BODY TEMPERATURE ABG ANTHROPOMETRIC MEASUREMENTS

Subnormal <36.6°C pH: 7.35-7.45 HCO3: 22-26mEq/L IDEAL BODY WEIGHT

Normal 37.4°C pCO2: 35-45 B.E.: +/- 2mEq/L
Subfebrile 35.7 – 38.0°C pO2: 80-100 O2 sat: 97% Age Kilograms Pounds
Fever 38.0°C
At Birth 3kg (Fil)
High fever >39.5°C 7
3.35kg (Cau)
Hyperpyrexia >42.0°C NORMAL LABORATORY VALUES 3-12 Age (mo) + 9 / 2 Age (mo) + 10 (F)
mo Age (mo) + 11 (C)
AGE HR (bpm) BP (mmHg) RR (cpm) NB Infant Child Adole 1-6 y Age (y) x 2 + 8 Age (y) x 5 + 17
RBC 4.8-7.1 3.8-5.5 3.8-5. M: 4.6-6.2 7-12 y Age (y) x 7 – 5 / 2 Age (y) x 7 + 5
Preterm 120-170 55-75/35-45 40-70 F: 4.2-5.4
Term 120-160 65-85/45-55 30-60 WBC 9-30,000 6-17,500 5-10,000 6-10,000
0-3 mo 100-150 65-85/45-55 35-55 Given Birth Weight:
PMNs 61% 61% 60% 60%
3-6 mo 90-120 70-90/50-65 30-45 Age Using Birth Weight in Grams
Lymph 31% 32% 30% 30%
6-12 mo 80-120 80-100/55-65 25-40 Hgb 14-24 11-20 11-16 M: 14-18 < 6 mo Age (mo) x 600 + birth weight (gm)
1-3 yrs 70-110 90-105/55-70 20-30 F: 12-16 6-12 mo Age (mo) x 500 + birth weight (gm)
3-6 yrs 65-110 95-110/60-75 20-25 Hct 44-64% 35-49 31-46 M: 40-54
6-12 yrs 60-95 100-120/60-75 14-22
12-17 yrs 55-85 110-135/65-85 12-18 Platelets 140-300 200-423
F: 37-47
150-450 150-450
Expected Body Weight (EBW):
Ret 2.6-6.5 0.5-3.1 0-2 0-2 Term Age in days – 10 x 20 + Birth Weight
 BP cuff should cover 2/3 of arm Pre-Term Age in days – 14 x 15 + Birth Weight
-: SMALL cuff: falsely high BP
-: LARGE cuff: falsely low BP COUNT (%)
Age of Infant Ideal Weight
BMI BT 1-5 min 1-6 1-6 1-6 4-5 months 2 x Birth Weight
CT 5-8 min 5-8 5-8 5-8 1 year 3 x Birth Weight
Asian Caucasian PTT 12-20sec 12-14 12-14 12-14 2 years 4 x Birth Weight
Underweight <18.5 <18.5
Normal 18.5 – 22.9 18.5 – 24.9 3 years 5 x Birth Weight
Overweight ≥ 23.0 25 – 29.9 5 years 6 x Birth Weight
at risk 23 – 24.9 7 years 7 x Birth Weight
Obese I 25 – 29.9 30 – 39.9 10 years 10 x Birth Weight
Obese II ≥ 30 >40

APGAR
LENGTH / HEIGHT
(50 cm) Age Transverse-AP 0 1 2
Inches Blue / Pink body/ Blue Completely
Diameter ratio A
Age Centimeters Inches At Birth 1.0 Transverse = AP Pale extremities pink
At Birth 50 20 1y 1.25 Transverse > AP P Absent Slow (<100) > 100
1y 75 30 6y 1.35 Transverse >>> AP Coughs,
(-)
2-12 mo Age x 6 + 77 Age x 2.5 + 30 G Grimaces Sneezes,
Response
Cries
FONTANELS (-) Some flexion / Active
A
Age Gain in 1st Year is ~ 25cm Movement extension movement
0-3 mo + 9 cm 3 cm per mo Appropriate size at birth: 2 x 2 cm (anterior) Good, strong
R Absent Slow / Irregular
Closes at: Anterior = 18 months, or as early cry
3-6 mo + 8 cm 2.67 per mo
6-9 mo + 5 cm 1.6 cm per mo as 9-12 months
8 – 10: Normal
9-12 mo + 3 cm 1 cm per mo Posterior = 6 – 8 weeks or
4 – 7: Mild / Moderate Asphyxia
2 – 4 months
0 – 3: Severe asphyxia

