BODY TEMPERATURE ABG ANTHROPOMETRIC MEASUREMENTS

Subnormal <36.6°C pH: 7.35-7.45 HCO3: 22-26mEq/L IDEAL BODY WEIGHT

Normal 37.4°C pCO2: 35-45 B.E.: +/- 2mEq/L
Subfebrile 35.7 – 38.0°C pO2: 80-100 O2 sat: 97% Age Kilograms Pounds
Fever 38.0°C
At Birth 3kg (Fil)
High fever >39.5°C 7
3.35kg (Cau)
Hyperpyrexia >42.0°C NORMAL LABORATORY VALUES 3-12 Age (mo) + 9 / 2 Age (mo) + 10 (F)
mo Age (mo) + 11 (C)
AGE HR (bpm) BP (mmHg) RR (cpm) NB Infant Child Adole 1-6 y Age (y) x 2 + 8 Age (y) x 5 + 17
RBC 4.8-7.1 3.8-5.5 3.8-5. M: 4.6-6.2 7-12 y Age (y) x 7 – 5 / 2 Age (y) x 7 + 5
Preterm 120-170 55-75/35-45 40-70 F: 4.2-5.4
Term 120-160 65-85/45-55 30-60 WBC 9-30,000 6-17,500 5-10,000 6-10,000
0-3 mo 100-150 65-85/45-55 35-55 Given Birth Weight:
PMNs 61% 61% 60% 60%
3-6 mo 90-120 70-90/50-65 30-45 Age Using Birth Weight in Grams
Lymph 31% 32% 30% 30%
6-12 mo 80-120 80-100/55-65 25-40 Hgb 14-24 11-20 11-16 M: 14-18 < 6 mo Age (mo) x 600 + birth weight (gm)
1-3 yrs 70-110 90-105/55-70 20-30 F: 12-16 6-12 mo Age (mo) x 500 + birth weight (gm)
3-6 yrs 65-110 95-110/60-75 20-25 Hct 44-64% 35-49 31-46 M: 40-54
6-12 yrs 60-95 100-120/60-75 14-22 F: 37-47 Expected Body Weight (EBW):
12-17 yrs 55-85 110-135/65-85 12-18 Platelets 140-300 200-423 150-450 150-450 Term Age in days – 10 x 20 + Birth Weight
Ret 2.6-6.5 0.5-3.1 0-2 0-2 Pre-Term Age in days – 14 x 15 + Birth Weight
 BP cuff should cover 2/3 of arm
-: SMALL cuff: falsely high BP COUNT (%) Age of Infant Ideal Weight
-: LARGE cuff: falsely low BP
4-5 months 2 x Birth Weight
BT 1-5 min 1-6 1-6 1-6 1 year 3 x Birth Weight
BMI CT 5-8 min 5-8 5-8 5-8 2 years 4 x Birth Weight
PTT 12-20sec 12-14 12-14 12-14 3 years 5 x Birth Weight
Asian Caucasian
Underweight <18.5 <18.5 5 years 6 x Birth Weight
Normal 18.5 – 22.9 18.5 – 24.9 7 years 7 x Birth Weight
Overweight ≥ 23.0 25 – 29.9 10 years 10 x Birth Weight
at risk 23 – 24.9
Obese I 25 – 29.9 30 – 39.9
Obese II ≥ 30 >40
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, strong
R Absent Slow / Irregular
Closes at: Anterior = 18 months, or as early cry
3-6 mo + 8 cm 2.67 per mo
6-9 mo + 5 cm 1.6 cm per mo as 9-12 months
8 – 10: Normal
9-12 mo + 3 cm 1 cm per mo Posterior = 6 – 8 weeks or
4 – 7: Mild / Moderate Asphyxia
2 – 4 months
0 – 3: Severe asphyxia

HEAD CIRCUMFERENCE GCS

(33-38 cms) THORACIC INDEX
Function Infants/Young Older
TI = transverse chest diameter Eye 4- Spontaneous Spontaneous
Age Inches Centimeters AP diameter Opening 3- To speech To speech
At Birth 35 cm (13.8 in) 2- To pain To pain
< 4 mo + 2 in + 5.08cm Birth : 1.0 1- None None
(1/2 inches / mo) (1.27cm / mo) 1 year : 1.25 Verbal 5- Appropriate Oriented
5-12 mo + 2 in + 5.08cm 6 years : 1.35 4- Inconsolable Confused
(1/4 inches / mo) (0.635cm / mo) 3- Irritable Inappropriate
1-2 yrs + 1 inch 2.54 cm 2- Moans Incomprehensible
3-5 yrs + 1.5 in + 3.81cm 1- None None
(1/2 inches / year) (1.27cm / mo) Motor 6- Spontaneous Spontaneous
6-20 yrs + 1.5 in + 3.81cm 5- Localize pain Localize pain
(1/2 inches / year) (1.27cm / mo) 4- Withdraw Withdraw
3- Flexion Flexion
2- Extension Extension
1- None None

