Rotation notes

 Poisoning management :
1) decontamination : induce vomiting ( by gag reflex or ipecac syrup ) is
better than gastric lavage
* Gastric lavage is C/I in caustic or hydrocarbon ingestion.
2) charcoal to Prevent absorption ( can be given until pt pass black stool) ,
useful for any poisoning except for heavy metals
3) Antidote administration if available
4) physical examination should focus on pt odor , pupils size , consciousness
level and on auscultation .
5) CBC , KFT , LFT and ECG should be performed to all cases .

 ABCD in pediatric : suction , oxygenation , cannulation and drug administration .

 ____________________
 Interrupted feeding and sleep disturbance may indicates cardiac diseases .
 ___________________
 Heart failure in pediatric : tachypnea , tachycardia and hepatomegaly .
 __________________
 Normal HBG in neonate is 16-18 mg/dl
 Physiological anemia in full term neonate occurs at 2 mo ( 8 to 12wks) , HGB may
reach 9 g/dl , for preterm , anemia start earlier ( at 3-6wks) , HGB reach 7 g/dl .
 Polycythemia in the newborn is defined as a central venous Hct over 65% or a
hemoglobin value above 22 g/dL .
 ________________
 Neonatal hypoglycemia, defined as a plasma glucose level of less than 30 mg/dL in
the first 24 hours of life and less than 45 mg/dL thereafter, is the most common
metabolic problem in newborns
 Immunological workup :
1) CBC with differentials
2) immunoglobulin level ( especially IgG ) , level sholud be plotted on spacial
charts specific for age
3) flow cytometry
4) Mitogen and Antigen proliferation test for Tcell function ( candidin or tuberculin
test)
5) Nitroblue tetrazolium test (N.B.T.) for neutrophils function .
 Severe congenital neutropenia (SCN), also often known as Kostmann syndrome or
disease, is a group of rare disorders that affect myelopoiesis, causing a congenital
form of neutropenia,
 Most cases of SCN respond to treatment with granulocyte colony-stimulating factor
(filgrastim)
 Left shift : >20% band cells
 ____________
 Fever : Regulated rise to a new thermoregulatory set point mediated by cytokines
( IL1 , IL6. IFN , TNF)
o Rectal core temperature : 38.2
o Oral = rectal - 0.5 = 37.7
o Axillary = rectal - 1 = 37.2
 Causes : infection , inflammation , connective tissue disease , cancer , Drugs .
 Hyperthermia : an increase in body temperature over the thermoregulatory set
point due to excessive heat production and inadequate thermoregulation . Temp
rises above 41
 _____________
 Complex febrile seizure has 10% risk of epilepsy so need EEG and CT .
 Simple febrile seizure has 1% risk of epilepsy .

2
 Diarrhea : changes in stool consistency or volume (water content in the stools above
the normal value of approximately 10 mL/kg/d in the infant and young child, or 200
g/d in the teenager and adult ).
 _____________
 Causes of poorly controlled asthma :
1) non compliance on medications
2) inadequate treatment .
3) environmental causes : smoking , cat , ....
4) comorbid diseases : GERD , Sinusitis , cardiac diseases .
5) wrong diagnosis : CF , Congenital immotile cilia syndrome .
 Bronchopulmonary dysplasia frequently cause Chronic chest problems early in life
 Asthma exacerbation management :
1) oxygen mask
2) SABA : nebulizer or metred dose inhaler with spacer
3) ipratropium bromide : nebulizer or inhaler
4) systemic corticosteroid : no role for ICS in exacerbation .
 If the pt not responding to above management then it is called status asthmaticus ,
pt can be given the following :
1) theophylline *
2) MgSO4 *
3) systemic sympathomimetic such Subcutaneous adrenaline : used in case of
silent chest
4) heliox : has low density gas with high penetration to lower airways ( make air
flow more laminar)
* Pt should be on monitor
 Pt should have also chest x-ray and ABG ( for subsequent intubation , pt should be in
respiratory alkalosis due to tachypnea , normal pH or acidosis may require
intubation .... pH of 7. 25 is acceptable ( permissible hypercapnia ) , below that pt
requires intubation
3
 Controller medications :
1) inhaler corticosteroid : oral thrush and myopathy of vocal cord .. hoarseness of
voice
2) LABA : don't give as monotherapy , increase risk of sudden death and cardiac
arrhythmia , used for exercise asthma .
3) LRA : once daily , orally , may used in mild persistent asthma as an alternative to
ICS
4) cromolyn sodium : 4 times daily , mainly used for allergic conjunctivitis
 ____________
 Guthrie test : neonatal heel prick :‫وخز الكعب الوليدي‬one of the core newborn
screening tests , in Jordan used to detects hypothyroidism , phenylketonuria and
G6PD .
 One of the indications to use high dose aspirin in pediatric is Kawasaki disease , but
before giving , you should vaccinate the child with flu vaccine .
 Most common cause of HTN in childhood is UTI and renal impairment
 MCC of hematuria : UTI
 Distinguish between VWD and hemophilia by bleeding time
 Sydenham chorea imp in rheumatic fever : specific for it
 Normal bleeding time ~2 to 3 min
 _________________
 One lab test for pt with stridor ??? Calcium level ... Hypocalcemia may cause stridor
 Before any physical examination , don't forget the following ... Very very imp :
o Introduce yourself ... take permission .. ensure privacy and warm will lighted
environment ... Wash hands ...
o Exposure and position .
o General exam then vitals then Growth parameters.
Sorry for any mistake ….. Razan yaseen.