HEAD CIRCUMFERENCE GCS

(33-38 cms) THORACIC INDEX
Function Infants/Young Older
TI = transverse chest diameter Eye 4- Spontaneous Spontaneous
Age Inches Centimeters AP diameter Opening 3- To speech To speech
At Birth 35 cm (13.8 in) 2- To pain To pain
< 4 mo + 2 in + 5.08cm Birth : 1.0 1- None None
(1/2 inches / mo) (1.27cm / mo) 1 year : 1.25 Verbal 5- Appropriate Oriented
5-12 mo + 2 in + 5.08cm 6 years : 1.35 4- Inconsolable Confused
(1/4 inches / mo) (0.635cm / mo) 3- Irritable Inappropriate
1-2 yrs + 1 inch 2.54 cm 2- Moans Incomprehensible
3-5 yrs + 1.5 in + 3.81cm 1- None None
(1/2 inches / year) (1.27cm / mo) Motor 6- Spontaneous Spontaneous
6-20 yrs + 1.5 in + 3.81cm 5- Localize pain Localize pain
(1/2 inches / year) (1.27cm / mo) 4- Withdraw Withdraw
3- Flexion Flexion
2- Extension Extension
1- None None

EXPANDED PROGRAM ON IMMUNIZATION ADVERSE REACTIONS FROM VACCINES

VACCINE AGE DOSE # ROUTE SITE INTERVAL BCG 1. Wheal ► small ► abscess ► ulceration ► healing / scar formation in
BCG-1 Birth 0.05mL 1 ID R- 12 wks
or 6 wks (NB) Deltoid 2. Deep abscess formation, indolent ulceration, glandular enlargement,
0.1mL suppurative lymphadenitis
(older) DPT 1. Fever, local soreness
DPT 6 wks 0.5mL 3 IM Upper 2. Convulsions, encephalitis / encephalopathy, permanent brain
Outer damage
thigh OPV Paralytic Polio
OPV 6 wks 2 drops 3 PO Mouth 4 wks HEPA B Local soreness
HEPA B 6 wks 0.5mL 3 IM Antero- 4 wks MEASLES 1. Fever & mild rash
lateral 2. Convulsions, encephalitis / encephalopathy, SSPE, death
thigh
MEASLES 9 mos 0.5mL 1 SC Outer 4 wks ACTIVE PASSIVE
upper BCG Diphtheria
arm DPT Tetanus
BCG-2 School entry 0.1mL 1 ID L- OPV Tetanus Ig
Deltoid Hep B Measles Ig
TetToxoid Childbearing 0.5mL 3 IM Deltoid 1 mo then Measles Rabies (HRIg)
Hib Hep A Ig
women 6-12 mos
MMR Hep B ig
Tetanus Toxoid Rubella Ig
Varicella
 H.E.A.D.S.S.S. H.E.A.D.S.S.S. NUTRITION
Sexual activities Home Environment AGE WT. CAL CHON
◦ Sexual orientation? ◦ With whom does the adolescent live? 0-5 mo 3-6 115 3.5
◦ GF/BF? Typical date? ◦ Any recent changes in the living 8-11 mo 7-9 110 3.0
◦ Sexually active? When started? # of persons? situation?
Contraceptives? Pregnancies? STDs? 1-2 y 10-12 110 2.5
◦ How are things among siblings? 3-6 y 14-18 90-100 2.0
◦ Are parents employed?
Suicide/Depression 7-9 y 22-24 80-90 1.5
◦ Are there things in the family he/she
◦ Ever sad/tearful/unmotivated/hopeless? 10-12 y 28-32 70-80 1.5
wants to change?
◦ Thought of hurting self/others? 13-15 y 36-44 55-65 1.5
◦ Suicide plans? Employment and Education 16-19 y 48-55 45-50 1.2
◦ Currently at school? Favorite subjects?
Safety ◦ Patient performing academically? TCR β = Wt at p50 x calories
◦ Use seatbelts/helmets? ◦ Have been truant / expelled from TCR = CHON X ABW
◦ Enter into high risk situations? school?
◦ Member of frat/sorority/orgs? ◦ Problems with classmates/teachers? Total Caloric Intake : calories X amount of
◦ Firearm at home? ◦ Currently employed? intake (oz)
◦ Future education/employment goals?
Gastric Capacity : age in months + 2
F.R.I.C.H.M.O.N.D. Activities
◦ What he/she does in spare time? Gastric Emptying Time : 2-3 hours
◦ Fluids ◦ Patient does for fun?
◦ Respiration ◦ Whom does patient spend spare time? 1:1 1:2
◦ Infection ◦ Hobbies, interests, close friends? Alacta Bonna
◦ Cardiac Enfalac Nursoy
◦ Hematologic Drugs Lactogen Promil
◦ Metabolic ◦ Used tobacco/alcohol/steroids? Lactum S-26
◦ Output & Input [cc/kg/h] N: 1-2 ◦ Illicit drugs? Frequency? Amount? Nan Similac
◦ Neuro Affected daily activities? Nestogen SMA
◦ Diet ◦ Still using? Friends using/selling? Nutraminogen
Pelargon
Prosobee

