BODY TEMPERATURE

ABG ANTHROPOMETRIC MEASUREMENTS

Subnormal <36.6°C
Normal 37.4°C pH: 7.35-7.45 HCO3: 22-26mEq/L IDEAL BODY WEIGHT
Subfebrile 35.7 – 38.0°C pCO2: 35-45 B.E.: +/- 2mEq/L
Fever 38.0°C pO2: 80-100 O2 sat: 97% Age Kilograms Pounds
High fever >39.5°C At Birth 3kg (Fil)
7
Hyperpyrexia >42.0°C 3.35kg (Cau)
NORMAL LABORATORY VALUES 3-12 Age (mo) + 9 / 2 Age (mo) + 10 (F)
AGE HR (bpm) BP (mmHg) RR (cpm) mo Age (mo) + 11 (C)
NB Infant Child
Adole 1-6 y Age (y) x 2 + 8 Age (y) x 5 + 17
Preterm 120-170 55-75/35-45 40-70 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
Term 120-160 65-85/45-55 30-60 F: 4.2-5.4
0-3 mo 100-150 65-85/45-55 35-55 WBC 9-30,000 6-17,500 5-10,000 6-10,000 Given Birth Weight:
3-6 mo 90-120 70-90/50-65 30-45 PMNs 61% 61% 60% 60% Age Using Birth Weight in Grams
6-12 mo 80-120 80-100/55-65 25-40 Lymph 31% 32% 30% 30% < 6 mo Age (mo) x 600 + birth weight (gm)
1-3 yrs 70-110 90-105/55-70 20-30 Hgb 14-24 11-20 11-16 M: 14-18 6-12 mo Age (mo) x 500 + birth weight (gm)
3-6 yrs 65-110 95-110/60-75 20-25 F: 12-16
6-12 yrs 60-95 100-120/60-75 14-22 Hct 44-64% 35-49 31-46 M: 40-54 Expected Body Weight (EBW):
12-17 yrs 55-85 110-135/65-85 12-18 F: 37-47 Term Age in days – 10 x 20 + Birth Weight
Platelets 140-300 200-423 150-450 150-450 Pre-Term Age in days – 14 x 15 + Birth Weight
Ret 2.6-6.5 0.5-3.1 0-2 0-2
 BP cuff should cover 2/3 of arm
-: SMALL cuff: falsely high BP Age of Infant Ideal Weight
-: LARGE cuff: falsely low BP COUNT (%) 4-5 months 2 x Birth Weight
1 year 3 x Birth Weight
BMI BT 1-5 min 1-6 1-6 1-6 2 years 4 x Birth Weight
CT 5-8 min 5-8 5-8 5-8 3 years 5 x Birth Weight
Asian Caucasian PTT 12-20sec 12-14 12-14 12-14 5 years 6 x Birth Weight
Underweight <18.5 <18.5 7 years 7 x Birth Weight
Normal 18.5 – 22.9 18.5 – 24.9 10 years 10 x Birth Weight
Overweight ≥ 23.0 25 – 29.9
at risk 23 – 24.9
Obese I 25 – 29.9 30 – 39.9
Obese II ≥ 30 >40
APGAR

