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Flashcards in pediatrics Deck (125)
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31

Invasive infection of the subarachnoid space

Meningitis (can cause fever and seizures)

32

how does meningitis occur

usually by hematogenous spread from the upper respiratiory tract,

or direct inoculation from sinusitis,

mastoidits or otitis media or skull fracture

33

The younger the child, the _____ likely he or she is to exhibit the classic symptoms of fever, headache, and meningeal signs.

1. The younger the child, the less likely he or she is to exhibit the classic symptoms of fever, headache, and meningeal signs.

34

Neonatal meningitis associated with

Neonatal meningitis associated with maternal infection or pyrexia at delivery

35

Younger than 3 months, nonspecific symptoms of meningitis include

Younger than 3 months, nonspecific symptoms, including hyperthermia or hypothermia, change in sleeping or eating habits, irritability or lethargy, vomiting, high pitched cry, or seizures

36

Meningismus and a bulging fontanel may be observed but are not needed for diagnosis

as well as ____ irritability

paradoxical

child is irritated wehn you touch them

37

after 3 mos of age typical sxs associated with meningitis include

a. Fever
b. Vomiting
c. Irritability
d. lethargy, or any change in behavior

38

2-3 yrs of age typical sxs associated with meningitis include

a. headache
b. stiff neck
c. photophobia
d. Course may be brief and fulminant ( N. meningitidis) or gradual

39

in young infants with meningitis sxs are

a. specific findings are rare
b. May be febrile or hypothermic
c. Bulging fontanelle, diastasis of skull sutures, nuchal rigidity are late signs.

40

toddlers and children with meningitis usally present like

a. Meningeal signs
b. headache
c. nuchal rigidity
d. positive Kernig or Brudzinski's sign
e. Focal neurological signs
f. Seizures in 30% of cases
g. Obtundation or coma in 15-20%
h. Petechial-purpuric rash

41

Petechial-purpuric rash is usually

(found with Neiserria meningitis)

non blanching
i. < 3mm red spots that don’t blanch when compressed

42

labs for meningitis

1. Complete blood count (CBC) with differential
2. Blood cultures
3. Coagulation studies
4. Serum glucose
5. Erythrocyte sedimentation rate (ESR)
6. Electrolytes
7. Serum and urine osmolalities
8. Bacterial antigen studies can be performed on urine and serum. They are mostly useful in cases of pretreated meningitis

43

why are head CTs done for meningitis

a. Focal neurological signs
b. To rule out other pathology
c. Does not rule out increased intracranial pressure

44

how should the patient be positioned for a LP

knees are lined up directly and directly vertical

shoulders lined up

hyper flex

advance needle slowly without the stylette

45

what are you looking for in a LP of a child suspected of having meninigitis

a. Measure opening pressure
b. Cell count
c. Gram stain
d. Culture and sensitivity
e. Glucose
f. Protein and antigen
g. Acid-fast bacillus
h. Fungal stains

46

age range of epiglottitis

ii. Age range 1-6 years

47

history of epiglottitis


1. Acute onset of fever and sore throat
2. Dysphagia
3. Distress
4. Drooling
5. Cough is rare

48

Exam of epiglottitis

1. toxic appearing
2. Sniffing position
3. Muffled voice
4. Stridor
5. Lymphadenopathy

49

what to do if you think it is epiglottitis

DO NOT STICK A TONGUE DEPRESSOR IN AND LOOK IN THEIR EFFIN THROAT


1. Intubate in OR
2. Admit to ICU
3. IV abx
4. Steroids not proven

50

late signs of epiglottitis

Oximetry, hypoxia and cyanosis are late signs.

51

other respiratory issues you see commonly in winter

age range

croup

with noisy audible breathing

ii. Age range: usually 3 months- 3years

52

airway managrement for epiglottitis and tx

assemble a team that can manage airway

1. Fiberoptic naso-tracheal intubation, in the OR
2. Rapid Sequence Intubation, orotracheal, in the ER
3. Needle crico-thyrotomy if intubation fails
4. Long slow breaths if bag valve mask used prior to intubation

3. Disposition
4. Intubate in OR
5. Admit to ICU
6. IV abx
7. Steroids not proven

53

hx seen with croup

1. Gradual onset of URI symptoms
2. Rhinorrhea
3. Cough, barking like a seal
4. Fever
5. Stridor, often resolves by time of ED presentation.

54

exam with croup

1. Generally non toxic
2. May be playful and cooperative or restless and anxious
3. Stridor: inspiratory > expiratory

55

treatment for croup

1. Cool mist
2. Racemic epinephrine
3. Dexamethasone 0.6mg kg IM or PO (same efficacy), some authors recomend repeat dose in 6 hrs.
4. Nebulized Budesonide

56

Consultation/Admission, consider Intubation if for croup if

1. Hypoxia, cyanosis
2. Retractions unrelieved by initial treatment
3. Diminished breath sounds, diminished stridor
4. Change in mental status

57

home care for croup

1. Tobacco/irritant free environment
2. Vaporizer
3. Cool night air
4. Antipyrexia

58

RPA

Retropharyngeal abscess

Bacterial infection of retropharyngeal space leads to abscess formation and airway obstruction

59

what are we concerned abotu with RPA

ii. Can progress to mediastinitis (50% mortality), pericarditis, jugular vein thrombosis, carotid artery erosion, sepsis.

60

Hx of the patient with RPA

1. Sore throat
2. Odynophagia
3. Fever
4. Neck stiffness
5. Neck swelling (97% in infants)
6. Cough (33% in in infants)