Pediatrics 2Nd Half

Front 1

In the newborn exam, what are 4 things that you should ask in the History?

Back 1

- Genetic history (mother + father)
- Prior pregnancies and outcomes
- Antipartum/Intrapartum events
(prenatal care, substance use, maternal illness/medications, infections like GBS HBV and HSV, preterm labor, intact vs. ruptured membranes, blood type)
- Delivery: Vaginal or Caesarian Section

Front 2

What is better, a low or high APGAR score?

Back 2

High

Front 3

-What is considered full term in weeks for a newborn?

-What is considered pre-term?

-What is considered post-term?

Back 3

Term = 37-42 weeks

Preterm = < 37 weeks

Post-term = > 42 weeks

Front 4

What are normal vital signs for a newborn? (HR, RR, BP)

Back 4

HR = 100-160
RR = 30-60 (with periodic breathing)
BP = 65/30 to 90/60

Front 5

With a newborn physical exam, what are 3 things to look for in assessing their skin?

Back 5

-Perfusion: cyanosis, acryanosis, mottling

-Birthmarks: hemangiomas, mongolian spots

- Jaundice (it's pathologic within 1st 24 hours of life)

Front 6

With a newborn physical exam, what are 3 things to look for in assessing their HEENT?

Back 6

Head (fontanelles, caput vs. cephalohematoma)

Eyes: red flexes, subconjunctival hemorrhage

Throat/mouth: cleft lip/palate, natal teeth

Front 7

With a newborn physical exam, what are 3 things to look for in assessing their heart? (the 3 Ps)

Back 7

PDAs, PACs, pulses:

Murmurs (PDA closure)

Arrhythmias (PAC's)

Cardiovascular (femoral pulses)

Front 8

With a newborn physical exam, what are some things to look for in assessing their lungs?

Back 8

Grunting, flairing, retracting

breath sounds - symmetry

Front 9

With a newborn physical exam, what are 3 things to look for in assessing their abdomen?

Back 9

- Umbilical cord: 2 arteries - 1 vein

- Omphalocoele or gastroschisis (intestines poking out of belly button)

- Anus: patent (open) or imperforate (no butthole or blocked butthole)

Front 10

With a newborn physical exam, what are things to look for in assessing their genitalia? (male, female... other... yeah)

Back 10

males: hypospadius (undescended testes)

Female: vaginal discharge

Ambiguous genitalia... seriously... yikes

Front 11

With a newborn physical exam, what are things to look for in assessing their hands/feet/hips/clavicle?

Back 11

Hips: ortolani/barlow maneuvers (DHD)

Feet/hands: Clubfoot, metatarsus adductus, polydactyly (extra digits), syndactyly (webbed digits)

Clavicle fracture with trauma

Front 12

With a newborn physical exam, what are things to look for in assessing their neurologic function? Including spine/back?

Back 12

-Tone, reflexes, nerve palsies (brachial plexus)

-Jitteriness, irritability

-Spine/back: sacral dimple

Front 13

How frequent are major congenital abnormalities in newborns (% of live births, % of perinatal/neonatal deaths)?

-What are some examples of dysmorphologies/syndromes?

Back 13

1.5% of live births have major congenital defects.
15-20% of perinatal/neonatal deaths due to this.

-Ex. Trisomy 21, neural tube defects

Front 14

What are 3 examples of prophylactic measures for newborns?

Back 14

- Ophthalmic prophylaxis
- Vitamin K (prevents hemorrhagic disease of newborn)
- Hepatitis B Vaccine (add HBIG if mother is HbsAg (+) withing 12 hours)

Front 15

Name 2 examples of newborn screening?

Back 15

-Oto-acoustic emissions (OAE)

-Newborn metabolic screening
(PKU, hypothyroidism, galactosemia, hemoglobinopathies). FYI: in 2006 expanded to 36 disorders!... Utah added Cystic Fibrosis in '09.

-Repeat at 2 weeks

Front 16

Name some benefits of breast feeding for newborns?

Back 16

- They get host resistance factors (IgE, IgA)
-Decreases URI, GI infections in infancy
-Enhances neurodevelopment outcome

Front 17

What's normal weight loss for a newborn? When should they return to normal birthweight?

Back 17

- up to 7-10% is acceptable

- should return to birthweight by 2 weeks

Front 18

Upon discharging a newborn from the nursery, what are 4 things you should make sure the patients know?

Back 18

- Umbilical cord care

- Sleep position (back to sleep!)