THE SEVEN HABITS OF

HIGHLY EFFECTIVE PEOPLE
by Stephen R. Covey

Habit 1: Be Proactive
Habit 2: Begin with the end in mind
Habit 3: Put First Things First
Habit 4: Think Win-Win
Habit 5: Seek first to understand and
then to be understood
Habit 6: Synergize
Habit 7: Sharpen the saw

EXPECTED LA SALLIAN
GRADUATE ATTRIBUTES
(ELGA)

1. Competent & safe physicians

2. Ethical & socially responsible
Doctors / practitioners
3. Reflective lifelong learners
4. Effective communicators
5. Efficient & innovative managers
 DIARRHEA ACUTE DIARRHEA (at least 3x BM in 24 hrs) ETIOLOGY of AGE

◦ Chronic : >14 days, non-infectious causes 4 Major Mechanisms Bacteria Viruses

◦ Persistent : >14 days, infectious cause Aeromonas Astroviruses
1. Poorly absorbed osmotically active substances in Bacillus cereus Caloviruses
lumen Campylobacter jejuni Norovirus
◦ ORS vol. after each loose stool 1 day 2. Intestinal ion secretion (increased) or decreased Clostridium perfringens Enteric Adenovirus
absorption Clostridium difficile Rotavirus
<24 mo 5-100mL 500mL 3. Outpouring into the lumen of blood, mucus Escherichia coli Cytomegalovirus
2-10 y.o. 100-200mL 1000mL 4. Derangement of intestinal motility Plesiomonas shigelbides Herpes simplex virus
>10 y.o. As much as wanted 2000mL Salmonella
Shigella
Rotaviral AGE (vomiting first then diarrhea) Staphylococcus aureus
For severe dehydration / WHO hydration Ingestion of rotavirus ► rotavirus in intestinal villi Vibrio cholerae 01 & 0139
(fluid: PLR 100cc/kg) ►destruction of villi Vibrio parahaemolyticus
Yersinia enterocolitica
Age 30mL/kg 75mL/kg
(secretory diarrhea ▼absorption ▲ secretion) ► AGE
<12 1H 5H Parasites
>12 30 mins 2½H Balantidium coli
Assessment of dehydration (Skin Pinch Test) Blastocyctis hominis
Cryptosporidium
Patient in SHOCK ◦ (+) if > 2 seconds Giardia lamblia
◦ no dehydration if skin tenting goes back
◦ 20-30cc/kg IV fast drip immediately
◦ but in infants 10cc/kg IV (repeat if not stable) Amoeba Metronidazole
◦ If responsive & stable 75/kg x 4-6 hours Ascariasis Al/mebendazole
Cholera Tetracyline
Shigella TMP/SMX (Cotri)
Salmonella Chloramphenicol

TREATMENT PLAN A TREATMENT PLAN C

4 Rules of Home Treatment Treat severe dehydration QUICKLY!
1. Give extra fluid (as much as the child 1. Start IV fluid immediately
will take) 2. If the child can drink, give ORS by mouth while the
IV drip is being set up
> Breastfeed frequently & longer at each feeding 3. Give 100mL/kg Lactated Ringer’s solution
> if the child is exclusively breastfed, give one or
more of the following in addition to breastmilk First give Then give
◦ ORS solution Age
30mL/kg in: 70mL/kg in:
◦ food based fluid (e.g. soup, rice, water)
Infants
clean water 1 hour* 5 hours
(<12mo)
How much fluid to be given in addition to the usual Children
30 min* 2 ½ hours
fluid intake? (12mo-5yrs)

Up to 2 years: 50-100 mL after each

loose stool Repeat once if radial pulse is very weak or not
detectable
2 years or more: 140-200 mL ◦ reassess the child every 15-30 min.
:- give frequent small sips from a cup if dehydration is not improving,
:- if the child vomits, wait for 10 min then give IV fluid more rapidly
resume
:- continue giving extra fluids until diarrhea ◦ also give ORS (~5mL/kg/hr) as soon as the child
stops can drink [usually after 3-4 hours in infants; 1-2
hours in children]
2. Give Zinc supplements
◦ reassess after 6 hrs (infant) & 3 hrs (child)
Up to 6 mo: 1 half tab per day for 10-14 days
6 months or more: 1 tab or 20mg
OD x 10-14 days