EXPANDED PROGRAM ON IMMUNIZATION ADVERSE REACTIONS FROM VACCINES

VACCINE AGE DOSE # ROUTE SITE INTERVAL BCG 1. Wheal ► small ► abscess ► ulceration ► healing / scar formation in
BCG-1 Birth 0.05mL 1 ID R- 12 wks
or 6 wks (NB) Deltoid 2. Deep abscess formation, indolent ulceration, glandular enlargement,
0.1mL suppurative lymphadenitis
(older) DPT 1. Fever, local soreness
DPT 6 wks 0.5mL 3 IM Upper 2. Convulsions, encephalitis / encephalopathy, permanent brain
Outer damage
thigh OPV Paralytic Polio
OPV 6 wks 2 drops 3 PO Mouth 4 wks HEPA B Local soreness
HEPA B 6 wks 0.5mL 3 IM Antero- 4 wks MEASLES 1. Fever & mild rash
lateral 2. Convulsions, encephalitis / encephalopathy, SSPE, death
thigh
MEASLES 9 mos 0.5mL 1 SC Outer 4 wks ACTIVE PASSIVE
upper BCG Diphtheria
arm DPT Tetanus
BCG-2 School entry 0.1mL 1 ID L- OPV Tetanus Ig
Deltoid Hep B Measles Ig
TetToxoid Childbearing 0.5mL 3 IM Deltoid 1 mo then Measles Rabies (HRIg)
Hib Hep A Ig
women 6-12 mos
MMR Hep B ig
Tetanus Toxoid Rubella Ig
H.E.A.D.S.S.S. H.E.A.D.S.S.S. Varicella NUTRITION
Sexual activities Home Environment AGE WT. CAL CHON
◦ Sexual orientation? ◦ With whom does the adolescent live? 0-5 mo 3-6 115 3.5
◦ GF/BF? Typical date? ◦ Any recent changes in the living 8-11 mo 7-9 110 3.0
◦ Sexually active? When started? # of persons? situation?
Contraceptives? Pregnancies? STDs? 1-2 y 10-12 110 2.5
◦ How are things among siblings? 3-6 y 14-18 90-100 2.0
◦ Are parents employed?
Suicide/Depression 7-9 y 22-24 80-90 1.5
◦ Are there things in the family he/she
◦ Ever sad/tearful/unmotivated/hopeless? 10-12 y 28-32 70-80 1.5
wants to change?
◦ Thought of hurting self/others? 13-15 y 36-44 55-65 1.5
◦ Suicide plans? Employment and Education 16-19 y 48-55 45-50 1.2
◦ Currently at school? Favorite subjects?
Safety ◦ Patient performing academically? TCR β = Wt at p50 x calories
◦ Use seatbelts/helmets? TCR = CHON X ABW
◦ Enter into high risk situations? ◦ Have been truant / expelled from
◦ Member of frat/sorority/orgs? school? Total Caloric Intake : calories X amount of
◦ Firearm at home? ◦ Problems with classmates/teachers? intake (oz)
◦ Currently employed?
◦ Future education/employment goals? Gastric Capacity : age in months + 2
F.R.I.C.H.M.O.N.D.
Activities Gastric Emptying Time : 2-3 hours
◦ Fluids
◦
◦
What he/she does in spare time?
Patient does for fun? 1:1 1:2
◦ Respiration ◦
◦
Whom does patient spend spare time?
Hobbies, interests, close friends?
Alacta
Enfalac
Bonna
Nursoy
◦ Infection Lactogen Promil
Drugs Lactum S-26
◦ Cardiac ◦ Used tobacco/alcohol/steroids? Nan Similac
◦ Illicit drugs? Frequency? Amount?
◦ Hematologic Affected daily activities?
Nestogen
Nutraminogen
SMA
◦ Still using? Friends using/selling?
◦ Metabolic Pelargon
Prosobee
◦ Output & Input [cc/kg/h] N: 1-2
 THE SEVEN HABITS OF
HIGHLY EFFECTIVE PEOPLE
by Stephen R. Covey

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)

1. Competent & safe physicians

2. Ethical & socially responsible
Doctors / practitioners
3. Reflective lifelong learners
4. Effective communicators
5. Efficient & innovative managers