LENGTH / HEIGHT 0 1 2
(50 cm) Blue / Pink body/ Blue Completely
Age Transverse-AP A
Inches Pale extremities pink
Age Centimeters Inches Diameter ratio P Absent Slow (<100) > 100
At Birth 50 20 At Birth 1.0 Transverse = AP
Coughs,
1y 75 30 1y 1.25 Transverse > AP (-)
G Grimaces Sneezes,
2-12 mo Age x 6 + 77 Age x 2.5 + 30 6y 1.35 Transverse >>> AP Response
Cries
(-) Some flexion / Active
A Movement extension movement
Age Gain in 1st Year is ~ 25cm FONTANELS
Good, strong
0-3 mo + 9 cm 3 cm per mo R Absent Slow / Irregular
cry
3-6 mo + 8 cm 2.67 per mo Appropriate size at birth: 2 x 2 cm (anterior)
6-9 mo + 5 cm 1.6 cm per mo Closes at: Anterior = 18 months, or as early 8 – 10: Normal
9-12 mo + 3 cm 1 cm per mo as 9-12 months 4 – 7: Mild / Moderate Asphyxia
Posterior = 6 – 8 weeks or 0 – 3: Severe asphyxia
2 – 4 months
GCS
HEAD CIRCUMFERENCE
(33-38 cms) Function Infants/Young Older
THORACIC INDEX
Eye 4- Spontaneous Spontaneous
Age Inches Centimeters TI = transverse chest diameter Opening 3- To speech To speech
At Birth 35 cm (13.8 in) AP diameter 2- To pain To pain
< 4 mo + 2 in + 5.08cm 1- None None
(1/2 inches / mo) (1.27cm / mo) Birth : 1.0 Verbal 5- Appropriate Oriented
5-12 mo + 2 in + 5.08cm 1 year : 1.25 4- Inconsolable Confused
(1/4 inches / mo) (0.635cm / mo) 6 years : 1.35 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)
6-12 mos Hib Hep A Ig
women
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 Home Environment AGE WT. CAL CHON
activities 0-5 mo 3-6 115 3.5
◦ Sexual orientation? ◦ With whom does the adolescent live? 8-11 mo 7-9 110 3.0
◦ GF/BF? Typical date? ◦ Any recent changes in the living 1-2 y 10-12 110 2.5
◦ Sexually active? When started? # of persons? situation? 3-6 y 14-18 90-100 2.0
Contraceptives? Pregnancies? STDs? ◦ How are things among siblings? 7-9 y 22-24 80-90 1.5
◦ Are parents employed? 10-12 y 28-32 70-80 1.5
Suicide/Depression ◦ Are there things in the family he/she 13-15 y 36-44 55-65 1.5
◦ Ever sad/tearful/unmotivated/hopeless? wants to change? 16-19 y 48-55 45-50 1.2
◦ Thought of hurting self/others?
◦ Suicide plans? Employment and Education
◦ 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 Gastric : age in months + 2
F.R.I.C.H.M.O.N.D.
Activities 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
Lactum
Promil
S-26
Drugs
◦ Cardiac ◦ Used tobacco/alcohol/steroids? Nan Similac
◦ Illicit drugs? Frequency? Amount? Nestogen SMA
◦ Hematologic Affected daily activities? Nutraminogen
Pelargon
◦ Metabolic
◦ Still using? Friends using/selling?
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

