Pediatrics
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| Potentially life threatening = | <3 mos; 101F (38.3C)
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| Viral rhinitis (3-8/yr): etiology | rhino, corona; more bronchial = adenovirus, RSV
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| Viral rhinitis (50% of URIs) transmission | hand, inhaled droplet; incubation 2-5 days; sx resolve 5-7 days
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| Viral rhinitis tx | tylenol; ibuprofen if >6 mos; no ASA; sudafed/ phenylephrine; poss Afrin >2 yo; DM for cough; No Role for antihistamines
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| FDA: viral rhinitis tx | no cough/cold meds for kids <2 yo
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| Purulent rhinitis s/s | persistent mucopurulent nasal d/c and irreg fever; often GAS / SP
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| Strep tx | Amox; clinda for tx failure
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| Sinus devt | maxil / ethmoid dz most common; fully formed at birth (clinical dz at 6 mos); sphenoid 7-8 yrs; frontal early teens
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| Rhinosinusitis: 2 presentations in kids | 1: ≥10 days nasal congestion, purulent nasal drainage and/or persistent cough; 2: abrupt onset w/ fever >101F, facial pain & purulent nasal drainage
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| Rhinosinusitis agents: | Big 3, esp SP (declining)
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| Chronic Rhinosinusitis agents: | alpha-hemolytic strep; SA; anaerobes
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| Mild-mod Rhinosinusitis tx | Amox (10-14 d); if allergy, 3G ceph or macrolide
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| Severe Rhinosinusitis tx | Augmentin; macro or ceph
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| Frontal osteomyelitis secondary to frontal sinusitis = | Pott puffy tumor; surgical drainage & IV Abx
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| Rhinosinusitis: indications for referral | need surgical drainage; need polypectomy; recurrent sinusitis (esp w/ exacerbation of asthma); rare/ resistant microbe; intracranial or orbital complications; suspected immunodeficiency
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| AOM most common in: | boys; formula-fed; winter; 6 mos-3 yo (esp 6-12 mos); 2nd peak at 5 yo
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| AOM agents | SP, H flu, M cat; GAS; RSV, rhino, CMV
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| AOM associated with conjunctivitis suggests: | H flu
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| Use Abx in AOM for which patients? | febrile children and those < 2 years
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| AOM: risk factors for penicillin resistant Strep pneumo (PRSP) | Recurrent tx w/beta-lactams. Recurrent AOM (>3 episodes in 6 months or >4 episodes/year). Day care. Winter. Age <2 years
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| AOM: indication for tubes | bilateral effusion for 3 mos AND a bilateral hearing deficiency
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| Flu incubation | 1-4 days post-exposure
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| Flu presentation in kids | croup, bronchiolitis, GI upset, conjunctivitis, OM; sore throat, nasal congestion, conjunctivitis, nonproductive cough
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| Flu: comps | Pneumonia; Myositis; Myocarditis, pericarditis; Aseptic meningitis; Encephalitis; Reye syndrome; Guillain-Barre syndrome
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| Flu: dx | Epidemiologic; Virus isolation or antigen detection; Serologic
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| Most common clinical manifestation of acute upper airway obstruction: | croup
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| Prolonged expiratory phase, hyper-resonance to percussion, and wheezing = | bronchiolitis
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| Bronchiolitis presentation | <2 yo (peak 6 mos); M>F; winter. 100,000 hospitalizations/year. Daycare / secondary smoke exposure. If cardiopulmonary dz / immunodeficiency: more severe disease
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| Bronchiolitis agent | RSV or human metapneumovirus (hMPV). Also possibly Parainfluenza adenovirus
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| Premature infants with bronchiolitis often have: | apneic spells as presenting sx
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| Bronchiolitis: X-ray may show: | hyperinflation, atelectasis, infiltrates, peribronchial cuffing
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| Croup/bronchiolitis tx | supportive; cool mist humidification; pulse ox, O2 if hypoxemia; poss bronchodilators
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| Pneumonia RFs | CHD/ lung dz; CF; asthma; SCD; immunodeficiency syndromes
