I'll have a G&T
The conventional definition of convulsive status epilepticus (CSE):
Continuous generalized tonic-clonic seizure activity with loss of consciousness for longer than 30 minutes
OR
Two or more discrete seizures without a return to baseline mental status
First line medication for convulsive status epilepticus (CSE)
Name all three for full $$$
Benzodiazepines:
Midazolam
- Intramuscular (IM): 0.2 mg/kg (maximum 10 mg)
- Intranasal: 0.2 mg/kg (maximum 5 mg/nostril)
- Buccal: 0.5 mg/kg (maximum 10 mg)
Lorazepam
- 0.1 mg/kg IV (maximum 4 mg)
- Buccal: 0.1 mg/kg (maximum 4 mg
Diazepam
- 0.3 mg/kg IV (maximum 5 mg if < 5 yrs) (maximum 10 mg if ≥ 5 yrs)
- PR: 0.5 mg/kg (maximum 20 mg)
____ is the most common chronic disease in young people. The general prevalence of ____ in Canada has been estimated at 10%. ____ is the leading cause of absenteeism from school.
___ is (perhaps) the most common cause for the pager going off at 3am when you have finally snuggled into the comfy gorgeous single bed.
ASTHMA
The most common causes of neutropenia in well-appearing, immunocompetent patients older than 3 months is ___
Viral illness
Who... Prefers a cookie over a co resident
Amelia
Definition of ‘early’ or ‘impending’ status epilepticus....
Continuous or intermittent seizures lasting longer than 5 minutes without full recovery of consciousness between seizures.
Second line therapy for seizures that are refractory to benzos....
$50 for each correct name
Fosphenytoin: 20 mg PE/kg (maximum 1000 mg PE). If using IV route, give medication over 5 to 10 minutes, mixed in normal saline (NS) or Dextrose 5% (D5W)
Phenytoin: 20 mg/kg (maximum 1000 mg), given over 20 minutes, mixed in NS
Keppra: 60 mg/kg (maximum 3000 mg), given over 5 to 15 minutes , mixed in NS or D5W
Valproate: 30 mg/kg (maximum 3000 mg), given over 5 minutes, mixed in NS or D5W
Phenobarbital: 20 mg/kg (maximum 1000 mg), given over 20 minutes, mixed in NS or D5W
____ is the most common trigger for asthma exacerbations in children and youth.
$50 for each cause listed
viral respiratory tract infection
- aeroallergens, air pollution, seasonal changes, and poor adherence to inhaled corticosteroids
But what is... "HOT"
Criteria for "temperature"
>38°C is typically considered a fever
Fever in neutropenic oncologic patients as a single oral temperature ≥38.3°C or a temperature ≥38°C sustained over 1 hour
There is no clear definition of fever in presumed immunocompetent children with neutropenia. Rectal temperature-taking is not recommended for children with severe neutropenia. Axillary or oral measurements (in cooperative children older than 5 years of age) should be obtained
Who... Does not know what cactus cuts are
Extra points if you provide said snack
Elise
First step to acute management of convulsive status epilepticus ?
Inadequate airway maintenance is the most critical immediate risk to the child or youth with CSE. Hypoxia is frequently present. Managing the airway includes positioning the child on their side and suctioning easily accessible secretions. The mouth should not be pried open. After suctioning, reposition the patient on their back and apply a chin lift or jaw thrust to help open the airway, if needed. Administer 100% oxygen by face mask, and use cardiorespiratory and oxygen saturation monitors. Consider assisted ventilation when the child shows signs of respiratory depression or oxygen saturations remain low (under 90%) despite receiving 100% oxygen by face mask.
~ Roid RAGE ~ Steroid dosing for AAE ?