TREATMENT PLAN A TREATMENT PLAN C

DIARRHEA ACUTE DIARRHEA (at least 3x BM in 24 hrs) ETIOLOGY of AGE
4 Rules of Home Treatment Treat severe dehydration QUICKLY!
4 Major Mechanisms Bacteria Viruses
◦ Chronic : >14 days, non-infectious causes 1. Give extra fluid (as much as the child
1. Aeromonas Start IV fluid immediately Astroviruses
1. will
Poorlytake)
absorbed osmotically active substances in
◦ Persistent : >14 days, infectious cause lumen
2.
Bacillus cereus
Campylobacter If jejuni
Caloviruses
the child can drink, give Norovirus
ORS by
2. > Breastfeed
Intestinal frequently(increased)
ion secretion & longer atoreach feeding
decreased Clostridium perfringens
> if the child is exclusively breastfed, give one or
absorption mouth while the IV drip is beingEnteric
set up Adenovirus
more of the following in addition to breastmilk Clostridium difficile Rotavirus
◦ ORS vol. after each loose stool 1 day
3. ◦ ORS Outpouring
solution into the lumen of blood, 3. Escherichia coliGive 100mL/kg Lactated Cytomegalovirus
Ringer’s
Plesiomonas
solution shigelbides Herpes simplex virus
<24 mo
2-10 y.o.
5-100mL
100-200mL
500mL
1000mL
◦
mucus
food based fluid (e.g. soup, rice, water)
4. Derangement of intestinal motility
Salmonella
clean water TREATMENT PLAN B
Shigella
>10 y.o. As much as wanted 2000mL First give Then give
Age
Staphylococcus aureus
30mL/kg in: 70mL/kg in:
How much fluid to be given Recommended
in addition to the amount
usual of ORS over 4 hour period
Vibrio cholerae 01 & 0139
Rotaviral AGE (vomiting first then diarrhea) Infants
fluid intake? Vibrio parahaemolyticus1 hour* 5 hours
For severe dehydration / WHO hydration Age up to: 4 mo – 4 mo 12 mo – 12(<12mo)
Yersiniamo 2 yrs – 2 yrs
enterocolitica 5 yrs
Ingestion of rotavirus ► rotavirus in intestinal villi
(fluid: PLR 100cc/kg) Wt: <6kg 6-9.9kgChildren 10-11.9kg 30 min* 2-19kg
2 ½ hours
Up to 2 years:►destruction 50-100 mL after each
of villi (12mo-5yrs) 700-900
(mL) 200-400 400-700
Parasites 900-1400
Age 30mL/kg 75mL/kg loose stool
(secretory diarrhea ▼absorption ▲ secretion) ► AGE Balantidium coli
<12 1H 5H ◦ Use
>12 30 mins 2½H 2 years or more: 140-200 mL child’s age only when weight is not known
Blastocyctis hominis
Repeat once if radial pulse is very weak or not
:- give frequent small sips◦ from Approximate
a cup amount of ORS (mL) Cryptosporidium
detectable
:- if the child
Assessment vomits, wait for
of dehydration 10 min
(Skin PinchthenTest) Giardia lamblia
resume CHILDS WT (kg) x 25
Patient in SHOCK ◦ (+):-if >continue
2 seconds giving extra fluids
◦ ifuntil diarrhea
the child
◦ reassess the child every 15-30 min.
wants more ORS than shown, give more Amoeba Metronidazole
◦
◦
20-30cc/kg IV fast drip
but in infants 10cc/kg IV (repeat if not stable)
◦ stops
no dehydration if skin tenting◦ goesgiveback
frequent small sips from a cup if dehydration
give IVAscariasis
is not improving,
fluid more rapidly Al/mebendazol
immediately ◦ if the child vomits, wait for 10 min then resume e
◦ If responsive & stable 75/kg x 4-6 hours 2. Give Zinc supplements ◦ continue breastfeeding whenever the child wants
◦ also give ORS
Cholera (~5mL/kg/hr) as soon as the child
Tetracyline
Up to 6 mo: 1 half tab per day for 10-14 days can drink [usually
Shigella after 3-4 hours in infants; 1-2
TMP/SMX
AFTER 4 HOURS hours in children]
6 months or more: 1 tab or 20mg (Cotri)
◦ reassess the child & classify dehydration status
OD x 10-14 days ◦ select the appropriate plan to continue◦ treatmentreassessSalmonella Chloramphenic
after 6 hrs (infant) & 3 hrs (child)
◦ begin feeding the child while at the clinic ol
3. Continue feeding
 IV-FLUID COMPOSITIONS (Commonly Used for Infants and Child):