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| Pneumonia: viral causes | more common in kids <5 yo; RSV, PIVs, Influenza, Adenovirus
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| Pneumonia: viral causes in neonates: | consider CMV, Herpes, rubella
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| Pneumonia: bac causes if <1 month old | GBS, SA, gram neg enteric bacilli; T. pallidum; Listeria
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| Pneumonia: bac causes for 1 month-5 yo | SP (most common); H flu; GAS; SA (&MRSA); M. pneumo; C. pneumoniae
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| Pneumonia: bac causes for >5 yo | M pneumo most common; SP, C pneumo; TB
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| Less common bacterial causes of pneumonia | C trachomatis (afebrile pneumo in 2 wks-3 mos); pertussis, PCP
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| Pneumonia: dx | CXR = segmental infiltrates, atelectasis, pleural effusions; poss empyema; blood cx pos in 10-30% of bac
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| Viral pneumonia s/s | tachypnea, retractions, nasal flaring & use of accessory mx; diffuse rales, wheezing; CXR diffuse interstitial infiltrates & hyperinflation
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| Mycoplasma pneumoniae findings | CXR interstitial or bronchopneumonic infiltrates, frequently in the middle or lower lobes; Fever, cough, HA, malaise; sore throat / OM
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| Pathology of hyaline membrane disease (HMD) | Deficiency/inactivation of pulmonary surfactant => decreased alveolar surface tension => poor lung compliance & atelectasis => hypoxemia
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| HMD incidence | 5% of infants born at 35-36 weeks. >50% in infants born <28 weeks.
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| HMD risk factors | C-section. Birth asphyxia. Diabetic mom. Siblings with hx of HMD.
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| HMD mgmt | Steroids to mom in preterm labor. Artificial surfactant in delivery room for infant born <27 weeks. O2, nasal CPAP, intubation PRN.
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| Croup bugs | parainfluenza types I to III, adenovirus, RSV
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| Croup sx/sx | Afebrile, normal sats. Concurrent URI. Retractions, tachypnea, audible stridor. Stridor, barking seal cough, worse at night. Steeple sx on neck xray.
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| Croup mgmt if not emergent | Neb mist, O2, possibly racemic epinephrine nebs. Steroids (dexamethasone) if stridor at rest
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| Bronchiolitis sx/sx | Tachy/tachy, low fever. Nasal flaring, retractions, rales, wheezes, long exp phase. Hypoxia on ABG
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| Croup presentation | 3 months-3 years old. M:F 3:1. october-April. 100-1000x more common than epiglottitis
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| Epiglottitis bug | H flu (HiB)
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| Epiglottitis presentation | M:F 2:1. 3 months - 6 yrs old. Any season
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| Epiglottitis sx/sx | Sudden rapid progression. Pharyngitis, dysphagia, odynophagia. High fever. Inspiratory stridor, tachypnea, tripod posture.
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| If Epiglottitis is suspected, DO NOT: | examine mouth or neck: may cause spasm and worsen upper airway obstruction
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| Epiglottitis workup | Soft tissue neck x-ray: thumb sign (swollen & posteriorly displaced epiglottis). BC often positive.
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| Epiglottitis mgmt | Hospitalize. Manage ABCs. Anesthesia for prn nasotracheal or orotracheal intubation. IVF & humidified O2. IV Abx: cefotaxime, CTX, or Unasyn
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| Croup mgmt if emergent (if upper airway obstruction) | Intubate (watch for post pulmonary edema)
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| Pertussis pathology | Tracheal cytotoxin, dermonecrotic factor, and adenylate cyclase => local epithelial damage => resp sxs
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| Pertussis stages | Cararrhal (1-2 weeks): prodrome, most contagious, URI sxs. Paroxysmal (2-4 weeks): severe cough. Convalescent (1-2 weeks): sxs decrease
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| Pertussis mgmt | Erythromycin (aborts dz in catarrahl stage, does not limit duration in later stage), azithro (kids <1 mo), clarithromycin. Steroid aerosols, mist O2.
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| AOM tx | Amox 90 mg/kg/day x10 days (azithro if allergy). If tx failure, use Augmentin 80-90 mg/kg/day
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