- Car seat... rear facing back seat

- 1st routine office appointment at 2 days... then 2 weeks

Front 19

What's the most common organism that causes neonatal sepsis? What are some other causes?

Back 19

-Group B Streptococcus

- E. Coli, strep viridans, staph aureus, enterococcus

Front 20

What are some risk factors for neonatal sepsis? (~6 things)

Back 20

- Prematurity
- Prolonged rupture of membranes (>18 hrs)
- Maternal fever
- Maternal GB strep carriage

- Hx of prior infant with GB strep disease
- Increased risk with multiple births (twins/triplets)

Front 21

What's the presentation of neonatal sepsis?

-What's the mortality rate of GBS sepsis?

Back 21

- Usually w/in 12-24 hours of birth
- Respiratory distress
- Poor perfusion/hypotension
- Temperature instability
- Lethargy or hypotonia
- Apnea
- Poor feeding

- (GBS) septis mortality = ~5%

Front 22

What will the lab reports show in neonatal sepsis?

- What is the definitive Dx?

Back 22

- increased WBC (>30,000) or decreased (<10,000)
- Increased ratio of immature to mature neutrophils
- Absolute neutrophil count (ANC <1,000)
-Thrombocytopenia
- Ches X-Ray: Infiltrates (pneumonia)

- Definitive Dx = (+) blood culture

Front 23

What's the Tx for neonatal sepsis?

Back 23

Ampicillin + gentamicin

Front 24

How frequent does jaundice occur in preterms?
- what percentage of infants are affected in 1st week of life?
-At what serum level is jaundice noted?
- Where does it start on the body and how does it progress?

Back 24

80% of the time
- 65%
- 5 mg/dl
- Starts on the head, progresses inferiorly

Front 25

What presentation in a newborn would merit an evaluation for SEVERE jaundice?

-What lab values would merit this?

Back 25

-Jaundice in FIRST 24 hours of life
- if persists beyond 2 weeks
- If any ill infant then gets jaundice

- bilirubin increases 5 mg/dl in 24 hrs
- Serum bilirubin > 15 or direct bilirubin > 1 mg/dl

Front 26

What's the Tx for jaundice?

- Why treat?

Back 26

Phototherapy... can also do an exchange transfusion (if bilirubin is > 20-25)

- to avoid kernicterus (bilirubin encephalopathy)

Front 27

Outside of treatment, what can you recommend to manage jaundice?

Back 27

- More frequent feedings (8-12 times daily)

ALSO: monitor and therapy using the Bhutani nomogram

Front 28

Give 2 major problems arising from an infant from a mother with diabetes?

Back 28

- Macrosomia (large sized baby)

- Hypoglycemia (due to acclimation of higher glucose and insulin levels in utero)

OTHERS: hypocalcenemia, polycythemia (high [hemoglobin] in blood)

Front 29

Name a few difficulties that a premature child can have?

Back 29

- Difficulty maintaining their temperature
- hard to control respiration (apnea)
- surfactant production is low...
- holes in heart (PAD, PFO, etc)
- poor suck, swallow and breathing
- poor renal function
- poor cerebral vasculature
- more susceptible to infection

Front 30

What is Transient Tachypnea of the newborn (TTN)?
-What's its Sx, CXR findings, Tx, prognosis?

Back 30

Retained amniotic fluid

Sx: respiratory distress first breaths of life
CXR: fluid in interlobar fissures
Tx: O2 support
Resolves w/in 12-24 hrs.

Front 31

What's Hyaline membrane disease (HMD)?
- Sx?, CXR findings?, Tx?

Back 31

It's surfactant deficiency.

Sx: respiratory distress in premature infants
CXR: "Ground-glass" appearance
Tx: O2 support, mechanical ventilation, and surfactant

Front 32

What's Bronchial pulmonary dysplasia (BPD)? Sx? Tx:?

Back 32

Chronic lung disease that follows hyaline membrane disease and respiratory stress syndrome
Sx: persistent O2 needs
Tx: O2 support, diuretics, bronchodilators, RSV prophylaxis

Front 33

What's Necrotizing entercolitis (NEC)?
Sx? Tx? CXR findings? Complications with it?

