Bronchiolitis
Other than RSV, we are responsible for wheezy wee ones. (Name 3)
What are:
Human metapneumovirus
Influenza
Rhinovirus
Adenovirus
Parainfluenza
What changes at 5% Versus 10%
What are:
The percentages of dehydration where ORF and IVF REHYDRATION should be considered.
Criteria for Anaphylaxis:
What are any of:
1. Acute: skin +/- mucosa with respiratory or perfusion
2. Two or more: skin/mucosa, respiratory, perfusion, GI
3. Reduced BP
These Microorganisms are responsible for most UTIs (Name 3)
What are:
Escherichia coli, Klebsiella pneumoniae, Enterobacter, Citrobacter, Serratia
Bonus: Staphylococcus saprophyticus (adolescent females)
Convulsive Status Epilepticus...
What is:
A continuous generalized tonic-clonic seizure activity with loss of consciousness for longer than 30 min, or two or more discrete seizures without a return to baseline mental status.
These diagnostic tests have what utility? CXR, NPA, CBC, CBG
What are:
CXR: For severe or alternate Dx
NPA: To cohort patients
CBC: Generally not helpful
CBG: To assess for respiratory failure
The scientific basis for ORF relates to co-transport across the intestinal cell membrane of what compounds.
What are:
Sodium and glucose via sodium-potassium-ATP pump.
The optimal glucose to sodium ratio to ensure maximal sodium absorption is 1:1.
1:10000 and the deltoid
What are:
The suboptimal concentrations and sites for IM epinephrine.
They should be 1:1000 and the anteriolateral thigh.
Ultrasounds are required to test for anatomical defects below this age.
What is:
2 years
"She's seizing...."
First-Line Approach
Second-Line Approach
Others...
What are:
First-Line Approach: ABC (bonus point), Lorazepam
Second-Line Approach:
Fosphenytoin (IV, IM) > phenytoin (IV)
Phenobarbital (IV, IO)
Paraldehyde (PR)
Valproic Acid (IV)
Pyridoxime (IV) under 18 months
Others: DEFG, Na
We can mimic bronchiolitis. (Name 4)
What are:
Asthma
Other lung infections, Laryngotracheomalacia, Foreign body aspiration, Gastroesophageal reflux, Congestive heart failure, Vascular ring, Allergic reaction, Cystic fibrosis, Mediastinal mass, Tracheoesophageal fistula
Ondansetron!
1. Class of Drug
2. Minimum Age
3. Side Effect
4. Dose
What are:
1. Serotonin receptor antagonist
2. 6 months
3. Diarrhea for up to 48 hours
4. Dose: 0.15 mg/Kg
8 - 15 kg: 2 mg
15 - 30 kg: 4 mg
> 30 kg: 6 mg to 8 mg
Other drug classes to use for anaphylaxis and their effects
What are:
H1 blockers: affect mainly skin
H2 blockers: synergism with H1 (non-CPS: unproven in systematic reviews)
Corticosteroids: later effect; no RCTs (non-CPS: unproven in a 2020 sytematic review)
Inhaled: salbutamol > epinephrine
Oral antibiotics are indicated for this group of patients.
What is:
Nontoxic children with a febrile UTI and no known structural urological abnormality, assuming that they are likely to receive and tolerate every dose?
How to give individual Benzos....
1. IV, IO, PR, buccal
2. IV, IN, IM, buccal
3. IV, PR
1. IV, IO, PR, buccal: Lorazepam
2. IV, IN, IM, buccal: Midazolam
3. IV, PR: Diazepam
We are the patients at most risk for severe disease. (Name 3 of 4)
We are:
<35 weeks’ gestation
<3 months of age
Hemodynamically significant CHD
Immunodeficiency
What is seen with Dehydration of:
Less than 5%
5 - 10%
Greater than 10%
What are the % dehydration criteria:
< 5: SLIGHTLY affected UO, thirst, MMs, HR
5 - 10: Affected UO, thirst, MMs, HR; reduced skin turgor, sunken eyes, sunken fontanelle
> 10: Cool skin, lethargy, hypotension, reduced LOC
Rebound occurs in these time frames and we should watch for this period...
What is:
Rebound can occur up to 72 hours later but usually in 4 - 6 hours.
We should watch for 4 - 6 hours.
Any growth, 10e8 and 10e7 CFU/L relate to ...
Where a UTI can be diagnosed on a:
Suprapubilc Aspirate specimen
Clean Catch specimen
Catheter specimen
Third-Line Approach for Refractory Status Epilepticus....
(which is unresponsive to 2 classes of treatment)
What are:
Midazolam infusion
Big Barbiturates
Propofol
Levetiracetam
Preparation to intubate (bonus point)
What treatments are ...
1. Evidence Based
2. Equivocal
3. Witchcraft
What are:
1. Oxygen & hydration
2. Epinephrine, saline, suction
3. Salbutamol, steroids, etc.
Gastrolyte is an ORF known to be...
What is:
The product that most closely mimics the WHO recommendations for optimal ORF?
Na, K, Cl, Base, Osm
WHO ORF: 245/75/20/65/10/13.5
Gastrolyte: 240/60/20/60/20/17.8
EpiPen Doses (both) and their weight indications...
What are:
0.15 mg (EpiPen Jr) and
0.3 mg (EpiPen)
EpiPen Jr: 10 - 25 Kg
EpiPen: > 25 Kg
A Sensitivity of 83% and a Specificity of 98% relate to these urinalysis tests.
What are:
Leukocyste Esterase (Sensitivity)
Nitrites (Specificity)
Match the side-effect with the drug...
(Barbiturates, Benzodiazepines, Phenytoins, Paraldehyde)
Sedation
Respiratory depression
Hypotension
Arrhythmia
Purple-Glove Syndrome
Pulmonary Edema
What are:
Sedation: Barbiturates, Benzodiazepines
Respiratory depression: Barbiturates, Benzodiazepines
Hypotension: Barbiturates, Benzodiazepines, Phenytoin
Arrhythmia: Phenytoin
Purple-Glove Syndrome: Phenytoin (extravasated)
Pulmonary Edema: Paraldehyde (IV...)