Kawasaki disease
#
1. symptoms
1. >5days fever
2. non purulent conjunctivitis
3. oral erythema
4. strawberry tongue
5. submandibular lymphadenopathy
6. erythema multiform
2. Refer the pt
Archive
Invagination
#
1. symptoms
1. 6-35 m/o
2. severe crampy pain lasting for 20 minutes
3. asymptomatic intervals
4. worsening pain
5. vomiting
6. mucosal-bloody stool
7. sausage shape mass in exam
2. Dx: Sonography
3. Visit pediatrics or surgeon
Influenza
#
1. Treatment
1. Cap oseltamivir 30 mg for 7 days
1. or syrup oseltamivir 60 mg/5/ml
2. or cap Flubivir 75 mg
3. or cap Tamiflu 30/45/75 mg
1. Symptom therapy only
1. Serum N/S 500-1000 cc IV infusion
2. Amp apotel 1gr (10-15mg/kg) INF
3. Amp ketorolac IV
4. Amp B-complex
2. Approach
1. if suspicious of pneumonia, take CXR
2. Vaccination in high risk group:
1. Vaccine Influvac #1
1. >3y/o 1 Amp
2. <1y/o 1/2 amp
3. <12y/o for first time, repeat 1 month later
4. for pregnancy, in 2nd and 3rd trimester
5. safe in breast feeding
6. contra indicated in dose who are sensitive to Egg’s protein
2. may cause GBS
3. use in
1. health care workers
2. old age
3. immunodeficient
4. chronic disease
Infantile Icterus
#
1. High risk group
1. icterus in first 24 hours
2. >15% direct bili
3.
1. Check
1. Bilirubin Total and Direct
2. CBC, diff
3. retic count, Blood group and Rh (infant and mother)
4. PBS
5. G6PD
6. Direct coombs
7. TSH, T3, T4
8. U/A, U/C
9. BS
2. Prolong Icterus
1. >2 weeks in term
2. >3weeks in preterm
3. Deciding for phototherapy or blood exchange is on specialists
Infantile hypothyroidism
#
1. check TSH, T4 in 3-5 days, if low T4 and high TSH
1. Start levothyroxine 10-15mic/kg/day (tab 0.5mg, 0.1mg)
2. check TSH monthly for 6 month, then every 2-3 month till 2y/o
3. D/C drug in 3 y/o if TSH and T4 are corrected
2. Dosage based on age:
1. 1-3 y/o ⇒ 4-6 mic/kg/day
2. 3-10 y/o ⇒ 3-5 mic/kg/day
3. 10-16 y/o ⇒ 2-4 mic/kg/day
Infantile colic
#
1. Criteria
1. <3m/o
2. >3 days per week
3. >3 hours per days
4. self-limited
5. NL examination
6. more severe in afternoon
2. Treatment
1. Drop colicEZ 10drop qid
1. or drop colic aid 10 drop qid
2. or syrup Gripe mixture for >1m/o 1 tea spoon qd
3. or drop dimethicone 10 drop qid
Growth pain
1. mostly in calves, worsening at night
2. Lab test
1. CBC, diff
3. Treatment
1. Susp acetaminophen 120mg/5ml w/2cc qid #1
Functional Pediatric abdominal pain
#
1. R/O
1. weight loss
2. chronic diarrhea
3. growth retardation
4. RLQ pain with fever
5. GIB
6. awakening pain
7. Celiac disease
8. functional and chronic pain
2. Treatment
1. Drop dimethicone 5drop tds
1. Syrup dicyclomine
Febrile Seizure in Pediatrics
1. Febrile seizure
1. >38-39 C
2. in 6m/o to 60m/o
3. presents as GTC
4. only one time in 24 hours
5. last less than 15 minutes
2. Check
1. brain CT without contrast
2. BUN, Cr
3. Na, K, Mg, Ca, P
4. BS
5. Trauma Hx
6. ECG for arrhythmias
7. Hx of seizure or poisoning
3. Management
1. LLP positioning
2. open airways
3. O2 therapy
4. Amp Diazepam 0.5mg/kg rectal/nasal if needed up to 3 times
1. or Amp diazepam 0.2mg/kg IV
2. or Amp midazolam 0.2mg/kg nasal
5. If not controlled:
1. Amp Phenytoin 20mg/kg in N/S
1. do not infuse in DW
2. Amp phenobarbital 20mg/kg
3. Drip Midazolam 0.05-0.2mg/kg/hr
4. do not use diazepam for infants
5. Discharge the pt with
1. Syrup acetaminophen 120mg/5ml w/2cc qid
2. Tab diazepam 0.3mg/kg tds for 2 days #20 (tab 2, 5, 10 mg)
1. or syrup diazepam 2mg/5l
2. or supp diazepam 5mg
6. prognosis:
1. if there is no risk factor: 10% chance of seizure
7.