i m m ed i a t el y
TREATMENT PLAN A 2. G iv e Z i n c s upplements
DIARRHEA ACUTE DIARRHEA (at least 3x BM in 24 hrs) TREATMENT PLAN C
4 Rules of Home Treatment Up to 6 ETIOLOGY
mo: 1 half tab
ofper
AGE day for 10-14 days 6 months or
41.Major MechGainviesmexstra fluid (as much as Treatmore: 1 tab
severe or 20mg OD
dehydration x 10-14 days
QUICKLY!
◦ Chronic : >14 days, non-infectious causes Bacteria Viruses
◦ Persistent : >14 days, nfectious cause
the child
1.
3. Continue feeding
A e romonas Start IV fluid immediatelyAstroviruses
1. wPoilol rtlaykaeb)sorbed osmotically active Bacillus cereus Caloviruses
2. substances
>InteBsretinin
aalumen
stl fieoendsferecqreuteiontly(in&crlo 2 .
Ca mpylobacteIfr jethjuenichild can drink, give NOorRoSvirub
ClosmtroiduituhmwhpielerfrtihnegeIVnsdrip is beingEsnetteuripc Ad
enagserd)atoer adcehcrfeaesdeindg
◦ ORS vol. after each loose stool 1 day a>give
bisf oone
thrpeticohnild is exclusively breastfed,
or more of the following in addition to
Clostridium difficile
.
100mL/kg coGliive
Escherichia
Rotavirus
LacCtaytteodmegRalionvgierur’s Plesolutomionas shi
SSVVY
<24 mo 5-100mL 500mL 3. breastmilk
◦ OROS ustoplouutiroing into the lumen of
2-10 y.o. 100-200mL 1000mL
>10 y.o. As much as wanted 2000mL ◦
mucus
blood,
food based fluid (e.g. soup, rice, water)
TRE
4. Derangement of intestinal motility
clean water 4 mo 1
For severe dehydration / WHO hydration of ORS ove
(fluid: PLR 100cc/kg)
HRoowtamviuraclhAflGuiEdRecommended
t(ovobme amountkg
400
Age 30mL/kg 75mL/kg igtiivnegnfiinrsat dthdietinondi taortrhheau)sual
Age up to: 4 mo –
P
<12 1H 5H fluid intake? Balantidium coli Blastocyctis hominis
Ingestion of rotavirus ► rotavirus Wt:in intestinal villi <6
>12 30 mins 2½H CrRypetpoespaot roidnicuemif radial pulse is very weak or not
Up to 2 years:►destruct5io0n-1o0f0vmilliL after 200-
(mL)
Giardia lamblia detectable
each
loose◦ stool
Use child’s age only
reassess the child every 15-30 min. if de
Patient in SHOCK
(secretory diarrhea ▼absorption◦ ▲ Approximate
secretion) ► amount
give
◦ 20-30cc/kg IV fast drip AGE 2 years or more: 140-200 mL alsohe child
◦ but in infants 10cc/kg IV (repeat if not stable) :- give frequent small sipsCHILDS
from a cup WT (kg) x 25
cannts; 1-2
◦ If responsive & stable 75/kg x 4-6 hours Ass:e- sifsmthencthoildf hour
◦ if the child wants mor
dvoemhyitdsr,awtiaoitnfo(Sr reas
◦ give frequent small si
k1i0nmPiinncthhenTest)
resume ◦ if the child vomits, wa
◦ (+):i-f >co2nstiencuoengdisving ◦ continue breastfeedin
extra fluids until
diarrhea
AFTER 4 HOURS
◦ no dehsytodprastion if skin tenting goes back
◦ reassess the child & c
 t
h
e

higella First give Then give

taphyloAcgoeccu re3u0smL/kg 70mL/kg in:
s au in: ATMENT PLAN B
ibrio
cInhfoalnetrsae & 0139
01 yticus1 hour* 5 hours r 4 hour period
ibrio (p<a1r2amh
aoe) mol 2 mo – 12 mo 2 yrs – 2 yrs 5 yrs
ersinia enterocoli tica 6-9.9kg 10-11.9kg 2-19kg
Children
30 min* 2 ½ hours 400-700 700-900 900-1400
ara(1s2itmeso-
5yrs)
s not known
of ORS (mL) when weight i

e hown, givehy A m o e
more
bd a rat io n mpMroevtirnogn,
i s not i idazole
O hen resumeIVAfsluciadrmia idAlyl/mebendazol
R he child wants s i s e
o r e rap
S
gCivheoOleRrS /
a (~5mL Tkegt/
t ration status hrar)cayslinseoon
h nue treatment as t
a clinic drSinhkig[eulsl fteTr M3P-
n

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 IV-FLUID COMPOSITIONS (Commonly Used for Infants and Child):

ORS ETIOLOGY OF PNEUMONIA

• Pedialyte 45 0r 90
Bacterial
-: prevention of DHN & to maintain normal fluidelectrolyte balance in mild to moderate dehydration.
a except CHOLERA. In burns, post- surgery replacement or maintenance, mild-salt loosing syndrome, heat cramps and heat exhaustion in adults. Streptococcus pneumoniae (neonates)
Group B streptococci
ARI PROTOCOL (PROGRAM FOR THE CONTROL OF ARI)

Group A streptococci (adolescents)

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

Glucose: 111mmol/L
Cl: 80mmol/L
Na: HCO3:Glucose: 11mml/L Na: Na: 20mEq lactate: 20mEq
90 mmol/L 5mmol/L 90 mmol/L K: K: 30mEq Ca: 4mEq Aspergillus sp. (immunosuppressed)
Young Infants < 2months old

K: 20 mmol/L - Mucormycosis
Energy:
20 mmol/L 20kcal/ 100ml (immunosuppressed)
Coccidioides immitis
Blastomyces dermatitides
Pneumocystis carinii