Back 33

Intestinal necrosis (like my niece Chantel had) +/- perforation and affects distal ileum/proximal colon.
Sx: Abdominal distention, vomiting, bloody stools
X-ray: air in bowel wall (Pneumotosis interstinalis)
Tx: broad-spectrum antibiotics, surgery!
Complications: interstitial perforation, sepsis (mortality ~10%)

Front 34

What's intraventricular hemorrhage (IVH)?
Sx:, Complications

Back 34

ischemia, reperfusion and vessel rupture in areas of low cerebral blood flow.
Sx: lethargy, apnea, seizures, shock
Complications: ventriculomegaly

Front 35

WRESTLE WITH THE ALGORITHM ON PAGE 77...

Back 35

Okay? He told us to...

Front 36

DON'T forget to work with the algorithm on page 77....

Back 36

Sound good?... YOU'RE A HANDSOME MAN!

Front 37

What's the criteria for SIDS?

Back 37

Sudden unexpected death
- infant under 1 y.o.
- death during sleep
- unexplained after thorough evaluation including autopsy and review of Hx.

Front 38

Risk factors for SIDS?

Back 38

Low birth weight
- Teenage mother
- Maternal smoking/drug use
- lack of breastfeeding
- late or absent prenatal care
- low SES (socioeconomic status)
- Fam Hx

Front 39

What are some things to avoid in child's sleep environment?

Back 39

- Sleeping on a soft surface (pillow, quilts, comforters)
- Any loose bedding (blankets or sheets)
- Co-sleeping
- Overheating
- PUT THEM on their back! Avoid PRONE! BE supine.

Front 40

what's the cause of SIDS?

Back 40

Not known...

Proposed hypothesis are:
- delayed development of arousal or cardiorespiratory control (breastfed children get this)
-Airway obstruction
- Brain stem immaturity or injury

Front 41

What's the relationship of APNEA and SIDS?

Back 41

none really... most kids with apnea don't die from SIDS. Most kids that died from SIDS don't have a Hx of apnea.

Front 42

What does positioning have to do with SIDS?

Back 42

INCREASED incidence of SIDS in infants with prone positioning. So......
"Back to sleep campaign"... (man he likes to plug things).

Front 43

What are some consequences of non-prone (supine) sleeping?

Back 43

- No increase of aspiration
- delayed attainment of gross motor skills
- increased incidence of occipital plagiocephaly (flattening out of back of head)

Front 44

Who's most affected by SIDS?

Back 44

Infants 21 days - 9 months (peak of 2-4 months)
- happens mostly between midnight and 8 a.m.

Front 45

What's ALTE?

Back 45

- Apparent Life Threatening Events

Examples:
- RSV or bacterial infection
- Cardiomyopathies..
- gastroesophageal reflux
- seizure
- CNS infection
- Poisoning
- munchausen syndrome

Front 46

What's the presentation of ALTE?

Back 46

Apnea
Color change
Change in muscle tone
Choking or gagging

Front 47

How do you manage ALTE?

Back 47

-hospitalize for observation
- do Dx by Hx and presentation
- Create a Tx directed at underlying cause
- TEACH PARENTS CPR! prior to discharge

Front 48

Is apnea home monitoring beneficial?

Back 48

No proven results that it is beneficial.

Front 49

What's the incidence of child abuse?

Back 49

~2% of all U.S. children are abused/neglected annually

Nearly 1700 children die from child abuse every year!!!! :(

Every 10 seconds, a child is reported abused or neglected.

Front 50

Name some risk factors of abusive families?

Back 50

- Poverty/economic strain (SES)
- Unmarried or teen mother
- Substance abuse
- Domestic violence

FYI: 1/3 of abuse cases occur in EXTRAfamilial settings

Front 51

What are some typical historical features with abuse cases?

Back 51

- Discrepant Hx (Hx doesn't match up)
- Delayed seeking care
- Hx of abuse in caregiver's childhood
- Stress in caregiver's family
- Hx of caregiver losing control from child behavior

Front 52

What are some clinical findings in a child that has been abused?

Back 52

- Multiple stages of healing

-abraisons, alopecia (hair loss), bites, bruises, burns, dental trauma, fractures, lacerations, ligature (strangulation) marks or scars.

Front 53

What's the most common manifestation of physical abuse?

Back 53

Suspicious bruises

-i.e. genitals, ears don't usually get bruised. They'll have multiple bruises of varied ages and may be patterned (like belt, pinch or cord marks)
- ANY bruise in a non-ambulatory patient raises concern!

Front 54

What are some signs of abusive burning on a child?

FYI: 25% of all pediatric burns are due to abuse!!!! CRAZY!

Back 54

- Any burn with circumferential, sharply demarcated edges ('stocking-glove distribution)

- Absence of splash marks in an immersion burn (bath tub)

- Cigarette, curling iron type burns

Front 55

What should you think of when you see a rib fracture?