3. Continue feeding
4. Know when to return

TREATMENT PLAN B

Recommended amount of ORS over 4 hour period

Age up to: 4 mo – 4 mo 12 mo – 12 mo 2 yrs – 2 yrs 5 yrs

Wt: <6kg 6-9.9kg 10-11.9kg 2-19kg
(mL) 200-400 400-700 700-900 900-1400

◦ Use child’s age only when weight is not known

◦ Approximate amount of ORS (mL)

CHILDS WT (kg) x 25
◦ if the child wants more ORS than shown, give more
◦ give frequent small sips from a cup
◦ if the child vomits, wait for 10 min then resume
◦ continue breastfeeding whenever the child wants

AFTER 4 HOURS
◦ reassess the child & classify dehydration status
◦ select the appropriate plan to continue treatment
◦ begin feeding the child while at the clinic
 ORS

• Glucolyte 60 • Pedialyte 45 0r 90

IV-FLUID COMPOSITIONS (Commonly Used for Infants and Child):

-: for acute DHN secondary to GE or other forms -: prevention of DHN & to maintain normal
of diarrhea except CHOLERA. In burns, post- fluidelectrolyte balance in mild to moderate
surgery replacement or maintenance, mild-salt dehydration.
loosing syndrome, heat cramps and heat
exhaustion in adults. Glucose 45mEq Glucose 90mEq
Na: 20mEq Na: 20mEq
Glucose: Cl: Gluconate: K: 35mEq K: 80mEq
100mmol/L 50mmol/L 5mmol/L Citrate: 30mEq Citrate: 30mEq
Na: Mg: Dextrose: 20g Dextrose: 25g
60 mol/L 5mmol/L
K: Citrate:
20 mmol/L 10 mmol/L
• Pedialyte mild 30
-: to supplement fluid & electrolyte loss due to
• Hydrite
active play, prolonged exposure, hot and humid
environment
-: 2 tab in 200ml water or 10sachets in 1L water
Glucose: 30mEq Mg: 4mEq
Glucose: Cl: Glucose: Na: 20mEq lactate: 20mEq
111mmol/L 80mmol/L 11mml/L
K: 30mEq Ca: 4mEq
Na: HCO3: Na:
Energy:
90 mmol/L 5mmol/L 90 mmol/L
20kcal/ 100ml
K: K:
20 mmol/L 20 mmol/L

ETIOLOGY OF PNEUMONIA

Bacterial
- Streptococcus pneumoniae
- Group B streptococci (neonates)
ARI PROTOCOL (PROGRAM FOR THE CONTROL OF ARI)

- Group A streptococci
- Mycoplasma pnemoniae (adolescents)
- Chlamydia trachomatis (infants)
- Mixed anearobes (aspiration pneumonia)
- Gram negative enteric (nosocomial pneumonia)

Viral
- Respiratory syncitial virus
- Parainfluenza type 1-3 (Croup)
- Influenza types A, B
- Adenovirus
- Metapneumovirus

Fungal
- Histoplasma capsulatum (bird, bat contact)
- Cryptococcus neoformans (bird
Child Age 2months up to 5years

contact)
Young Infants < 2months old

- Aspergillus sp. (immunosuppressed)

- Mucormycosis
(immunosuppressed)
- Coccidioides immitis
- Blastomyces dermatitides
- Pneumocystis carinii (immunosuppressed,
HIV, steroids)

LUDAN’S METHOD (HYDRATION THERAPY) SMR GIRLS

Stage Pubic Hair Breasts
MILD MODERATE SEVERE 1 Preadolescent Preadolescent
DEHYDRATION DEHYRATION DEHYDRATION Sparse, lightly pigmented, straight, Breast & papilla elevated, as small
2
< 15 kg, < 2 y/o 50 cc/kg 100 cc/kg 150 cc/kg medial border of labia mound, areola diameter increased
> 15 kg, 2 y/o 30 cc/kg 60 cc/kg 90 cc/kg 3 Darker, beginning to curl, ▲amount
Breast & areola enlarged, no contour
D5 0.3% in 1st hr: ¼ Plain LR 1st hr: ⅓ Plain LR separation
6-8 hours Next 5-7 hrs: Next 5-7 hrs: Course, curly, abundant but amount < Areola & papilla formed secondary
4
¾ D5 0.3% in ⅔ D5 0.3% in adult mound
5-7 hours 5-7 hours Adult, feminine triangle, spread to Mature, nipple projects, areola part of
5
medial surface of thigh general breast contour
HOLIDAY-SEGAR METHOD (MAINTENANCE)

