Peds Quick Review

Head Disorders

Migraines

• -Triptans

Eye and Vision Problems

Conjunctivitis

• Allergic Conjunctivitis
  • -Naphazoline + pheniramine
    
  • -Azelastine
    
  • -Olopatadine
• Infectious Conjunctivitis
  • -Ciprofloxacin, gentamycin, moxifloxacin, tobramycin, ofloxacin drops
    
  • -bacitracin and polymyxin

Ear Problems

Otitis Media

• -1st line: Amoxicillin 10-14 days
  
• -2nd line: Augmentin
• –if recurrent pressure equalization tube surgery (myringotomy)

Otitis Externa

Sinus Problems

Sinusitis

• -Amoxicillin
  
• -Augmentin

Nose Problems

Allergic Rhinitis

• -oral antihistamine, nasal steroid, and oral leukotriene inhibitor
  
• -Diphenhydramine (Benadryl) antihistamine H1 blocker
  
  • -SE: sedation, dry mouth
    
  • -not approved in < 2yrs
    
• -Montelukast (Singulair): leukotriene receptor antagonist

Mouth Problems

Streptococcal Pharyngitis

• 1st line -Amoxicillin X 10 days
  
• Penicillin
  
• PCN allergy – Clindamycin or Azithromycin

Thrush

• Candida albicans
  
• -Nystatin: GI symptoms
  
• -Fluconazole: Diflucan – caution in neonates = gasping syndrome

Upper Respiratory Diseases

Croup

• Aka: laryngotracheitis/laryngotracheobronchitis
• Path:
  • Inflammation of larynx and trachea
• Presentation:
  • -parainfluenza virus, RSV
  • *Barking cough
    
  • -fever
    
  • -Stridor
    
  • -wheezing
    
  • -retractions
• Dx:
  • CXR = Steeple sign*
  • labs not necessary
  • Severity: Westley croup score
• Tx:
  
  • -manage airway
    
  • – Racemic epinephrine (nebulized)
    • – *hospitalize patients requiring racemic epi
  • – decadron
    
  • – Prednisolone
    
  • – Dexamethasone

Tracheitis

• Path:
  • infection resulting in mucopurulent exudates that can obstruct the upper airway
  • Croup that is worsening or refractory to treatment
• Presentation:
  • -Toxic appearing
    
  • -Fever
    
  • -Stridor
    
  • -Evidence of airway obstruction
• Dx:
  • CXR – Steeple sign
• Tx:
  • -Broad-spectrum ABX
    
  • -aggressive airway clearance
    
  • -Pain management
    
  • +/- intubation

Epiglottitis

• Path:
  • H influenzae B MC
    Group A strep, S. aureus
• Presentation:
  • Tripod position/Sniffing position
    
  • 3 D’s:
    
  • -Drooling
    
  • -Dysphagia
    
  • -Distress
• Dx:
  • CXR: Thumbprint sign
• Tx:
  • Intubation in the OR
  • if suspect epiglottitis: DONT perform oral examination, can lead to irritation and sudden airway compromise

Lower Respiratory Diseases

Asthma

• -stepwise tx approach
  
  • -metered-dose inhaler with a mask and spacer
    
  • -MDI ve holding chamber
    
  • -nebulizer
    

• -SABA for acute attacks
  
• -Inhaled corticosteroids for long term management

Bronchiolitis

• Presentation:
  • RSV – MC in children <1
  • fever, raspy breathing, retractions, hyper resonance, wheezing and crackles
• Admit Inpatient:
  • -O2 sat <92 on RA
    
  • -Lethargy
    
  • -Intolerance to PO intake
    
  • -respiratory failure
• Dx:
  • Rapid RSV antigen/PCR
• Tx:
  • – management is supportive
    
  • – Preventative: Palivizumab given during RSV season
• Anticipatory guidance:
  • -symptoms last 2-3 weeks
    
  • -Do NOT use OTC cough/cold meds
    
  • -Return if child is cyanotic, poor feeding, and increased effort of breathing

Influenza

• Dx:
  • Rapid flu swab
    
  • PCR
• Tx: 
  • -antivirals: neuraminidase inhibitors
    
  • 1. Zanamivir (relenza)
    
  • 2. Oseltamivir (Tamiflu)

