Pediartic emegrancies

• Causes of hypokalemia in DKA

  Insulin
• Preventative way of DKA

  No hx --> Written management plan

  recurrent Hx --> listen to child concern
• Hyperglycemia and tachypnea what's next step in management

  Urine dipstick --> DKA
• Developing seizure after DKA treatment indicates?

  Cerebral oedema
• Management of Cerebral Oedema

  Mannitol -> 0.5 - 1mg /kg --> every 30 min --> max 2 doses

  if failed mannitol --> 3% n.s
• Fluid replacement in severe dehydration --> over 24 hours

  Fluid replacement in DKA and hyponatremia and hypernatremia --> over 48 hours
• Level of sodium management in hyper and hyponatremia :

  Hyper --> decrease by rate of 10-12 mmol/ day --> rapid correction leads to --> cerebral oedema

  Hypo --> increase by rate of 10-12 mmol/ day --> rapid correction may lead to --> central pontine neurolysis
• Duration of ORS treatment in mild to moderate dehydration:

  1 day if tolerate start clear diet
• cause of prolonged diarrhea after gastroenteritis :

  Temporary Lactose intolerance
• Classification of dehydration

  < 1 year old

  Mild ---> 5% ( 50 ml/kg)

  moderate --> 10% (100ml/kg)

  severe --> 15% ( 150ml/kg)

  >1 year old

  mild --> 3% (30ml/kg)

  Moderate --> 6% ( 60ml/kg)

  severe --> 9% (90ml/kg)
• Moderate dehydration

  Sunken eyes

  Decreased skin turgor

  slightly increased heart rate

  slightly increased blood pressure

  Normal mental status

  Thirsty

  Dry Mucus membrane

  Decreased tears

  Capillary refill --> delayed

  sunken AF

  decreased Urine out put
• Severe dehydration

  Eyes --> Markedly sunken

  skin turgor --> Tenting

  Heart rate --> increased

  Blood pressure --> increased

  Mental status --> lethargic

  Thirst --> increases

  mucus membrane --> parched

  AF --> absent

  Capillary refill --> cold extremities

  urine out put --> anuric
• Croup

  most concerning symptoms --> blue lips

  caused by --> parainfluenza virus

  age --> <5 years old

  Subglottic

  gradual fever

  barky cough

  presentation -0--> sitting supine

  NO salivation

  Low grade fever
• Management of Croup

  Mild ---> oral dexamethasone

  moderate to severe --> Oral dexamethasone + nebulized epinephrine

  Epinephrine --> can be repeated every 30 min

  observation --> rebound phenomenon
• Atopic dermatitis + Inspiratory stridor --> Spasmodic Croup
• Acute Epiglottis

  Caused by --> HIB virus

  2-6 years old

  Supraglottic

  Sudden onset

  no cough

  presentation --> sitting upright

  drooling of saliva

  high grade fever
• Xray finding of croup and epiglottitis :

  Croup --> steeple sign

  Epiglottitis --> thrumbprint sign
• Croup + not improved on treatment , what is next step:?

  Lateral Neck Xray --> if normal --> for CT neck
• Spontaneous Tension pneumothorax

  occurs in asthmatic patients and Cystic fibrosis

  Management by --> Thoracostomy in 2nd ICS
• Bacterial Tracheitis

  Hx of URTI 1 week ago

  age --> 3-5 years

  caused by --> staph auras

  Clinical features --> biphasic stridor
• • organophosphate --> Cholinergic --> Lacrimation , salivation , abdominal cramp and Miosis
  • Paracetamol --> liver problems
  • Narcotics --> miosis , respiratory depression
  • TCA --> dry mouth , Dry eye and convulsions
  • aspirin --> Tinnitus + metabolic acidosis
  • Alcohol --> Liver failure , Acidosis
• Best method for gastric decontamination :

  Active Charcoal

  if subsistence not absorbed by charcoal -->> Whole bowel irrigation
• Aspirin toxicity Antidot :

  Sodium bicarbonate
• Antidots :

  Organophosphates --> Atropine

  Narcotics --> Naloxone

  Benzodiazepine --> Flumazenil

  paracetamol --> N acetyl cysteine

  Metoclopramide -> Diphenhydramine or atropine

  TCA --> sodium bicarbonate

  Methanol --> ethanol or Fomepizole
• paracetamol toxicity :

  within 4 hours --> charcoal

  more than 4 hours / symptomatic / high serum levels --> N acetyl Cystine
• paracetamol toxicity stages

  Stage 1 --> 0-24 hrs --> General symptoms + mild to normal liver enzymes

  Stage 2 --> 24-72 hours --> improving of symptoms + RUQ pain + elevated LFT

  stage 3 --> 72-96 hours --> Hepatic failure + acidosis + pancreatitis

  stage 4 --> > 5 days --> either hepatic toxicity resolves or progress to multiorgan failure
• Iron toxicity

  IV Deferoxamine

  in cases of

  • high anion gab metabolic acidosis
  • iron dose of > 60 mg/kg
  • Iron levels > 500 mcq

  observation in mild cases :

  • 6 hours in iron tablets
  • 12 hours in extended release iron tablets
• Management in Caustic ingestion like bleach :

  Drink water

  do not induce vomiting

  leads to Esophageal stricture

  in severe cases insert NGT to avoid Complications ---> esophageal stricture
• Neonatal hypoglycemia

  D10% --> peripheral line

  D20% or more than 12.5% --> Central line
• Hypoglycemia management --> 2ml/kg bolus --> maintenance 5-8 mg /kg/min
• Blood sample from infant of diabetic mother with signs of hypoglycemia , site of sample is ?

  Capillary
• Ambiguous genitalia + hypoglycemia + hyponatremia + hyperkalemia

  congenital adrenal hyperplasia

  initial management --> Iv fluid and glucose
• Type of fluid in vomiting and diarrhea :

  Normal saline
• Type of fluid in vomiting --> Normal saline

  Type of fluid in diarrhea --> ringer lactate
• Intussusception

  Shock is the most common complication

  enema can be given up to 3 times --> no improvement --> surgical intervention

  contraindication of Enema :

  Perforation
• Hyaline membrane disease

  age --> preterm

  caused by --> surfactant deficiency

  Xray finding --> Ground glass appearance

  treatment --> oxygenation + surfactant
• Meconium aspiration syndrome

  age --> full term

  caused by --> Related to hypoxia

  Xray finding --> Ground glass appearance

  treatment --> oxygenation + surfactant +inhaled nitric oxide --> PPHTN
• Transient tachypnea of newborn

  age --> Term and late preterm ( 34 weeks)

  caused by --> Amniotic fluid aspiration

  Xray finding --> Fluid in lung fissure

  treatment --> oxygenation nasal canula --> 40 %

  Born by CS
• Congenital pneumonia :

  age --> preterm

  caused by --> PROM + positive Vaginal swab of GBS + Maternal fever + chorioamnionitis

  Xray finding -->Lobar pneumonia

  treatment --> Ampicillin + gentamycin
• Diaphragmatic hernia

  age --> Term

  caused by --> Scaphoid abdomen + bowel sounds heard in chest

  Xray finding --> Bowel in the plural cavity

  treatment --> ventilation and Surgical repair