ORS ETIOLOGY OF PNEUMONIA

• Glucolyte 60 • Pedialyte 45 0r 90 Bacterial

-: for acute DHN secondary to GE or other forms -: prevention of DHN & to maintain normal - Streptococcus pneumoniae
of diarrhea except CHOLERA. In burns, post- fluidelectrolyte balance in mild to moderate - Group B streptococci (neonates)
surgery replacement or maintenance, mild-salt dehydration. - Group A streptococci
ARI PROTOCOL (PROGRAM FOR THE CONTROL OF ARI)

loosing syndrome, heat cramps and heat - Mycoplasma pnemoniae (adolescents)

exhaustion in adults. Glucose 45mEq Glucose 90mEq - Chlamydia trachomatis (infants)
Na: 20mEq Na: 20mEq - Mixed anearobes (aspiration pneumonia)
Glucose: Cl: Gluconate: K: 35mEq K: 80mEq - Gram negative enteric (nosocomial pneumonia)
100mmol/L 50mmol/L 5mmol/L Citrate: 30mEq Citrate: 30mEq
Na: Mg: Dextrose: 20g Dextrose: 25g Viral
60 mol/L 5mmol/L - Respiratory syncitial virus
K: Citrate: - Parainfluenza type 1-3 (Croup)
20 mmol/L 10 mmol/L - Influenza types A, B
- Adenovirus
• Pedialyte mild 30
- Metapneumovirus
-: to supplement fluid & electrolyte loss due to
• Hydrite
active play, prolonged exposure, hot and humid
environment Fungal
-: 2 tab in 200ml water or 10sachets in 1L water - Histoplasma capsulatum (bird, bat contact)
- Cryptococcus neoformans (bird
Glucose: 30mEq Mg: 4mEq
contact)
Child Age 2months up to 5years

Glucose: Cl: Glucose: Na: 20mEq lactate: 20mEq

111mmol/L 80mmol/L 11mml/L - Aspergillus sp. (immunosuppressed)
Young Infants < 2months old

K: 30mEq Ca: 4mEq - Mucormycosis

Na: HCO3: Na:
Energy: (immunosuppressed)
90 mmol/L 5mmol/L 90 mmol/L
20kcal/ 100ml - Coccidioides immitis
K: K:
20 mmol/L 20 mmol/L - 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 st
1 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

HOLIDAY-SEGAR METHOD (MAINTENANCE) SMR BOYS

Stage Pubic Hair Penis Testes
WEIGHT TOTAL FLUID REQUIREMENT 1 None Preadolescent Preadolescent
0 - 10 kg 100 mL / kg Scanty, long slightly Enlarged scrotum, pink
2 Slightly enlargement
11- 20 kg 1000 + [ 50 for each kg in excess of 10 kg] pigmented texture altered
> 20 kg 1500 + [ 20 for each kg in excess of 20 kg] Darker, starts to curl, small
3 Longer Larger
amount
Resembles adult type but
NOTE: Computed Value is in mL/day Larger, glans &
4 less in quantity, course, Larger, scrotum dark
Ex. 25kg child breadth ▲ in size
curly
Answer: 1500 + [100] = 1600cc/day Adult distribution, spread
5 Adult size Adult size
to medial surface of thigh

ATYPICAL
DENGUE
PNEUMONIA Dengue Fever Syndrome (DFS) Dengue Shock Syndrome
> 3-12 mo
> MOT:
-: extrpulmonary mosquito
manifestations
bite (man as reservior) Biphasic
- RSV fever (2-7 days) with 2 or more of the ff: Manifestations of DHF plus signs of circulatory failure
-: low grade fever - Other respiratory viruses 1. rapid & weak pulse
-: Vector:
> patchy diffuse Aedesinfiltrates
aegypti 1. -headache
Streptococcus pneumoniae 2. narrow pulse pressure (<20mmHg)
-: poor response to Penicillin 2. -myalgia
Haemophilus
or arthralgia
influenzae (Type B) 3. hypotension for age
-: Factors
> negativeaffecting
sputum transmission:
gram stain 3. -retroorbital
C. trachomatis
pain 4. cold, clammy skin & irritability / restlessness
- breeding sites, high human population density, 4. -hemorrhagic
M. pneumoniae manifestations
mobile viremic human beings -[petechiae,
Group A Streptococcus
purpura, (+) torniquet test]
Etiologic Agents Grouped by Age 5. leukopenia DANGER SIGNS OF DHF
> Age incidence peaks at 4-6 yrs > 2-5 yrs
DENGUE PATHOPHYSIOLOGY