(immunosuppressed,
HIV, steroids)
 SMR GIRLS
Stage Pubic Hair Breasts
LUDAN’S METHOD (HYDRATION THERAPY)
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
> 15 kg, 2 y/o 30 cc/kg 60 cc/kg 90 cc/kg 3 Darker, beginning to curl, ▲amount
separation
D5 0.3% in 1st hr: ¼ Plain LR 1st hr: ⅓ Plain LR Course, curly, abundant but amount < Areola & papilla formed secondary
6-8 hours Next 5-7 hrs: Next 5-7 hrs: 4
adult mound
¾ D5 0.3% in ⅔ D5 0.3% in Adult, feminine triangle, spread to Mature, nipple projects, areola part of
5-7 hours 5-7 hours 5
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
Larger, glans &
NOTE: Computed Value is in mL/day Ex. 25kg child 4 less in quantity, course, Larger, scrotum dark
curly breadth ▲ in size
Answer: 1500 + [100] = 1600cc/day
Adult distribution, spread
5 Adult size Adult size
to medial surface of thigh

ATYPICDAELNPGNUEEUMONIA Dengue Fever Syndrome (DFS) Dengue Shock Syndrome

3-12 mo
Bip- hRaSsVic fever (2-7 days) with 2 or more of the ff:
->: MeOxtTrp:ulmonmaroysmquaintoifebsitteations (man as reservior) - Other respiratory viruses Manifestations of DHF plus signs of circulatory failure
-: low grade fever -hSeatrdeapctohceoccus pneumoniae rapid & weak pulse
>-: Vpeactctohry: diffuAsediensfiltareagteyspti -mHyaaelgmiaooprhialurtshrinafllguieanzae (Type B) narrow pulse pressure (<20mmHg)
-: poor response to Penicillin -reCtr.otorarbchitaolmpatiins hypotension for age
>-: Fnaecgtoartisveafsfepcuttiunmg tgraranmsmsistasiinon: -hMem. ponrrehuamgiocnmiaaenifestations cold, clammy skin & irritability / restlessness
- breeding sites, high human population density, mobile viremic human beings
-[pGertoeuchpiaAeS, ptruerpptuorcao,c(c+u)storniquet test]
Etiologic Agents Grouped by Age leukopenia
Age incidence peaks at 4-6 yrs 2-5 yrs
DENGUE PATHOPHYSIOLOGY

Neonates (<1mo) RSV Dengue Hemorrhagic Fever (DHF)

-InGcuBbSation period:4-6 days DANGER SIGNS OF DHF
Other respiratory viruses
E. coli -feSvterer,pptoecrosicscteunstlpynheiugmh ognraiade (2-7 days)
-Soetrhoetyrpgersa:m (-) bacilli -hHemaeomrrohapghiclusmianfliufesntzaatieon(sType B) abdominal pain (intense & sustained)
--STtyreppeto2coc–cumsopsnt ecuommnoiane --C(+. t)ratocrhnoiqmuaetistest persistent vomiting
--HTayepmesop1h&ilu3s influenza (Type B) --Mp.eptencehuiameo,neiacechymoses, purpura abrupt change from fever to hypothermia with sweating
Type 4– least common but most severe --GbrloeuepdinAgSftrroemptomcuoccucsuas, GIT, puncture sites restlessness or somnolence
1-3 months --Smtaeplehnau, rheeums atemesis
*MFaeinbrpilaethponpehuymsoionloiagic changes: Thrombocytopenia (< 100,000/mm3) 4>. 2H-e5myorsconcentration
a-. iRncSrVease in vascular permeability Shetrmepattoccorictc>u4s0p%neourmrisoenioafe>20% from baseline
Other respir▼atory viruses Haadermopoipnh>ilu2s0%infHlucetn(zfraoem(TbyapseelBin)e) following
eSxtrterapvtoacsoacticounsopf npelausmmoaniae - C. vtroaluchmoemraetpislacement Grading of Dengue Hemorrhagic Fever
H-ahemopchoilnucseintfrluaetionnza (Type B) - Msig. npsneoufmploansimaea leakage
- 3rd spacing of fluids G[prleourpaAl eSffturseipotno,caosccciutess, hypoproteinemia]
Afebrile pneumonia Staph aureus
b-. aCbhnlaomrmyadliahetrmacohsotamsaistis
-Mvyacsocpulalospmaathyhomilis
-CtMhrVombocytopenia
- 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 GLOM2ERULONEPHRITIS URINRAHREYUTMRAATCICT FINEFVECRTION TREATMENT OF RHEUMATIC FEVER

