Professional Documents
Culture Documents
Pedia Tickler
Pedia Tickler
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)
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
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)
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,
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
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