> Neonates (<1mo) - RSV Dengue Hemorrhagic Fever (DHF) 1. abdominal pain (intense & sustained)
> -Incubation
GBS period: 4-6 days - Other respiratory viruses 2. persistent vomiting
- E. coli 1. -fever,
Streptococcus
persistentlypneumoniae
high grade (2-7 days) 3. abrupt change from fever to hypothermia
> -Serotypes:
other gram (-) bacilli 2. -hemorrhagic
Haemophilusmanifestations
influenzae (Type B) with sweating
--Streptococcus
Type 2 – most pneumoniae
common - -C.
(+)trachomatis
torniquet test 4. restlessness or somnolence
--Haemophilus
Types 1& 3 influenza (Type B) - -M.
petechiae,
pneumoniae ecchymoses, purpura
- Type 4– least common but most severe - -Group
bleedingA Streptococcus
from mucusa, GIT, puncture sites
> 1-3 months - -Staph
melena,aureus
hematemesis Grading of Dengue Hemorrhagic Fever
> *Main
Febrile
pathophysiologic
pneumonia changes: 3. Thrombocytopenia (< 100,000/mm3)
a.- increase
RSV in vascular permeability 4.
> 2-5
Hemoconcentration
yrs
- Other respiratory
▼ viruses - Streptococcus
hematocrit >40% pneumoniae
or rise of >20% from baseline
- extravasation
Streptococcusofpneumoniae
plasma - Haemophilus
a drop in >20% influenzae
Hct (from(Type
baseline)
B) following
- Haemophilus
- hemoconcentration
influenza (Type B) - C. volume
trachomatis
replacement
- 3rd spacing of fluids - M.
signs
pneumoniae
of plasma leakage
* Afebrile pneumonia - Group
[pleuralAeffusion,
Streptococcus
ascites, hypoproteinemia]
b.- abnormal
Chlamydiahemostasis
trachomatis - Staph aureus
- -Mycoplasma
vasculopathyhomilis
- -CMV
thrombocytopenia
- coagulopathy
 MANAGEMENT OF DENGUE MANAGEMENT OF HEMORRHAGE

A. Vital Signs and Laboratory Monitoring

Monitor BP, Pulse Rate
We have to watch out for Shock (Hypotension)

Torniquet Test: SBP + DBP = mean BP for 5 mins.

