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Flashcards in pediatrics Deck (125)
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most common peds emergencies and their tx

om-amoxicillin 80- 90mg/kg/d

Viral URI-acetaminofen, hold the cough syrup

acute gastro -oral hydration


fluid for shock

Boluses of 20ml/kg in shock


fluid for dehydration

Boluses of 10ml/kg in dehydration

Re-assess after each bolus


IOs can be done where? why would you

is coding

flat part of tibia and the humorous


what are the reasons physicians miss illness

wellness bias
pressure to be productive
desire to avoid avoid unnecessary or expensive tests.


temp greater than in Peds is a

i. Temp greater than 38C


Temp less than ___ correlates to a low risk for bacteremia.

Temp less than 39C (102.2 F) correlates to a low risk for bacteremia.


common sites of fever for a pediatric patient include (4)

a. Otitis Media
b. Pharyngitis-URI
c. Pneumonia
d. Acute Gastro-enteritis


when assessing toxic appearance in a ped (4)

pale-check mucosa

poor profusion
-a. Cyanosis, mottled skin

respiratory distress-
a. Tachypnea, shallow breathing

altered mental status
-a. Poor eye contact, feeding, failure to respond to caregivers.


Neonates, age 0-28 days w/ fever 38c or more

what's the workup (6)

i. Admit them all. Let the pediatrician sort them out.

1. CBC
2. Blood cultures
3. Urinalysis
4. Urine culture
5. Lumbar puncture
6. Parenteral antibiotics


when would you do a CXR in a admitted neonate

a. Cough
b. Tachypnea
c. O2 sat less than 95%


when woudl you do stool studies in a neonate

2. Stool studies if diarrhea


Fever, age 28-90 days work up for a child with a fever

i. CBC
ii. Urinalysis, gram stain if available
iii. Urine culture
iv. Blood culture


what would you want to consider in a 28-90 day work up for a child with a fever

1. Lumbar puncture, (some authors say all patients in this category)
2. Chest x-ray
3. Stool studies
4. Fecal leucocyte count and stool culture


Fever without a source: who can go home is based on

Rochester criteria
for bacteremia risk in infants 28-90 days old, with fever


Overall risk of occult bacteremia in well appearing febrile infant

1. Overall risk of occult bacteremia in well appearing febrile infant: 7-9%

2. If all Rochester Criteria met, risk is less than 1%


labs associated with rochester criteria

a. WBC 5-15k; bands less than 1.5k

b. Urine less that 10wbc/hpf, or neg leukocyte esterase/nitrate or negative gram stain of unspun urine

c. Fecal smear less than 5wbc/hpf


If reliable caregivers and access to follow-up in office or ED for 28-90 day old infant

a. Blood culture
b. Urine culture
c. Consider LP and ceftriaxone 50mg/kg IV
d. Re-evaluate in 24 hours
e. Admit positive blood culture or febrile UTI
f. Treat afebrile UTI as outpatient.


3-36 months oldFever without source-

1. Occult UTI

what sxs is associated with a higher risk of UTI

a. 2% of FWS in children under 5yrs

b. 6-8% of girls; 2-3% of boys under 12mo

c. Higher temp correlates with increased likely hood of UTI


Untreated UTI can lead

to kidney damage and renal failure in adulthood


3-36 months oldFever without source-

what would you suspect

occult UTI
occult PNA
occult bacteremia


what reduces the likelihood of occult PNA

b. Heptavalent pneumococcal vaccine reduces likelihood of pneumonia


what is the major signs of PNA


Positive x-ray in 26% of children with temp >39C or wbc>20k


3% of cases of Pneumococcal bacteremia progress to



3-36 mo with toxic apperance workup

a. Admit
b. Septic work-up
c. IV antibiotics


Non toxic, Temp <39c 3-36 mo workup

a. No tests
b. Acetaminofen
c. Return if fever persists >48 hours or if condition deteriorates.


Nontoxic with temp> 39 C

when would you evaluate Urine

Evaluate urine for

all females < 12 months old;

uncircumcised males < 12 months old

circumcised males < 6 months old.

b. If UTI is found: culture urine, treat with antibiotics and and follow up in 48 hours.


when would you get a CXR in a non toxic kid wiht a temp >39

Chest x-ray if O2 sat < 95%,
tachypnea, rales, temperature

≥39.5°C and WBC count ≥20,000


febrile seizures are usually lesss than

Generalized seizure, less than 15 minutes duration associated with fever spike


is there a risk of epilepsy in kids with febrile seizures

2.4% risk of epilepsy by age 25, double average risk