Pediatrics

Board Review: Pediatrics

A 2 year old boy presents with his mom for recurrent bouts of abdominal pain and vomiting. Mom denies fevers but noticed decreased appetite. Mom states there has been a "stomach bug" going around the daycare. Vitals reveal a blood pressure of 90/50, heart rate of 120, rectal temperature of 99.0, respiratory rate of 36, SpO2 of 100% on room air. Exam is unremarkable, revealing a playful child with a normal abdominal and GU exam. The nurse asks you to reassess the patient and you see a very uncomfortable child, crying and holding his abdomen, his legs drawn toward his abdomen.

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Back to Basics: Intussusception

BACKGROUND:

-One segment of intestine telescopes into another

-Most commonly ileum into colon

-Most common cause of intestinal obstruction in children under 2 y/o

-Rare before 2 months old

CLINICAL:

-Classically infant with intermittent episodes of severe abdominal pain with legs drawn to chest, asymptomatic between episodes

-Classic Triad: abdominal pain, palpable sausage shaped abdominal mass, bloody stools (“currant jelly”)

- rarely all 3 present

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Advanced Practice: High Flow Nasal Canula in Pediatrics!

You are caring for a 2 yo with multifocal pneumonia who is hypoxic on standard nasal canula. You decide to institute high flow nasal canula (HFNC) in an effort to stave off orotracheal intubation. Your repspiratory therapist requests parameters including flow rate (typically 0-40 LPM). What is the optimal flow rate to decrease work of breathing in this pediatric patient?

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Advanced Practice - Practice Changing Landmark Peds DKA Study!

For decades now, aggressive fluid replacement in pediatric DKA patients has been thought to contribute to cerebral edema and neurologic injury. This has resulted in a general policy of cautious fluid replacement with isotonic crystalloid, and perhaps even contributed to under-resuscitation of these patients. In this first large, randomized, prospective study to examine the role of type of fluid (0.9% NaCl vs 0.45% NaCl) and rate of administration, the hope was to detemine if type of fluid, rate of adminstration, or both were associated with cerebral edema and neurologic injury in this patient population. Read on for the key results of this practice changing paper!

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