ACUTE GLOMERULONEPHRITIS
2 URINARY
RHEUMATIC
TRACT FEVER
INFECTION TREATMENT OF RHEUMATIC FEVER

Complications
if ≥20 petechial of rash
AGNper sq. inch on antecubital fossa JONES CRITERIA: A. Antibiotic Therapy
-(+)CHFtest2° to fluid overload Suggestive UTI: - 10 days of Oral Penicillin or Erythromycin
- HPN encephalopathy A.
- Pyuria: WBC ≥ 5/HPF or 10mm3
Major Manifestations - IM Injection of Benzethine Penicillin
-Herman’s
ARF due Rash:
to ê GFR - Absence
- Carditisof pyuria doesn’t rule out UTI (50-60%)
- usually appears after fever lysed - Pyuria
- Polyarthritis
can be present w/o UTI (70%) *** NOTE: Sumapen = Oral Penicillin!
- initially appears on the lower extremities - Chorea (15-20%)
- not a common
STAGES of AGN finding among dengue patients Presumptive
- Erythema Marginatum
UTI: (3%) B. Anti-Inflammatory Therapy
- Oliguric
“an island phase
of white
[7-10days]
in an ocean–ofcomplications
red” sets in - (-)
- Subcutaneous
urine culture Nodules (1%)
- Diuretic phase [7-10days] – recovery starts - lower colony counts may be due to: 1. Aspirin (if Arthritis, NOT Carditis)
- Convalescent phase [7-10days] – patients are B.*Minor
overhydration
Manifestations Acute: 100mg/kg/day in 4 doses x 3-5days
B. Secondary Prevention
usually sent home *- recent
Arthralgia
bladder emptying Then, 75mg/kg/day in 4 doses x 4 weeks
*- previous
Fever antibiotic intake
Recommended Guidelines for Transfusion: - Laboratory Findings of: 2. Prednisone
Prognosis Proven ▲ Acute
or Confirmed
Phase Reactants
UTI: (ESR / CRP) 2mg/kg/day in 4 doses x 2-3weeks
Transfuse:
- Gross hematuria 2-3 weeks - (+) urine
Prolonged
culturePR
≥ 100,000
interval cfu/mL urine of a single Then, 5mg/24hrs every 2-3 days
-- PC < 100,000 with signs of bleeding 3-6 weeks
Proteinuria organism
-- ▼C3
PC < 20,000 even if asymptomatic 8-12 weeks C.
- multiple
PLUS Supporting
organisms inEvidence
culture may
of Antecedent
indicate a
-- microscopic
use FFP if without overt bleeding
hematuria 6-12 mo or contaminated
Group-A Strep sample
Infection
- FWB in cases with overt bleeding or 1-2 years - (+) Throat Culture or Rapid Strep-Ag Test PREVENTON
signs
- HPN of hypovolemia 4-6 weeks - ▲Rising Strep-AB Test
C. Duration of Chemoprophylaxis
A. Primary Prevention
> if PT & PTT are abnormal: FFP
>
> ifHyperkalemia
PTT only: cryprecipitate
may be seen due to Na+ retention - 10 days of Oral Penicillin or Erythromycin
> Ca++ decreases in PSAGN - IM Injection of Benzethine Penicillin
3-7cc/kg/hr
> ▲ in ASO titerdepending on the Hct (1st no.) level
(D5LR)
- normal within 2 weeks
10-20cc/kg fast2drip
- peaks after PLR - hypotension, narrow pulse
weeks
pressure
- more fair pulse
pronounced in pharyngeal infection
than in cutaneous
Leukopenia in dengue: probable etiology is
Pseudomonas
 KAWASAKI DISEASE
TYPES OF SEIZURES CLASSIFICATION
TREATMENTBY CAUSE SIMPLE SEIZURES
FEBRILE SEIZURE
CDC-CRITERIA FOR DIAGNOSIS:
ADOPTED FROM KAWASAKI
A. Partial Seizures (Focal / Local) A.
Currently
Acute Symptomatic
Recommended Protocol: A. Criteria for an SFS
(ALL SHOULD BE PRESENT)
– Simple Partial (shortly after an acute insult) > Seizures:
– sudden event <caused
15 minutes
by abrupt,
A. –IV-Immunoglobulin
Infection – uncontrolled, hypersynchronous
Generalized-tonic-clonic
–
A) HIGH Grade Partial
Complex Fever (>38.5 Rectally)
(Partial SeizurePRESENT
+ – Hypoglycemia, low sodium, low calcium – discharges of Fever
neurons> 100.4 rectal to
for AT LEAST 5-days without Impairedother Explanation
Consciousness) –2g/kg
HeadRegimen
trauma Infusion EQUALLY Effective in 101 F (38 to 38.4 C)
“High Grade Fever of at least 5 days”
–
DOESPartial
NOT Seizures
Respond evolving
to any to Tonic-Clonic
kind of Antibiotic!
–Prevention
Toxic ingestion
of Aneurysms and Superior to 4-day
Regimen with respect to Amelioration of Inflammation
> Epilepsy:
–
–
tendency for recurrent
No recurrence
unprovoked byNo
seizures
anpost-ictal
immediate
in 24
neuro
that
cause
hours
are
Convulsion B. Remote Symptomatic
as measured by days of abnormalities (e.g. Todd’s paresis)
B) Presence of 4 of the 5 Criteria
Fever,
– Pre-existing
ESR, CRP,brain
Platelet
abnormality
Count, Hgb,
or insult
and Albumin > Status
– epilepticus: >30min
Most common
or back-to-back
6 months to
1.
B. Bilateral CONGESTION
Generalized Seizures of the Ocular Conjunctiva – Brain injury (head trauma, low oxygen) 5 years w/o return to baseline
(seen in 94%)
– Absence
2. Changes of the Lips and (Petit mal) (At least ONE)
Oral Cavity
NOTE:
– Meningitis
– Stroke
There is a TIME FRAME of 10 days –
> Etiology:
–
Normal development
No CNS infection or prior
– Myoclonic
3. Changes of the Extremities (At least ONE)
– Tumor - V ascular
afebrile seizures
: AVM, stroke, hemorrhage
– Clonic
4. Polymorphous Exanthem (92%)
B. –Aspirin
Developmental brain abnormality - I nfections : meningitis, encephalitis
– TonicAdenopathy = Non-Suppurative Cervical
5. Cervical
-B.T Risk
raumatic
Factors:
– Tonic-Clonic
Adenopathy (should be >1.5cm) in 42%)
C. HIGH
Idiopathic
Dose ASA (80-100mg/kg/day divided q 6h) - A utoimmune : SLE, vasculitis, ADEM
– Atonic
should
– No history
be givenofInitially
precedingin Conjunction
insult with IV-IG –
- M etabolic : Febrile seizure
electrolyte in 1st / 2nd
imbalance
HARADA Criteria degree relative
– Likely “genetic” component
THEN - I diopathic : “idiopathic epilepsy”
- used to determine whether IVIg should be given
Reduced to Low Dose Aspirin (3-5mg/kg/day) - N –eoplastic : Neonatal
space nursery lesion
occupying stay of
SIMPLE
- assessed within FEBRILE
9 days SEIZURE
from onset of illness >30 days :
AND - S tructural cortical malformation,
1. WBC > 12,000 vs. – Developmental delay
Continued until Cardiac Evaluation COMPLETED prior stroke
COMPLEX FEBRILE SEIZURE
2. PC <350,000
(approximately 1-2 months AFTER Onset of Disease) - S–yndrome : Height of
genetic temperature
disorder
3. CRP > 3+
Febrile Seizure:
4. Hct <35% C. Risk Factors for Epilepsy
5.
“A seizure in association with a febrile illness in the
absence of Albumin
a CNS <3.5 g/dL or acute electrolyte
infection
(2 to 10% will go on to have epilepsy)
– Developmental delay
6. Age 12
imbalance in months
children older than 1 month of age – Complex FS (possibly > 1
7. Gender:
without male seizures”
prior afebrile complex feature)
– 5% > 30 mins => _ of all
• IVIg is given if ≥ 4 of 7 are fulfilled
childhood status
• If < 4 with continuing acute symptoms,
– Family History of Epilepsy
risk score must be reassessed daily
– Duration of fever
 BRONCHIAL ASTHMA (GINA GUIDELINES)