JONES CRITERIA: Antibiotic Therapy

Cifo≥m20plpiceateticohniasl orafsAhGpNer sq. inch on antecubital fossa Suggestive UTI: 10 days of Oral Penicillin or Erythromycin
-(+C) HteFst2° to fluid overload A- .PMyuarjioar: ManWifeBsCta≥tio5n/HsPF or 10mm3 IM Injection of Benzethine Penicillin
HPN encephalopathy A-bCsaerndciteisof pyuria doesn’t rule out UTI (50-60%)
-HAeRrmFadnu’se RtoaêshG:FR P-yPuorilayacrathnribties present w/o UTI(70%)
usually appears after fever lysed - Chorea(15-20%) *** NOTE: Sumapen = Oral Penicillin!
initially appears on the lower extremities Pr-eEsurymthpetmivae MUaTrIg: inatum(3%)
-SnToAtGaEcSomomf AoGn Nfinding among dengue patients (- Suribnceutcaunlteuoreus Nodules(1%)
- Diuretic phase [7-10days]–
O“alnigiusrliacnpdhoafswe recovery starts
h[7it-e1i0ndanyso]cean–ocformedp”lications lower colony counts may be due to:
sets in B. Anti-Inflammatory Therapy
Aspirin (if Arthritis, NOT Carditis)
- Convalescent phase [7-10days] – patients are B.*Moivneorhr yMdarantiifoenstations Acute: 100mg/kg/day in 4 doses x 3-5days Then, 75mg/kg/day in
B. Secondary Prevention
usually sent home *- rAercthernatlgbiladder emptying
*- pFreevveior us antibiotic intake
Recommended Guidelines for Transfusion: - Laboratory Findings of: Prednisone
Prognosis Prov▲enAocrutCeoPnhfiarmseedReUacTIt:ants (ESR / CRP) 2mg/kg/day in 4 doses x 2-3weeks Then, 5mg/24hrs every 2-3 da
T- Grarnossfsuhsem: aturia 2-3 weeks (+) uPrrinolocne uglteudrePR≥ 1in0t0er,0v0al0 cfu/mL urine of a single organism
PCrot<ei1n0u0ri,a000 with signs of bleeding
3-6 weeks C- .mPuLltUiplSeSourgpapnoisrtminsginEcvuidlteurnecemoafy Ainnditecactedaent
P▼C <3 20,000 even if asymptomatic 8-12 weeks coGnrtoamupin-AatSetdrespamInfpelection
umsiecroFsFcPopificwihtheomuat touvrieart 6-12bleeding
mo or (+) Throat Culture or Rapid Strep-Ag Test
- FWB in cases with overt bleeding or 1-2 years ▲Rising Strep-AB Test PREVENTON
- sHigPnNs of hypovolemia 4-6 weeks
C. Duration of Chemoprophylaxis
if PT & PTT are abnormal: FFP A. Primary Prevention
iHf yPpTeTrkoanlelym: icarympraeycbipeitaste n due to Na+ retention
Ca++ decreases in PSAGN
3>-▲7ccin/kAgS/hOr tidterpending on the Hct (1st no.) level (D5- LnRor)mal within 2 weeks 10 days of Oral Penicillin or Erythromycin
10--2p0ecack/skgafftaesr t2dwripeePkLsR - hypotension, narrow pulse IM Injection of Benzethine Penicillin
pre-smsuore fparior npouulsneced in pharyngeal infection
than in cutaneous
Leukopenia in dengue:probable etiology is
Pseudomonas
 KAWASAKI DISEASE
CDC-CRITERI TYPES OF SEIZURES CLASSIFTIRCEAATITOMNEBNYT CAUSE SIMPLE SEIZURES
FEBRILE SEIZURE
A FOR DIAGNOSIS:
A. Partial SAeDizOuPreTsE(DFoFcRaOl M/ LKoAcaWl)ASAKI
AC.uArrceuntelySRyemcpotmomeantidced A. Criteria for an SFS
– Simp(lAe LPLarStiHalOULD BE PRESENT)
Protocol: > Seizures:
– sudden event < caused
15 minutes
by abrupt,
(shortly after an acute insult) – uncontrolled, Generalized-tonic-clonic
hypersynchronous
–
H IGCHoGmrpaldexe PFaervteiarl (>38(.P5aRrteiacltSalelyiz)uPreR+ESENT for AT LEAST 5-days
A. –IV-IImnfemcutinonoglobulin wImithpoaiuret dotChoenrsEcxiopulsanneastiso)n