Pneumonia

• Presentation:
  • SOB
    
  • Chest pain
    
  • Cough
    
  • Fever, sweats/chills
    
  • Muscle aches
    
  • *retractions and nasal flaring in infants
• Dx:
  • Leukocytosis
    
  • Viral: high Lymphocytes
    
  • Bacterial: high neutrophils
    
  • CXR
• Viral PNA: RSV
• Bacterial PNA:
  • S. Pneumoniae
    
  • HiB 2nd
  • Tx:
    • Uncomplicated community-acquired pneumonia (UCAP):
      • 1st line: amoxicillin
        
      • 2nd line: macrolides or 3rd gen cephalosporin
    • For school-aged children Pneumonia:
      • Macrolides (azithromycin) macrolides
    • Hospitalized Acquired Pneumonia:
      • -Third gen cephalosporin with macrolide
        
      • -plus clarithromycin or azithromycin
    • Atypical PNA:
      • Mycoplasma: Azithromycin or Doxycycline

Pertussis

• Contagious:
  • ~21 days after start of symptoms
    
  • – No longer infectious 5 days after start of ABX
• Stages:
  • Catarrhal Stage: 1-2 weeks, Non-specific: conjunctival injection, rhinorrhea, fever
  • Paroxysmal stage: 2-4 weeks, Whooping Cough
  • Convalescent stage: 1-2 weeks, resolution of cough
• Dx:
  • Clinical, PCR is only about 60% sensitive
• Tx:
  • Azithromycin q5d or
    
  • TMP/SMX q10d

Infectious Diseases

Infectious mononucleosis

• -Epstein-Barr virus
  
• -Dexamethasone
  
• -Amoxicillin

MRSA

• -Vancomycin plus a cephalosporin

Pinworms

• -enterobiasis – helminth Enterobius vermicularis
  
• -Mebendazole (Vermox)

Gastrointestinal Diseases

Constipation

• Polyethylene glycol (MiraLAX)
• more effective than lactulose, senna, or magnesium hydroxide in head-to-head studies

Flatulence

• -Simethicone drops

GERD

Nausea and Vomiting

• -diet and feeding changes
  
• -1st line therapy: Histamine-2 receptor antagonist …..Ranitidine, famotidine, cimetidine, nizatidine
  
• -PPI …………..Lansoprazole, Esomeprazole, Rabeprazole, Pantoprazole

• -Promethazine
  
• -Ondansetron
  
• -Prochlorperazine

Diaphragmatic hernia

• Path:
  • MC Left
  • Pulmonary Hypoplasia from abdominal organs occupying space in chest cavity
•  Px:
  • Tachypnea, cyanosis,
    
  • scaphoid abdomen,
    
  • One side of chest appearing larger
• Dx:
  • -Prenatal US (diaphragm forms at 8 weeks)
    
  • -CXR
• Tx:
  • surgery soon after birth

Pain Management

• -Acetaminophen (Tylenol) or ibuprofen (Advil or Motrin)
  
• -avoid aspirin – Reye’s syndrome
  
• -caution acetaminophen with G6PD deficiency
  
• -Ibuprofen contraindicated in GI distress, dehydration, hepatic or renal insufficiency

Psychiatric Disorders

ADHD

• -Psychostimulant stimulants
  
• -Methylphenidate (Ritalin, Methylin, metadat, etc)
  

• -Dexmethylphenidate HCL
  
• -Amphetamine and/or dexmethylphenidate
  
• -Atomoxetine
  
• -Lisdexamfetamine dimesylate

Ortho Disorders

Radial head subluxation

• Aka: nursemaid’s elbow
• Management:
  • no outward signs of fracture or abuse it is considered safe and appropriate to attempt reduction of the radial head before moving on to imaging studies

Skin Disorders

Acne

• Neonatal:
  • 20% of newborns, pustules confined to the cheeks, chin, eyelids, and forehead.
  • typically mild, self-limited, and best managed by reassuring the parents.
• Infants: 
  • typically males 6–12 mo., self-limited
• Mid-childhood:
  • Rare.
  • if present warrants referral for extensive laboratory testing to identify an underlying endocrine abnormality.
• Preadolescents and adolescents:
  • Very likely to develop acne as a result of normal ovarian/testicular development.

Peds Diagnosis 1

Peds Infectious Diseases Treatments