Back 55

ABUSE!

Front 56

IMPORTANT!

What's the triad for Shaken Baby Syndrome?

What's the outcomes?

Back 56

1) Severe intracranial injury
2) Retinal hemorrhages
3) with minimal or no external signs of trauma

Outcome: 1/3 death, 1/3 permanent neurological sequelae, 1/3 'normal'

Front 57

What are some indications of head and skeletal trauma in an abused child?

Back 57

Fractures in multiple stages of healing, and ones in specific bones (ribs, sternum, scapula, vertebrae)

- Subdural hemorrhages, retinal hemorrhages (usually bilateral)

Front 58

What should you do if a child presents with skeletal or head trauma?

Back 58

Obtain a skeletal survey after any suspicious fracture (repeat survey in 2 weeks)

- obtain an ophthalmology consult

Front 59

What organ is most commonly injured in abdominal trauma during child abuse?

Back 59

LIVER!!!!

Other organs injured are pancreas, small bowel, duodenum.

Front 60

What's the 2nd leading cause of death in child abuse cases?

What type of imaging do you want to order if a child presents with this?

Back 60

- Abdominal trauma (mortality approaches 50%!!!!!!!!!)

Imaging = CT scan

Front 61

What do sexually abused patients present with?

Back 61

NOTHING! (in 95% of patients there are no physical findings)

BUT: can have,
- STDs, Sleep disturbance, difficulty holding bladder when toilet trained, recurrent genital or anal pain, phobias, sexual behaviors... etc (pg. 95)

Front 62

What are some common presentations for emotional abuse?

Back 62

- Eroded child's self esteem
- Sleep disturbances, witness abuse
headache and abdominal pain, avoidance behaviors (avoids being with parent's or uncle's house... or whoever!)

Front 63

What are 3 categories of child neglect?

Back 63

- Emotional (no apparent child-parent attachment)
- Physical (not giving food, clothing etc)
- Medical (not providing medical care)

Front 64

What is failure to thrive (FTT), and what are some presentations of it?

Back 64

Someone is not providing enough nutrition to this child for their need.

- Marked growth deceleration (preservation of head circumference), loss of subcutaneous fat, Hx of social risk factors (family dysfunction, substance abuse)

- Often reverses when child is placed with a new caregiver.

Front 65

What's Munchausen Syndrome?

- Who is usually the perpetrator?

Back 65

"Fastitious Disorder by Proxy" Caregiver creates signs/symptoms of illness in child (like on the 6th Sense movie when they catch the mom poisoning her child)

- Mother 95% of the time

Front 66

How do we manage abuse from Munchausen Syndrome?

Back 66

Immediately treat physical injuries!

- Establish a safe environment
- MANDATORY reporting (child abuse hotline or a child protective service agency)
- Use non-accusatory empathic actions. Remain objective and perform a open-ended question interview.
- Investigation by social services and law enforcement

Front 67

How do you prevent child abuse?

Back 67

- Use home health visitor to at-risk family
- Give education to parent regarding stress situations
- Counsel mother about safe child care arrangements
- Teach child about personal privacy (private parts, good touch and bad touch)
- Educate parents about age-appropriate discipline

Front 68

What is the definition of a child fever?

Back 68

T (rectal) > 38 degrees C (100.4 F)

Front 69

What are some causes of increased temperature?

Back 69

-Rise in hypothalamic set point (infection, cancer or collagen-vascular disease can cause hypothalmus disorders...)
- Body heat production exceeds heat loss mechanisms (malignant hypothermia)
- Heat loss mechanisms are not working (ectodermal dysplasia)
- Extrinsic heat sourses (hot weather, warm bath, excessive clothing, exercise)

Front 70

What's the pathophysiology of a fever?

Back 70

- Infectious agent induces macrophages to release cytokines ==> endogenous pyrogen
- These interact with anterior hypothalmus ==> releases prostaglandins and other mediators
- Prostaglandins increase metabolic rate ==> heat production, rise in core body temperature

Front 71

What's the most common cause of a fever in a child?
- how long does it take to resolve?

Back 71

Viral infection.
- 3-4 days

Front 72

At what temperature does a correlation between fever and serious bacterial infection occur?

Back 72

- When temp rises over 40 degrees C

Front 73

Can a fever cause brain damage?

Back 73

Apparently no... weird. I though it did.

Front 74

Is Matt a handsome man?