WEIGHT TOTAL FLUID REQUIREMENT SMR BOYS

0 - 10 kg 100 mL / kg Stage Pubic Hair Penis Testes
11- 20 kg 1000 + [ 50 for each kg in excess of 10 kg] 1 None Preadolescent Preadolescent
Scanty, long slightly Enlarged scrotum, pink
> 20 kg 1500 + [ 20 for each kg in excess of 20 kg] 2 Slightly enlargement
pigmented texture altered
Darker, starts to curl, small
NOTE: Computed Value is in mL/day 3 Longer Larger
amount
Ex. 25kg child Resembles adult type but
Answer: 1500 + [100] = 1600cc/day Larger, glans &
4 less in quantity, course, Larger, scrotum dark
breadth ▲ in size
curly
Adult distribution, spread
5 Adult size Adult size
to medial surface of thigh
 ATYPICAL PNEUMONIA
> 3-12 mo
-: extrpulmonary manifestations - RSV
-: low grade fever - Other respiratory viruses
-: patchy diffuse infiltrates - Streptococcus pneumoniae
-: poor response to Penicillin - Haemophilus influenzae (Type B)
-: negative sputum gram stain - C. trachomatis
- M. pneumoniae
- Group A Streptococcus
Etiologic Agents Grouped by Age
> 2-5 yrs

DENGUE PATHOPHYSIOLOGY
> Neonates (<1mo) - RSV
- GBS - Other respiratory viruses
- E. coli - Streptococcus pneumoniae
- other gram (-) bacilli - Haemophilus influenzae (Type B)
- Streptococcus pneumoniae - C. trachomatis
- Haemophilus influenza (Type B) - M. pneumoniae
- Group A Streptococcus
> 1-3 months - Staph aureus
* Febrile pneumonia
- RSV > 2-5 yrs
- Other respiratory viruses - Streptococcus pneumoniae
- Streptococcus pneumoniae - Haemophilus influenzae (Type B)
- Haemophilus influenza (Type B) - C. trachomatis
- M. pneumoniae
* Afebrile pneumonia - Group A Streptococcus
- Chlamydia trachomatis - Staph aureus
- Mycoplasma homilis
- CMV

DENGUE Dengue Fever Syndrome (DFS) Dengue Shock Syndrome

> MOT: mosquito bite (man as reservior) Biphasic fever (2-7 days) with 2 or more of the ff: Manifestations of DHF plus signs of circulatory failure
1. rapid & weak pulse
> Vector: Aedes aegypti 1. headache 2. narrow pulse pressure (<20mmHg)
2. myalgia or arthralgia 3. hypotension for age
> Factors affecting transmission: 3. retroorbital pain 4. cold, clammy skin & irritability / restlessness
- breeding sites, high human population density, 4. hemorrhagic manifestations
mobile viremic human beings [petechiae, purpura, (+) torniquet test]
5. leukopenia DANGER SIGNS OF DHF
> Age incidence peaks at 4-6 yrs
Dengue Hemorrhagic Fever (DHF) 1. abdominal pain (intense & sustained)
> Incubation period: 4-6 days 2. persistent vomiting
1. fever, persistently high grade (2-7 days) 3. abrupt change from fever to hypothermia
> Serotypes: 2. hemorrhagic manifestations with sweating
- Type 2 – most common - (+) torniquet test 4. restlessness or somnolence
- Types 1& 3 - petechiae, ecchymoses, purpura
- Type 4– least common but most severe - bleeding from mucusa, GIT, puncture sites
- melena, hematemesis Grading of Dengue Hemorrhagic Fever
> Main pathophysiologic changes: 3. Thrombocytopenia (< 100,000/mm3)
a. increase in vascular permeability 4. Hemoconcentration
▼ - hematocrit >40% or rise of >20% from baseline
extravasation of plasma - a drop in >20% Hct (from baseline) following
- hemoconcentration volume replacement
- 3rd spacing of fluids - signs of plasma leakage
[pleural effusion, ascites, hypoproteinemia]
b. abnormal hemostasis
- vasculopathy
- thrombocytopenia
- coagulopathy

