. persistent vomiting
3. abrupt change from fever to hypothermia
> Serotypes: 1. fever, persistently high grade (2-7 days) with sweating
- Type 2 – most common 2. hemorrhagic manifestations 4. restlessness or somnolence
- Types 1& 3 - (+) torniquet test
- Type 4– least common but most severe - petechiae, ecchymoses, purpura
- bleeding from mucusa, GIT, puncture sites Grading of Dengue Hemorrhagic Fever
> Main pathophysiologic changes: - melena, hematemesis
a. increase in vascular permeability 3. Thrombocytopenia (< 100,000/mm3)
▼ 4. Hemoconcentration
extravasation of plasma - hematocrit >40% or rise of >20% from baseline
- hemoconcentration - a drop in >20% Hct (from baseline) following
- 3rd spacing of fluids volume replacement
- signs of plasma leakage
b. abnormal hemostasis [pleural effusion, ascites, hypoproteinemia]
- vasculopathy
- thrombocytopenia
- coagulopathy
B. Secondary Prevention
BRONCHIAL ASTHMA (GINA GUIDELINES)
Clinical Features:
TUBERCULOSIS RESPIRATORY DISTRESS SYNDROME
(Hyaline Membrane Disease) 1. Tachypnea, nasal flaring, subcostal and
A. Pulmonary TB
intercostal retractions, cyanosis, grunting
– fully susceptible M. tuberculosis, o Male, preterm, low BW, maternal DM, & perinatal 2. Pallor – from anemia,
– no history of previous anti-TB drugs asphyxia peripheral vasoconstriction
– low local persistence of primary resistance to
3. Onset – within 6 hours of life
Isoniazid (H) o Corticosteroids: Peak severity – 2-3 days
• most successful method to induce fetal lung Recovery – 72 hours
2HRZ OD then 4HR OD or 3x/wk DOT maturation
• Administered 24-48 hours before delivery Retractions:
– Microbial susceptibility unknown or initial drug decrease incidence of RDS o Due to (-) intrapleural pressure produced by
resistance suspected (e.g. cavitary) • Most effective before 34 weeks AOG interaction b/w contraction of diaphragm & other
– previous anti-TB use
respiratory muscles and mechanical properties of
– close contact w/ resistant source case or living o Microscopically: diffuse atelectasis, eosinophilic the lungs & chest wall
in high areas w/ high pulmonary resistance to membrane
H.
Nasal flaring:
–
o Due to contraction of alae nasi muscles leading to
2HRZ + E/S OD, then 4 HR + E/S OD or Pathophysiology: marked reduction in nasal resistance
3x/week DOT
1. Impaired/delayed surfactant synthesis & secretion Grunting:
2. V/Q (ventilation/perfusion) imbalance due to o Expiration through partially closed vocal cords
B. Extrapulmonary TB deficiency of surfactant and decreased lung • Initial expiration: glottis closed
– Same in PTB compliance lungs w/ gas
3. Hypoxemia and systemic hypoperfusion inc. transpulmo P w/o airflow
– For severe life threatening disease 4. Respiratory and metabolic acidosis • Last part of expiration: gas expelled against
(e.g. miliary, meningitis, bone, etc) 5. Pulmonary vasoconstriction partially closed cords
6. Impaired endothelial &epithelial integrity
2HRZ + E/S OD, then 10HR + E/S OD or 7. Proteinous exudates Cyanosis:
3x/wk DOT 8. RDS o Central – tongue & mnucosa (imp. Indicator of
impaired gas exchange); depends on
total amount of desaturated Hgb
UMBILICAL CATHERIZATION
NEWBORN RESUSCITATION Cathether length
Indications • Standardize Graph
AIRWAY: open & clear • Vascular access (UV) – Perpedicular line from the tip of the shoulder to
Positioning • Blood Pressure (UA) and blood gas monitoring in the umbilicus
Suctioning critically ill infants • Measure length from Xiphoid to umbilicus and add
Endotracheal intubation (if necessary) 0.5 to 1cm.