PO Dexamethasone dosing:
PO Pred dosing:
IV Methylpred:
100$ for each
PO dex: 0.3 mg/kg to 0.6 mg/kg (max 10 to 16 mg)
PO prednisolone or
prednisone: 1 mg/kg to 2 mg/kg (max 50 mg)
IV Methylpred: 1 to 2 mg/kg (max 80 to 125 mg)
Well-controlled asthma criteria in preschoolers, children, and adolescents:
$50 for each listed
Daytime symptoms ≤2 days per week
Nighttime symptoms <1 night per week
Physical activity: Normal
Exacerbations: Mild and infrequent
Absence from work or school due to asthma: None
Need for a reliever (SABA or bud/form): ≤2 doses per week
FEV1 or PEF: ≥90% of personal best PEF diurnal variation<10% to15%
Severe vs moderate vs mild neutropenia is classified as:
100$ for each correct classification
Severe neutropenia: ANC <0.5 x 10 9 /L
Moderate neutropenia: ANC 0.5 to <1.0 x 10 9 /L
Mild neutropenia:ANC 1.0 to <1.5 x 10 9 /L
Who... Somehow caught a suntan in April.. yes, in Canada
Natasha
The main goals of treating CSE?
1.
2.
200$ for each
2. Prevent brain injury
3 side effects of IV Magsulfate?
100$ for each + 100$ for prophylactic tx for SE
Hypotension, nausea, bradycardia
Fluids bolus
PRAM severity:
Mild
Moderate
Severe
Mild 0-3
Moderate 4-7
Severe 8-12
Risk factors associated with invasive bacterial infections (IBI) in children and youth with neutropenia
$100 for each
Immunocompromised status
• Malignancy or post-transplant
• Primary immunodeficiency
• Immunosuppressant therapy (including chronic steroid use) • Aplastic anemia or other bone marrow failure
History of neutropenia
• Prior episodes
• Congenital or cyclical neutropenia
• Autoimmune neutropenia
Previous severe or recurrent infection (e.g., meningitis, severe pneumonia, sepsis, recurrent abscesses, osteomyelitis, cellulitis)
Intravascular device
Significant co-morbidities
• Chronic medical condition (e.g., sickle cell disease, chronic lung disease, cardiomyopathy) • Known or suspected genetic condition
• Failure to thrive or short stature
Vaccines for encapsulated bacteria not up to date (pneumococcal, meningococcal, Haemophilus influenzae type b)
Family History:
• Known immunodeficiency
• Chronic neutropenia • Bone marrow failure • Leukemia
Who... Never has the right name
Spell it out
Sara(no h) SMALL
Name 5 causes of convulsive status epileptics in children (100 for each correct answer)
1.
2.
3.
4.
5.
CNS infection (meningitis, encephalitis)
Anoxic injury
Metabolic (hypoglycemia, hyperglycemia, hyponatremia, hypocalcemia)
TBI
Drug/Meds
Prolonged febrile convulsion
Cerebral dysgenesis
HIE
Neurodegenerative disorders
Idiopathic
For individuals ≥12 years of age, consider PRN ___ when there is poor adherence to daily MDI medication despite substantial education and support.
Budesonide/formoterol
PRAM me
Bonus points if you can tell me what PRAM stands for
Paediatric Respiratory Assessment Measure (PRAM)
Oxygen saturation
≥ 95% 0 92% to 94% 1<92% 2
Suprasternal retraction
Absent 0 Present 2
Scalene muscle contraction
Absent 0 Present 2
Air entry
Normal 0 ↓ At the base 1 ↓ At the apex and the base 2 Minimal or absent 3
Wheezing
Absent 0 Expiratory only 1 Inspiratory (± expiratory) 2 Audible without stethoscope or silent chest (minimal or no air entry) 3
Encapsulated organisms:
100$ for each
Some Nasty Killers Have Some Capsule Protection
Streptococcus pneumoniae
Neisseria meningitidis
Klebsiella pnemoniae
Haemophilus influenzae
Salmonella typhi
Cryptococcus neoformans
Pseudomonas aeruginosa
Who is... #1 penpal
Charis