MANAGEMENT OF DENGUE MANAGEMENT OF HEMORRHAGE

A. Vital Signs and Laboratory Monitoring

Monitor BP, Pulse Rate
We have to watch out for Shock (Hypotension)
Torniquet Test: SBP + DBP = mean BP for 5 mins.
2 URINARY TRACT INFECTION

if ≥20 petechial rash per sq. inch on antecubital fossa

(+) test Suggestive UTI:
- Pyuria: WBC ≥ 5/HPF or 10mm3
Herman’s Rash: - Absence of pyuria doesn’t rule out UTI
- usually appears after fever lysed - Pyuria can be present w/o UTI
- initially appears on the lower extremities
- not a common finding among dengue patients Presumptive UTI:
- “an island of white in an ocean of red” - (-) urine culture
- lower colony counts may be due to:
* overhydration
* recent bladder emptying
* previous antibiotic intake
Recommended Guidelines for Transfusion:
Proven or Confirmed UTI:
Transfuse: - (+) urine culture ≥ 100,000 cfu/mL urine of a single
- PC < 100,000 with signs of bleeding organism
- PC < 20,000 even if asymptomatic - multiple organisms in culture may indicate a
- use FFP if without overt bleeding contaminated sample
- FWB in cases with overt bleeding or
signs of hypovolemia

> if PT & PTT are abnormal: FFP

> if PTT only: cryprecipitate

3-7cc/kg/hr depending on the Hct (1st no.) level

(D5LR)
10-20cc/kg fast drip PLR - hypotension, narrow pulse
pressure fair pulse

Leukopenia in dengue: probable etiology is

Pseudomonas

ACUTE GLOMERULONEPHRITIS RHEUMATIC FEVER TREATMENT OF RHEUMATIC FEVER

Complications of AGN JONES CRITERIA: A. Antibiotic Therapy

- CHF 2° to fluid overload - 10 days of Oral Penicillin or Erythromycin
- HPN encephalopathy A. Major Manifestations - IM Injection of Benzethine Penicillin
- ARF due to ê GFR - Carditis (50-60%)
- Polyarthritis (70%) *** NOTE: Sumapen = Oral Penicillin!
- Chorea (15-20%)
STAGES of AGN - Erythema Marginatum (3%) B. Anti-Inflammatory Therapy
- Oliguric phase [7-10days] – complications sets in - Subcutaneous Nodules (1%)
- Diuretic phase [7-10days] – recovery starts 1. Aspirin (if Arthritis, NOT Carditis)
- Convalescent phase [7-10days] – patients are B. Minor Manifestations Acute: 100mg/kg/day in 4 doses x 3-5days
usually sent home - Arthralgia Then, 75mg/kg/day in 4 doses x 4 weeks
- Fever
- Laboratory Findings of: 2. Prednisone
Prognosis ▲ Acute Phase Reactants (ESR / CRP) 2mg/kg/day in 4 doses x 2-3weeks
- Gross hematuria 2-3 weeks Prolonged PR interval Then, 5mg/24hrs every 2-3 days
- Proteinuria 3-6 weeks
- ▼C3 8-12 weeks C. PLUS Supporting Evidence of Antecedent
- microscopic hematuria 6-12 mo or Group-A Strep Infection
1-2 years - (+) Throat Culture or Rapid Strep-Ag Test PREVENTON
- HPN 4-6 weeks - ▲Rising Strep-AB Test
A. Primary Prevention

> Hyperkalemia may be seen due to Na+ retention - 10 days of Oral Penicillin or Erythromycin
> Ca++ decreases in PSAGN - IM Injection of Benzethine Penicillin
> ▲ in ASO titer
- normal within 2 weeks
- peaks after 2 weeks
- more pronounced in pharyngeal infection
than in cutaneous