Controlled Partly Controlled Uncontrolled

Day
none > 2x per wk
symptoms
Limitation of
none any
activities
3 or more symptoms
Nocturnal Sx
none any of Partly Controlled
(awakening)
Asthma in any week
Need for
< 2x per wk > 2x per wk
reliever
Lung
normal < 80%
function
Exacerbation none > 1x per yr 1x / week

Clinical Features:
TUBERCULOSIS RESPIRATORY DISTRESS SYNDROME
(Hyaline Membrane Disease) 1. Tachypnea, nasal flaring, subcostal and intercostal
A. Pulmonary TB retractions, cyanosis, grunting
– fully susceptible M. tuberculosis, o Male, preterm, low BW, maternal DM, & perinatal
asphyxia 2. Pallor – from anemia,

– no history of previous anti-TB drugs peripheral vasoconstriction

– low local persistence of primary resistance to

o Corticosteroids:
• most successful method to induce fetal lung
3. Onset – within 6 hours of life
Isoniazid (H) Peak severity – 2-3 days
maturation
Recovery – 72 hours
• Administered 24-48 hours before delivery
☤ 2HRZ OD decrease incidence of RDS
then 4HR OD or 3x/wk DOT Retractions:
• Most effective before 34 weeks AOG
o Due to (-) intrapleural pressure produced by
– Microbial susceptibility unknown or initial drug o Microscopically: diffuse atelectasis, eosinophilic interaction b/w contraction of diaphragm & other
respiratory muscles and mechanical properties of
resistance suspected (e.g. cavitary) membrane
the lungs & chest wall
– previous anti-TB use
– close contact w/ resistant source case or living Nasal flaring:
in high areas w/ high pulmonary resistance to Pathophysiology:
o Due to contraction of alae nasi muscles leading to
H. marked reduction in nasal resistance
– 1. Impaired/delayed surfactant synthesis &
secretion
☤ 2HRZ + E/S 2. V/Q (ventilation/perfusion) imbalance Grunting:
o Expiration through partially closed vocal cords
OD, then 4 HR + E/S OD or 3x/week DOT due to deficiency of surfactant and decreased lung

3.
compliance
Hypoxemia and systemic hypoperfusion
• Initial expiration: glottis closedà
4. Respiratory and metabolic acidosis lungs w/ gasà
B. Extrapulmonary TB inc. transpulmo P w/o airflow
– Same in PTB 5. Pulmonary vasoconstriction
6. Impaired endothelial &epithelial integrity • Last part of expiration: gas expelled against
partially closed cords
– For severe life threatening disease
(e.g. miliary, meningitis, bone, etc)
7. Proteinous exudates
8. RDS Cyanosis:

☤ 2HRZ + E/S OD, then 10HR + E/S OD Central – tongue & mnucosa (imp. Indicator of
or 3x/wk DOT impaired gas exchange); depends on
 UMBILICAL CATHERIZATION
NEWBORN RESUSCITATION Cathether length
Indications • Standardize Graph
• Vascular access (UV)
 AIRWAY: open & clear • Blood Pressure (UA) and blood gas monitoring in – Perpedicular line from the tip of the shoulder to
• Positioning critically ill infants the umbilicus
• Suctioning • Measure length from Xiphoid to umbilicus and add
Complications 0.5 to 1cm.
• Endotracheal intubation (if necessary) • Infection • Birth weight regression formula
• Bleeding
• Hemorrhage
– Low line : UA catheter in cm = BW + 7
 BREATHING is spontaneous or assisted • Perforation of vessel – High line : UA catheter = [3xBW] + 9
• Thrombosis w/ distal embolization
• Tactile stimulation (drying, rubbing) –
• Positive-pressure ventilation • Ischemia or infarction of lower extremities, bowel
UV catheter length = [0.5xhigh line] + 1
or kidney
Procedure
• Arrhythmia
• Determine the length of the catheter
 CIRCULATION of oxygenated blood is • Air embolus
• Restrain infant and prep the area using sterile
adequate technique
• Chest compressions Cautions
• Flush catheter with sterile saline solution
• Medication and volume expansion • Never for:
• Place umbilical tape around the cord. Cut cord
– Omphalitis
about 1.5-2cm from the skin.
– Peritonitis
• Identify the blood vessels.
• Contraindicated in
(1thin=vein, 2thick=artery)
RESUSCITAION MEDICATIONS – NEC
• Grasp the catheter 1cm from the tip. Insert into the
– Intestinal hypoperfusion
vein, aiming toward the feet.
Atropine 0.02 ml/k IM, IV, ET • Secure the catheter
Bicarbonate 1-2 meq/k Line Placement
• Observe for possible complications
• Arterial line
Calcium 10 mg elem Ca/k slow IV
• Low line
Calcium chloride 0.33/k (27 mg Ca/cc)
– Tip lie above the bifurcation between L3 & L5
Calcium gluconate 1 cc/k (9 mg Ca/cc) • High line
1g/k = 2 cc/k D50 – Tip is above the diaphram between T6 & T9
Dextrose
4 cc/k D25
Epinephrine 0.01 cc/k IV, ET