– “High Grade Fever of
discharges of Feverat
neuronsleast 5 days”
> 100.4 rectal to
DOPEaSrtNiaOl STeRizeusrpeosnedvtolvaingy tkoinTdoonficA-Cntliobnioictic!– Hypoglycemia, low sodium, low calcium 101 F (38 to 38.4 C)
Convulsion –2g/HkegaRdetgraimumena Infusion EQUALLY > Epilepsy:
– tendency for recurrent
No recurrence
seizures
in that
24 hours
are
Presence of 4 of the 5 Criteria Effective in – unprovoked byNo anpost-ictal
immediate neuro
cause
B1.. BGilaetneeraral lCizOeNd GSEeiSzTuIrOesN of the Ocular Conjunctiva –PreTvoexnitcioingoefsAtinoenurysms
(seen in 94%) and abnormalities (e.g. Todd’s paresis)
Superior to 4-day Regimen with munatli,tyHogrb,inasnudlt
respect to Albumin > Status
– epilepticus: >30min
Most common
or back-to-back
6 months to
Amelioration of Inflammation 5 years w/o return to baseline
–
2. ChanAgbessenocf ethe Lips (Petitand
mal)
Oral Cavity (At least ONE) B. Remote Symaspmtoemasautirced
by days of Fe–verP, rEeS-
–
> Etiology:
–
Normal development
No CNS infection or prior
C–hanMgyeosclofntihce Extremities(At least ONE)
eRx,isCtiRngP,bPralaintealebtnCoro - V ascular
afebrile seizures
: AVM, stroke, hemorrhage
P–olyCmlornpichous Exanthem(92%)
– Brain injury (head trauma, low oxygen) - I nfections : meningitis, encephalitis
C–ervTicoanlicAdenopathy = Non-Suppurative Cervical
NO–TE:MeningTitihsere is a TIME FRAME of 10 -B.T Risk
raumatic
Factors:
TonicA-Cdloe noicpathy (should be >1.5cm) in 42%)
Atonic
days
– Stroke –
- A utoimmune :
- M etabolic :
SLE, vasculitis, ADEM
Febrile seizure
electrolyte in 1st / 2nd
imbalance
HARADA Criteria degree relative
– Tumor - I diopathic : “idiopathic epilepsy”
used to determine whether IVIg should be given –- N eoplastic Neonatal
B. –AspDierivnelopmental brain abnormality : spacenursery staylesion
occupying of
assessed wSitIhMinP9LEdaFyEsBfrRomILEonSsEetZI oUf RillnEess 1. WBC > 12,000vs. >30 days :
- S tructural cortical malformation,
PC <C350OM,0P0L0EX FEBRILE SEIZURE C. HIdIGioHpaDthosice ASA (80-100mg/kg/day – Developmental delay
prior stroke
CRP > 3+ divided q 6h) s–houNlod – - S yndrome : Height genetic
of temperature
disorder
Feb4ri. leHScet i<z3u5re:% hbiestgoirvyenofIpnriteiaclelydingCionnsujultnction
with IV-IG C. Risk Factors for Epilepsy
“A 5 .
absence
s ei of zurealbCumNSin <in3f.e5cgti/odnL
in Aassociation with a febrileorillness
acutein electrolyte
the – Likely
imb6a.lanAcge “genetic”
1in2 coTmHpEoNnent
mchoinldthresn (2 to 10% will go on
older than 1 month of age with7o.utGperinodrearf:embraille
Reduced to Low Dose Aspirin (3-5mg/kg/day) –
to have epilepsy)
seizures”
Developmental delay
IVIg is given if ≥ 4 of 7 are fulfilled
If < 4 with continuing acute symptoms, risk score must be reassessed daily AND – Complex FS (possibly > 1
Continued until Cardiac Evaluation COMPLETED complex feature)
(approximately 1-2 months AFTER Onset of Disease) – 5% > 30 mins => _ of all
childhood status
– Family History of Epilepsy
– 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)
A. Pulmonary TB 1. Tachypnea, nasal flaring, subcostal and intercostal retractions, cyanos

