![]() BASICS
Seizure
Syncope
Red flags of syncope - exertional (not after the exertion), family hx, cp, palpitations, syncope, brought on by sudden loud noise, febrile illness, abrupt syncope, <10 years
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![]() Case 1 - Bloody Diaper in the Neonate Common causes of BRBPR in kids 1. Ingested maternal blood 2. Necrotizing enterocolitis 3. Milk protein allergies 4. Anal fissure Key learning points 1. Hgb nadir at 6-8 weeks in full term down to 9g, premies drop faster and farther, 7g by about 3-4 weeks 2. Reassess potentially sick frequently 3. NEC is possible in full term, keep it in your differential! Nec info: Mortality 15-30%. Pathophys: intestinal immaturity and over active immune response Generally affects preterm infants, but not uncommon and increasing in frequency in full term infants Case 2 - 14 month old cold, seizing baby
History of an Takayasu arteritis and new seizures. ICH seen on CT Takayasu Arteritis Most commonly involved vessel
![]() Basics
Some Concerning History?
Migraine
Consider Imaging for:
Treatments for benign HA
Congenital Adrenal Hyperplasia
Always consider adrenal insufficiency in hypotensive patients who remain hypotensive despite appropriate fluid resuscitation and initiation of pressors (whether adult or pediatric)... but particularly think of it in neonates!!
2) Age-based - 0-3 yo: 25mg IV; 3-12 yo: 50mg IV; >12 yo: 100mg IV 3) Randy's Rules (from the brilliant mind of Dr. Cordle) - Give at LEAST 25mg; 3x their current dose; or 2mg/kg
-- Limitations - requires patient cooperation, not definitive airway. -- Intubate when the above doesn't work - but increased morbidity and mortality with intubation
- Respiratory rate - Short inspiratory time - I:E ratio 1:3 to 1:5 Delayed sequence intubation
10 day old with vomiting
- Hx of "GERD" since day of life 4; Mom GBS + but treated and baby full term without complications; +constipation - Green emesis day of presentation - looks great at bedside - Neonate with Bilious Emesis - KEEP IT SIMPLE... Neonate with Bilious Emesis = Badness until proven otherwise. -- Surgical vs non surgical - Surgical includes duodenal atresia, malrotation with volvulus, NEC. Also consider Sepsis. Malrotation - arrest of normal rotation of embryonic gut > usually presents in infancy -- >50% of kids will present before one month of age -- >90% have vomiting - it won't always be bilious -- > Urgent surgical consultation if kid looks bad - Imaging -- Plain films - not sensitive or sepcific - May see double bubble sign -- Upper GI = study of choice
16 yo with syncope 16 yo who passed out on airplane with lots of social stressors.
13 yo with abdominal pain "Chronic" abdominal pain over past 2-3 months.
Pediatric myocarditis Background
8 day old with Respiratory Distress, Mottling, and Hypoxia
Intermittent grunting Poor feeding No fevers Jaundiced DDX: Very Broad and includes terrible potential problem. Keep the following in mind! THE MISFITS
2 year old s/p Fall Fall not witnessed Possible LOC Fussy initially, then baseline Blood tinged emesis x 1 Neuro exam unremarkable To CT or Not to CT? PECARN Minor Head Injury Rule - see PedEMMorsel |
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