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

KRAMERS CLASSIFICATION OF JAUNDICE

SERUM
ZONE JAUNDICE
BILIRUBIN
I Head & neck 6-8
Upper trunk
II 9-12
to umbilicus
Lower trunk
III 12-16
to thigh
Arms, legs,
IV 15
below
V Hands & feet 15

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)
Procedure
• spinal cord stops near L2 – Guillain-Barré syndrome, (inflammation of the * If per day,
Empirical divide total (mL) by the # of divided doses
dose
• Apply local anesthetic
lower lumbar creambetween
spine (usually (ideally)L3-L4 or nerves)  6 months ¼ tsp TID QID
• Position the patient
L4–5) is preferable Dose x6 preparation
 mos – 2 yrs x frequency½=tsp mkd
• Prepare the skin using sterile techniques Complication  2-6 weight 1 tsp
•CSFAnesthetize the area with lidocane • Local pain  6-9 1 ½ tsp
• clear, watery liquid that protects the central
• Puncture the skinfrom
nervous system in the midline just caudal to the
injury
• Infection
• Bleeding
 9-12 2 tsp
• spinus
cushions process,
the brain angle
fromcephalad toward the
the surrounding bone. • Spinal fluid leak  Paracetamol Drops = Wt: move 1
• umbilicus
It contains:using a g23 needle • Hematoma (spinal subdural hematoma decimal
• Collect the CSF for analysis • Spinal headache point to the left
– glucose (sugar) • Acquired epidermal spinal cord tumor Age Wt
CSF Analysis 1 10 kg
–
1. Gram protein
stain, culture and sensitivity Caution & Contraindications 2 12
– white
2. Cell count,blood cells count
differential CLINICAL FEATURES3 14
CLASSIFICATION BASED ON SEVERITY • Increased ICP
•3. Rate :Chemistries
500ml/day or 0.35ml/min
– sugar, protein • Bleeding diasthesis
• Traumatic Tap MILD MODERATE
4
5SEVERE
16
18 RESPIRATORY
ARREST
•
4. Special studies
Range : 0.3-04 ml/min PERSISTENT
• Overlying skin infection
- talking
6 20
INTERMITTENT • Unstable patient
•
After care : 50ml (infants)
Volume
• Cover the puncture site with a sterile
MILD
bandage,
Affects daily
MODERATE
Affects daily
SEVERE
Limits daily
- INF: softer,
1 drop - at rest
shorter, cry, - INF: stops
= 1/20 mL
150ml (adults) - walking 1 teaspoonful = 5 mL
apply pressure packing.
Exacerbation Brief activity & activity & activity & Breathless difficulty 1 tablespoonful
feeding = 15 mLImminent
- can lie down
• Patients must remain lying down for 4-6 sleep hours sleep sleep feeding 1 wineglassful
- hunched = 60 mL = 2 ounces
Indication
NPO for
•Day-time 4 hrs
Sxs <1x/wk >1x/wk daily continuous - prefers 1 glassful forward = 250 mL = 8 ounces
• to diagnose some malignancies (brain cancer and
Nightime Sxs <2x/mo >2x/mo >1x/wk frequent sitting 1 grain = 60 mg
leukemia)
PEFR >80% >80% 60 - <80% <60% Talks in sentences phrases 1 pint words = 500 mL
• to assess
PEFR VAR patients <20% with certain 20psychiatric
- 30% >30% >30% Alertness
may be usually 1 quart usually = 1000 mLdrowsy /
symptoms
FEV1 and conditions.
>80% >80% 60 - <80% <60% agitated agitated 1 ounce agitated = 30 mLconfused
1 Kg often >30 = 2.2 lbs
• for injecting chemotherapy directly into the CSF RR ▲ ▲
mins
bradypnea
Accessory
(+) thoracoabd
muscles & none (+) (+)
movement
retractions