– fully susceptible M. tuberculosis, Male, preterm, low BW, maternal DM, & perinatal asphyxia 2. Pallor – from anemia,

– no history of previous anti-TB drugs 3.

peripheral vasoconstriction

– low local persistence of primary resistance to Corticosteroids: Onset – within 6 hours of life
Isoniazid (H) most successful method to induce fetal lung maturation Peak severity– 2-3 days
Administered 24-48 hours before delivery decrease incidence of RDS Recovery– 72 hours
2HRZ OD Most effective before 34 weeks AOG
then 4HR OD or 3x/wk DOT
Retractions:
Microscopically: diffuse atelectasis, eosinophilic membrane Due to (-) intrapleural pressure produced by interaction b/w contraction o
– Microbial susceptibility unknown or initial
drug resistance suspected (e.g. cavitary)
– previous anti-TB use Nasal flaring:
– close contact w/ resistant source case or Due to contraction of alae nasi muscles leading to marked reduction in na
living in high areas w/ high pulmonary Pathophysiology:
resistance to H.
– 1. Impaired/delayed surfactant synthesis & Grunting:
secretion Expiration through partially closed vocal cords
2HRZ + E/S V/Q (ventilation/perfusion) imbalance due to deficiency of surfactant and decreased
Initial lung
expiration: compliance
glottis closedà lungs w/ gasà
OD, then 4 HR + E/S OD or 3x/week DOT Hypoxemia and systemic hypoperfusion inc. transpulmo P w/o airflow
Respiratory and metabolic acidosis Last part of expiration: gas expelled against partially closed cords
Pulmonary vasoconstriction
B. Extrapulmonary TB Impaired endothelial &epithelial integrity
– Same in PTB Proteinous exudates Cyanosis:
RDS Central– tongue & mnucosa (imp. Indicator of impaired gas exchange); d
– For severe life threatening
disease (e.g. miliary, meningitis,
bone, etc)

2HRZ + E/S OD, then 10HR + E/S OD

or 3x/wk DOT
 UMBILICAL CATHERIZATION
NEWBORN RESUSCITATION Cathether length
Indications • Standardize Graph
 AIRWAY: open & clear
• Vascular access (UV)
• 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
– Low line : UA catheter in cm = BW + 7
 BREATHING is spontaneous or assisted
• Hemorrhage
• Perforation of vessel – High line : UA catheter = [3xBW] + 9
 Tactile stimulation (drying, rubbing)
• Thrombosis w/ distal embolization
–
 Positive-pressure ventilation • Ischemia or infarction of lower extremities, bowel
UV catheter length = [0.5xhigh line] + 1