B. Secondary Prevention

C. Duration of Chemoprophylaxis
 KAWASAKI DISEASE
TREATMENT SEIZURES
CDC-CRITERIA FOR DIAGNOSIS:
ADOPTED FROM KAWASAKI Currently Recommended Protocol:
(ALL SHOULD BE PRESENT) > Seizures: sudden event caused by abrupt,
A. IV-Immunoglobulin uncontrolled, hypersynchronous
A) HIGH Grade Fever (>38.5 Rectally) PRESENT discharges of neurons
for AT LEAST 5-days without other Explanation 2g/kg Regimen Infusion EQUALLY Effective in
“High Grade Fever of at least 5 days” Prevention of Aneurysms and Superior to 4-day > Epilepsy: tendency for recurrent seizures that are
DOES NOT Respond to any kind of Antibiotic! Regimen with respect to Amelioration of Inflammation unprovoked by an immediate cause
as measured by days of
B) Presence of 4 of the 5 Criteria Fever, ESR, CRP, Platelet Count, Hgb, and Albumin > Status epilepticus: >30min or back-to-back
1. Bilateral CONGESTION of the Ocular Conjunctiva w/o return to baseline
(seen in 94%) NOTE: There is a TIME FRAME of 10 days
2. Changes of the Lips and Oral Cavity (At least ONE) > Etiology:
3. Changes of the Extremities (At least ONE) - V ascular : AVM, stroke, hemorrhage
4. Polymorphous Exanthem (92%) B. Aspirin - I nfections : meningitis, encephalitis
5. Cervical Adenopathy = Non-Suppurative Cervical - T raumatic :
Adenopathy (should be >1.5cm) in 42%) HIGH Dose ASA (80-100mg/kg/day divided q 6h) - A utoimmune : SLE, vasculitis, ADEM
should be given Initially in Conjunction with IV-IG - M etabolic : electrolyte imbalance
HARADA Criteria THEN - I diopathic : “idiopathic epilepsy”
- used to determine whether IVIg should be given Reduced to Low Dose Aspirin (3-5mg/kg/day) - N eoplastic : space occupying lesion
- assessed within 9 days from onset of illness AND - S tructural : cortical malformation,
1. WBC > 12,000 Continued until Cardiac Evaluation COMPLETED prior stroke
2. PC <350,000 (approximately 1-2 months AFTER Onset of Disease) - S yndrome : genetic disorder
3. CRP > 3+
4. Hct <35%
5. Albumin <3.5 g/dL
6. Age 12 months
7. Gender: male

• IVIg is given if ≥ 4 of 7 are fulfilled

• If < 4 with continuing acute symptoms,
risk score must be reassessed daily

TYPES OF SEIZURES CLASSIFICATION BY CAUSE SIMPLE FEBRILE SEIZURE

A. Partial Seizures (Focal / Local) A. Acute Symptomatic A. Criteria for an SFS

– Simple Partial (shortly after an acute insult) – < 15 minutes
– Complex Partial (Partial Seizure + – Infection – Generalized-tonic-clonic
Impaired Consciousness) – Hypoglycemia, low sodium, low calcium – Fever > 100.4 rectal to
– Partial Seizures evolving to Tonic-Clonic – Head trauma 101 F (38 to 38.4 C)
Convulsion – Toxic ingestion – No recurrence in 24 hours
– No post-ictal neuro
B. Generalized Seizures B. Remote Symptomatic abnormalities (e.g. Todd’s paresis)
– Absence (Petit mal) – Pre-existing brain abnormality or insult – Most common 6 months to
– Myoclonic – Brain injury (head trauma, low oxygen) 5 years
– Clonic – Meningitis – Normal development
– Tonic – Stroke – No CNS infection or prior
– Tonic-Clonic – Tumor afebrile seizures
– Atonic – Developmental brain abnormality
B. Risk Factors
C. Idiopathic – Febrile seizure in 1st / 2nd
SIMPLE FEBRILE SEIZURE – No history of preceding insult degree relative
vs. – Likely “genetic” component – Neonatal nursery stay of
COMPLEX FEBRILE SEIZURE >30 days
– Developmental delay
Febrile Seizure: – Height of temperature
“A seizure in association with a febrile illness in the
absence of a CNS infection or acute electrolyte C. Risk Factors for Epilepsy
imbalance in children older than 1 month of age (2 to 10% will go on to have epilepsy)
without prior afebrile seizures” – Developmental delay
– Complex FS (possibly > 1
complex feature)
– 5% > 30 mins => _ of all
childhood status
– Family History of Epilepsy
– Duration of fever

BRONCHIAL ASTHMA (GINA GUIDELINES)