Complications • Birth weight regression formula
BREATHING is spontaneous or assisted • Infection – Low line : UA catheter in cm = BW + 7
Tactile stimulation (drying, rubbing) • Bleeding – High line : UA catheter = [3xBW] + 9
Positive-pressure ventilation • Hemorrhage – UV catheter length = [0.5xhigh line] + 1
• Perforation of vessel
CIRCULATION of oxygenated blood is adequate • Thrombosis w/ distal embolization Procedure
Chest compressions • Ischemia or infarction of lower extremities, bowel • Determine the length of the catheter
Medication and volume expansion or kidney • Restrain infant and prep the area using sterile
• Arrhythmia technique
• Air embolus • Flush catheter with sterile saline solution
• Place umbilical tape around the cord. Cut cord
RESUSCITAION MEDICATIONS Cautions about 1.5-2cm from the skin.
• Never for: • Identify the blood vessels.
– Omphalitis (1thin=vein, 2thick=artery)
Atropine 0.02 ml/k IM, IV, ET
– Peritonitis • Grasp the catheter 1cm from the tip. Insert into the
Bicarbonate 1-2 meq/k • Contraindicated in vein, aiming toward the feet.
Calcium 10 mg elem Ca/k slow IV – NEC • Secure the catheter
Calcium chloride 0.33/k (27 mg Ca/cc) – Intestinal hypoperfusion • Observe for possible complications
Calcium gluconate 1 cc/k (9 mg Ca/cc)
1g/k = 2 cc/k D50 Line Placement
Dextrose
4 cc/k D25 • Arterial line
Epinephrine 0.01 cc/k IV, ET • Low line
– Tip lie above the bifurcation between L3 & L5
• High line
– Tip is above the diaphram between T6 & T9
BILIRUBIN
PRETERM:
mg/dl mmol/L
0-1 hr 1-6 17-100
1-2 d 6-8 100-140
3-5 d 10-12 170-200
TERM
mg/dl mmol/L
0-1 hr 2-6 34-100
1-2 d 6-7 100-120
3-5 d 4-12 70-200
1 mo <1 <17
SERUM
ZONE JAUNDICE
BILIRUBIN
I Head & neck 6-8
Upper trunk
II 9-12
to umbilicus
Empirical dose Lower trunk
III 12-16
6 months ¼ tsp TID QID to thigh
6 mos – 2 yrs ½ tsp Arms, legs,
IV 15
2-6 1 tsp below
6-9 1 ½ tsp V Hands & feet 15
9-12 2 tsp
MKD COMPUTATION
LUMBAR PUNCTURE • To diagnose other medical conditions such as:
– viral and bacterial meningitis Wt x mkd x preparation [mg/mL] = mL per dose
• the technique of using a needle to withdraw – syphilis, a sexually transmitted disease
cerebrospinal fluid (CSF) from the spinal canal. – bleeding around the brain and spinal cord e.g. 12kg x 10mg x 5ml = 5mL per dose
– multiple sclerosis, (affects the myelin coating of 120mg
SPINE the nerve fibers of the brain and spinal cord)
• spinal cord stops near L2 – Guillain-Barré syndrome, (inflammation of the * If per day, divide total (mL) by the # of divided doses
• lower lumbar spine (usually between L3-L4 or nerves)
L4–5) is preferable Dose x preparation x frequency = mkd
Complication weight
CSF • Local pain
• clear, watery liquid that protects the central • Infection
nervous system from injury • Bleeding Paracetamol Drops = Wt: move 1 decimal
• cushions the brain from the surrounding bone. • Spinal fluid leak point to the left
• It contains: • Hematoma (spinal subdural hematoma Age Wt
– glucose (sugar) • Spinal headache 1 10 kg
– protein • Acquired epidermal spinal cord tumor 2 12
– white blood cells 3 14
• Rate : 500ml/day or 0.35ml/min Caution & Contraindications 4 16
• Range : 0.3-04 ml/min • Increased ICP 5 18
• Volume : 50ml (infants) • Bleeding diasthesis 6 20
150ml (adults) • Traumatic Tap
• Overlying skin infection 1 drop = 1/20 mL
Indication • Unstable patient 1 teaspoonful = 5 mL
• to diagnose some malignancies (brain cancer and 1 tablespoonful = 15 mL
leukemia) 1 wineglassful = 60 mL = 2 ounces
• to assess patients with certain psychiatric 1 glassful = 250 mL = 8 ounces
symptoms and conditions. 1 grain = 60 mg
• for injecting chemotherapy directly into the CSF 1 pint = 500 mL
(intrathecal therapy) 1 quart = 1000 mL
1 ounce = 30 mL
1 Kg = 2.2 lbs
1 lb = 0.45359 Kg