Back 74

YES! Much better than Coach Roscoe...

Front 75

What immediate evaluation should occur with a child presenting with a fever? (about 9 things...)

Back 75

- Age>3 months
- Fever Temp>40.6 C/ 105 F
- Breathing is labored
- Inconsolable crying
- Child is difficult to arouse
- Neck stiffness/sore (Nuchal rigidity)
- Petechiae
- Convulsion with fever
- Child looks or act VERY sick!

Front 76

How do you treat a childhood fever?

Back 76

- Check first for potential causes
- Use antipyretic therapy (goal is just to relieve discomfort, REDUCE temp)
- Encourage more fluid intake
- Limited sponging - tepid water

Front 77

What are two drugs that can be used as antipyretics?

Back 77

- Acetominophen (tylenol)
- Ibuprofen (advil, motrin)

Front 78

What drug should you AVOID as a fever treatment (antipyretic)?

- Why?

Back 78

ASPIRIN!

- Due to Reye's Syndrome. Can enhance fever risk due to influenza or varicella

Front 79

What's important for you to identify in a child with a fever?

- What are examples of this?

Back 79

Serious Bacterial Infection (pg. 106)

- UTI (74%), Sepsis/bacteremia, meningitis, bacterial pneumonia, bacterial gastroenteritis, bone/soft tissue infections (osteomyelitis, septic arthritis, abscess)

Front 80

What does "fever without a source" mean?

Back 80

Acute febrile illness, cause of fever is not apparent after a careful Hx and examination.

Front 81

What does "lethargy" mean?

Back 81

Altered level of consciousness.
- Decreased eye contact or level of interaction

Front 82

What are some signs of toxicity in a child?

Back 82

- LETHARGY! but also... poor perfusion, cyanosis, hyper/hypo-ventillation

Front 83

What does "occult bacteremia" mean?

Back 83

When child isn't toxic appearing clinically, and has the presence of bacterial pathogens in blood.

Front 84

What does "sepsis" mean?

Back 84

Presence of bacteria in blood of a patient that is ALSO toxic!

-Different from occult bacteremia

Front 85

What's a risk with hypothermia (temp < 36C)?

Back 85

severe bacterial infection (SBI)

Front 86

What's the correlation between an increase in fever and SBI?

Back 86

As fever increases, SBI risk increases.

Front 87

If a child age 1-90 days old presents with a fever and is toxic, what percentage of risk for SBI do they have?

Back 87

17%

Front 88

If a child age 1-90 days old presents with a fever and is not toxic, what percentage of risk for SBI do they have?

Back 88

9%

Front 89

If a child age 1-90 days old presents with a fever and is "low risk", what percentage of risk for SBI do they have?

Back 89

1.4%

Front 90

What's the Rochester criteria for low-risk infants? (page 108) ... this is stupid...

Back 90

It evaluates febrile infants < 60 days old that...

- have non-toxic appearance
- were previously healthy
- No skin, soft tissue, bone, joint or ear infection noted
- have WBC: 5000-15,000 with <1500 bands (WBC count > 15,000 increases bacteremia risk 3 fold)
- Urinalysis < 10 WBC/hpf

Front 91

What is the most common pathogen in severe bacterial infection (SBI) fever?

Back 91

E. Coli (page 108)

Front 92

How do you manage a 1-30 day old child with severe bacterial infection (SBI) fever? (3 steps)

Back 92

1) Full sepsis workup
2) Hospitalize
3) IV antibiotics, pending culture results (ampicillin + cefotaxime and gentamicin)... if meningitis is suspected: triple the coverage. If just uti, then do the first two.

Front 93

How do you manage a 30-90 day old child with severe bacterial infection (SBI) fever? (2 steps) [think high and low risk]

Back 93

1) If doesn't meet low risk criteria:
a) sepsis work-up, hospitalize, iv antibiotics
2) If low risk
a) sepsis work-up, out patient antibiotics and follow-up in 24 hours
b) Urine culture only, outpatient observation w/ no antibiotic, follow-up in 24 hours.

Front 94

If a 28-90 days old child presents with a fever, and if WBC & differential urinalysis/stool exam (if diarrhea) comes back with positive labs, what should you do next? (algorithm on page 109)

Back 94

Admit them

Front 95

If a 28-90 days old child presents with a fever, and if WBC & differential urinalysis/stool exam (if diarrhea) comes back with negative labs, what two options do you have? (algorithm on page 109)

Back 95

Option A: Perform a urine culture, blood culture, CSF culture, give ceftiaxone and return in 24 hours
Option B: Urine culture, and observation

Front 96

If a 28-90 days old child presents with a fever, and you receive a positive CSF culture, how do you manage that?