Controlled Partly Controlled Uncontrolled

Day
none > 2x per wk
symptoms
Limitation of
none any
activities
3 or more symptoms
Nocturnal Sx
none any of Partly Controlled
(awakening)
Asthma in any week
Need for
< 2x per wk > 2x per wk
reliever
Lung
normal < 80%
function
Exacerbation none > 1x per yr 1x / week
 Clinical Features:
TUBERCULOSIS RESPIRATORY DISTRESS SYNDROME
(Hyaline Membrane Disease) 1. Tachypnea, nasal flaring, subcostal and intercostal
A. Pulmonary TB retractions, cyanosis, grunting
– fully susceptible M. tuberculosis, o Male, preterm, low BW, maternal DM, & perinatal 2. Pallor – from anemia,
– no history of previous anti-TB drugs asphyxia peripheral vasoconstriction
– low local persistence of primary resistance to 3. Onset – within 6 hours of life
Isoniazid (H) o Corticosteroids: Peak severity – 2-3 days
• most successful method to induce fetal lung Recovery – 72 hours
☤ 2HRZ OD maturation
then 4HR OD or 3x/wk DOT • Administered 24-48 hours before delivery Retractions:
decrease incidence of RDS o Due to (-) intrapleural pressure produced by
– Microbial susceptibility unknown or initial drug • Most effective before 34 weeks AOG interaction b/w contraction of diaphragm & other
resistance suspected (e.g. cavitary) respiratory muscles and mechanical properties of
– previous anti-TB use o Microscopically: diffuse atelectasis, eosinophilic the lungs & chest wall
– close contact w/ resistant source case or living membrane
in high areas w/ high pulmonary resistance to Nasal flaring:
H. o Due to contraction of alae nasi muscles leading to
– Pathophysiology: marked reduction in nasal resistance
☤ 2HRZ + E/S
OD, then 4 HR + E/S OD or 3x/week DOT 1. Impaired/delayed surfactant synthesis & Grunting:
secretion o Expiration through partially closed vocal cords
2. V/Q (ventilation/perfusion) imbalance
B. Extrapulmonary TB due to deficiency of surfactant and decreased lung • Initial expiration: glottis closedà
– Same in PTB compliance lungs w/ gasà
3. Hypoxemia and systemic hypoperfusion inc. transpulmo P w/o airflow
– For severe life threatening disease 4. Respiratory and metabolic acidosis • Last part of expiration: gas expelled against
(e.g. miliary, meningitis, bone, etc) 5. Pulmonary vasoconstriction partially closed cords
6. Impaired endothelial &epithelial integrity
☤ 2HRZ + E/S OD, then 10HR + E/S OD 7. Proteinous exudates Cyanosis:
or 3x/wk DOT 8. RDS o Central – tongue & mnucosa (imp. Indicator of
impaired gas exchange); depends on
total amount of desaturated Hgb

UMBILICAL CATHERIZATION
NEWBORN RESUSCITATION Cathether length
Indications • Standardize Graph
 AIRWAY: open & clear • Vascular access (UV) – Perpedicular line from the tip of the shoulder to
 Positioning • Blood Pressure (UA) and blood gas monitoring in the umbilicus
 Suctioning critically ill infants • Measure length from Xiphoid to umbilicus and add
 Endotracheal intubation (if necessary) 0.5 to 1cm.
Complications • Birth weight regression formula
 BREATHING is spontaneous or assisted • Infection – Low line : UA catheter in cm = BW + 7
• Bleeding – High line : UA catheter = [3xBW] + 9
 Tactile stimulation (drying, rubbing) • Hemorrhage – UV catheter length = [0.5xhigh line] + 1
 Positive-pressure ventilation • Perforation of vessel
• Thrombosis w/ distal embolization Procedure
 CIRCULATION of oxygenated blood is adequate • Ischemia or infarction of lower extremities, bowel • Determine the length of the catheter
 Chest compressions or kidney • Restrain infant and prep the area using sterile
 Medication and volume expansion • Arrhythmia technique
• Air embolus • Flush catheter with sterile saline solution
• Place umbilical tape around the cord. Cut cord
Cautions about 1.5-2cm from the skin.
RESUSCITAION MEDICATIONS • Never for: • Identify the blood vessels.
– Omphalitis (1thin=vein, 2thick=artery)
Atropine 0.02 ml/k IM, IV, ET – Peritonitis • Grasp the catheter 1cm from the tip. Insert into the
Bicarbonate 1-2 meq/k • Contraindicated in vein, aiming toward the feet.
– NEC • Secure the catheter
Calcium 10 mg elem Ca/k slow IV
– Intestinal hypoperfusion • Observe for possible complications
Calcium chloride 0.33/k (27 mg Ca/cc)
Calcium gluconate 1 cc/k (9 mg Ca/cc) Line Placement
1g/k = 2 cc/k D50 • Arterial line
Dextrose
4 cc/k D25 • Low line
Epinephrine 0.01 cc/k IV, ET – Tip lie above the bifurcation between L3 & L5
• High line
– Tip is above the diaphram between T6 & T9

BILIRUBIN

PRETERM:
mg/dl mmol/L
0-1 hr 1-6 17-100
1-2 d 6-8 100-140
3-5 d 10-12 170-200

TERM
mg/dl mmol/L
0-1 hr 2-6 34-100
1-2 d 6-7 100-120
3-5 d 4-12 70-200
1 mo <1 <17

KRAMERS CLASSIFICATION OF JAUNDICE

SERUM
ZONE JAUNDICE
BILIRUBIN
I Head & neck 6-8
Upper trunk
II 9-12
to umbilicus
Lower trunk
III 12-16
to thigh
Arms, legs,
IV 15
below
V Hands & feet 15