or kidney
Procedure
 CIRCULATION of oxygenated blood is
•
•
Arrhythmia
Air embolus
• Determine the length of the catheter
adequate • Restrain infant and prep the area using sterile
 Chest compressions technique
Cautions
 Medication and volume expansion • Flush catheter with sterile saline solution
• 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
RESUSCITAION MEDICATIONS (1thin=vein, 2thick=artery)
– NEC
• Grasp the catheter 1cm from the tip. Insert into the
– Intestinal hypoperfusion
Atropine 0.02 ml/k IM, IV, ET vein, aiming toward the feet.
Bicarbonate 1-2 meq/k • Secure the catheter
Line Placement • Observe for possible complications
Calcium 10 mg elem Ca/k slow IV • Arterial line
Calcium chloride 0.33/k (27 mg Ca/cc)
• Low line
Calcium gluconate 1 cc/k (9 mg Ca/cc)
– Tip lie above the bifurcation between L3 & L5
1g/k = 2 cc/k D50 • High line
Dextrose 4 cc/k D25
– Tip is above the diaphram between T6 & T9
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
To diagnose other medical conditions such as:
LUMBAR PUNCTURE viral and bacterial meningitis Wt x mkd x preparation [mg/mL] = mL per dose
syphilis, a sexually transmitted disease
bleeding around the brain and spinal cord
the technique of using a needle to withdraw cerebrospinal fluid (CSF) from themultiple sclerosis, (affects the myelin coating of the nerve fibers of the braine.g.12kg
spinal canal. and spinal x cord)
10mg x 5ml = 5mL per dose
SPINE Guillain-Barré syndrome, (inflammation of the nerves) 120mg
P• roscpeidnaulrceord stops near L2 Empirical dose
Alopwpelyr lluomcablarnsepsitnhe t(iucscuraelalymbe(itdweaellny)L3-L4 or  6 months ¼ tsp TID QID
* If perDose
day, xdivide total (mL) by the # of =divided
mkd doses
LP4o–s5it)ioins pthrefpearatibelnet  6 preparation
mos – 2 yrs x frequency½ tsp
Prepare the skin using sterile techniques Complication weight2-6
 1 tsp
•CSFAnesthetize the area with lidocane Local pain  6-9 1 ½ tsp
•
•neurnvcot
clear, u srestyhsetesmkinfroinmthinejumryid ne just cauda to the
watery liquid that liprotects the l central
Infection
Bleeding
 9-12 2 tsp
scpuisnhuiosnpsrothcessb,raaingflreomcetpheaslaudrrtouwnadridngthbeone. Spinal fluid leak  Paracetamol Drops = Wt: move 1
uItmcobnilitcauinssu: sing a g23 needle Hematoma (spinal subdural hematoma decimal
Collect the CSF for analysis point to the left
– glucose (sugar)
Spinal headache
Acquired epidermal spinal cord tumor Age Wt
–
CSF Analysis culture and sensitivity
Grapmrostetainin,
Caution & Contraindications
1
2
10 kg
12
–Cellwchoituenbt,lodoifdfecreenlltsial count
Increased ICP CLI NICAL FEATURES 3 14
CLASSIFICATION BASED ON S
•3. : 500ml/d o–r s0u.3g5amr, lp/mroitnein EVERITY
RateChemistriaeys Bleeding diasthesis
Traumatic Tap
MILD M ODERATE
4
5 SEVERE
16 RESPIRATORY
18
•
4 .Range0
Special studies
.3-04 ml/min PERSISTENT
Overlying skin infection
- talking
6 20 ARREST
Unstable patient
• INTERMITTENT
AfteVrocluamree : 5
Cover the p 0ml (infants)
uncture
MILD MODERATE
site with a steAriflfecbtsanddaialyge, Limits
Affects daily activity
SEVERE
daily activity & sleep
& sleep
- INF: softer,
shorter, cry,
1 drop - at rest = 1/20 mL
- INF: stops = 5 mL
Exacpeprlbyaptrioen
50ml (adults)
1 1 teaspoonful
ssure packinBgr.ief or 4-6 shloeuerps difficulty 1 tablespoonful
feeding = 15 mLImminent
wal king feeding 1 wineglassful
- hunched
Patients mus t remain lying down f = 60 mL= 2 ounces
Indication can lie down prefers forward
DayN-PtimOefoSrx4shr
s <1x/wk rain >c1axn/cwekr and daily continuous Breathless - 1 glassful = 250 mL= 8 ounces
to diagnose some malignancies (b
<2x/moPEFR
NiglehutimkeemSiax)s >2x/mo >1x/wk frequent sitting 1 grain = 60 mg
>80% >80% 60 - <80% <60% Talks in sen tences phrases 1 pint words = 500 mL
PEtoFR aVsAsRess patient<s20%with cert ain 20p-sy3c0h%iatric >30% >30% Alertness may be usually 1 quart usually = 1000 mL drowsy /
sFymEVp1toms and condi>ti8o0n%s. >80% 60 - <80% <60% ag itated agitated 1 ounce agitated = 30 mLconfused
RR often >30
▲ ▲ bradypnea
mins
Accessory muscles & retractions (+) thoracoabd movement

none (+) (+)