Back 96

Admit them, give IV antibiotics (ampicillin + gentamicin + CEF)

Front 97

If a 28-90 days old child presents, and you receive a positive blood culture, how do you manage that?

Back 97

If it's S. pneumonia (non-resistant) and patient is stable (afebrile): give ceftriaxone (IM), then oral amoxicillin x 10 days
- If a different pathogen, admit, IV antibiotics (ampicillin + CEF)

Front 98

If a 28-90 days old child presents, and you receive a positive urine culture, how do you manage that?

Back 98

If afebrile w/o bacteremia, give oral antibiotic (cefdinir) x 10 days
- If febrile or bacteremic, admit and iv antibiotics (ampicillin + CEF)/ (ceftriaxone if > 60 days)

Front 99

If a 28-90 days old child presents with a fever, and if WBC & differential urinalysis/stool exam (if diarrhea) comes back with positive labs, what should you do next? (algorithm on page 109)

Back 99

Admit them

Front 100

If a 28-90 days old child presents with a fever, and if WBC & differential urinalysis/stool exam (if diarrhea) comes back with negative labs, what two options do you have? (algorithm on page 109)

Back 100

Option A: Perform a urine culture, blood culture, CSF culture, give ceftiaxone and return in 24 hours
Option B: Urine culture, and observation

Front 101

If a 28-90 days old child presents with a fever, and you receive a positive CSF culture, how do you manage that?

Back 101

Admit them, give IV antibiotics (ampicillin + gentamicin + CEF)

Front 102

If a 28-90 days old child presents, and you receive a positive blood culture, how do you manage that?

Back 102

If it's S. pneumonia (non-resistant) and patient is stable (afebrile): give ceftriaxone (IM), then oral amoxicillin x 10 days
- If a different pathogen, admit, IV antibiotics (ampicillin + CEF)

Front 103

If a 28-90 days old child presents, and you receive a positive urine culture, how do you manage that?

Back 103

If afebrile w/o bacteremia, give oral antibiotic (cefdinir) x 10 days
- If febrile or bacteremic, admit and iv antibiotics (ampicillin + CEF)/ (ceftriaxone if > 60 days)

Front 104

What's the correlation with fever over 41 degrees and risk of occult bacteremia in infants 3-36 months?

- What's the common pathogen associated with a fever in this age group?

Back 104

risk increases

- E. coli... again!

Front 105

How do you manage a fever in a child age 3-36 months? (hint: look at it with a fever over 39 toxic and non-toxic and under 39 degrees... what do you do?)

Back 105

1st: eliminate from consideration patients with obvious viral infection or those with a defined source (like Ottits Media)
-THEN: for fever < 39, evaluate, antipyretics, and follow-up
- For fever > 39: IF TOXIC (or immuniodeficient)... admit, septic work-up, IV antibiotics
IF NON-TOXIC use the screening tests! (these are described later on)

Front 106

What are the screening tests used for non-toxic febrile (>39 degrees) children ages 3-36 months? (5 things)

Back 106

-WBC
- Blood culture
- Urinalysis/Urine culture
- Chest X-Ray
- Stool culture
Read page 111 of syllabus to understand details of these.

Front 107

What are some management decisions that you need to make with a febrile child (>39 degrees) age 3-36 months?

Back 107

Get CBC... if WBC is > 15,000, obtain BCx and treat with ceftriaxone
- get Urine culture: in all females and males to check for UTI
- Get chest X-ray or stool culture if clinically indicated

Front 108

IF a child age 3-36 months gets a positive blood culture, what should you do?

Back 108

If afebrile with S. Pneumoniae, give ceftriaxone, then amoxicillin x 10 days
- If febrile, ill or non-S. pneumoniae: repeat blood culture, obtain CSF culture and admit for IV antibiotics

Front 109

If a child age 3-36 months has a positive urine culture, what do you do?

Back 109

If afebrile: oral antibiotics x 10 days

If febrile or ill: admit for IV antibiotics.

Front 110

IF a child over 90 days presents with a fever over 39 degrees and a WBC count under 15,000... what would you do?

Back 110

Just observe

Front 111

IF a child over 90 days presents with a fever over 39 degrees and a WBC count over 15,000... what would you do?

Back 111

Get a blood culture and treat with ceftriaxone.