Pediatric Emergencies: A Quick Guide for Healthcare Professionals

Posted on Oct 16, 2024 in Medicine & Health

Cardio

Congenital Heart Defects

ASDVSDCAPDAASFallotSVTVT
  • S2 Split
  • RVH
Surgery
  • RVH
  • LVH
  • Sys+Thrill
  • HR/RR(+)
  • 50% close
  • 50% surgery
  • LVH
  • BP(+)/RR(+)
  • No Sys Mur
  • 0 Femoral pulse
  • surgery
  • 3-10YO
  • mechine murmor
  • S2(+)
  • LVH
  • -Indomethacin (Preterm/noCHF)
  • -Surgeu
  • LVH
  • Systolic to right
  • Dizzy/yncope
Surgery
  • RVH
  • Cardiomegaly
  • Cyanosis
  • Surgery
  • Comp: (IE/Fe def/thrombsi)
  • -Vagal
  • -Adenosine12mg
  • -amiodoron
  • cardioversion
  • Pulse(+): Cardioversion
  • Pulse(-): Defibr/NE/Resusitate!

HBP Monotherapy =CCB!!

Arrhythmias

SVT

  • Vagal maneuvers
  • Adenosine 12mg
  • Amiodarone
  • Cardioversion

VT (No P)

  • Pulse(+): Cardioversion
  • Pulse(-): Defibrillation/NE/Resusitate!

Rh

Rheumatic Diseases

ReactiveOligoPolySystemicSLEDermatomyositisSclerodermaHenoch-Schönlein Purpura (HSP)KawasakiRh Fever
  • Uveitis
  • Asmm
  • NSAID
  • Steroid Inj
  • metho
  • TNF block
  • >5
  • NSAID
  • Metho
  • Metho
  • TNF bloc
  • -Fever
  • ->1Joint
  • -extra
  • NSAID
  • Pulse
  • NSAID /Metho
  • -butterfly
  • -Polyrhtist
  • -Lung(Pn)
  • -Renal(GNitis)
  • IV GCD
  • Pulse
  • X modiftying
  • -Weakness
  • -EMG(myositis)
  • -Biopsy(infla
  • -Enzymes(+) Crkinase
  • -Gotton + erythm periorbital

GCD ———-> methotraxate

  • -Morphea
  • -Linear
  • -coupsabre
Emolients
  • -Small vasculitis
  • -post infection (low palpable purpora)
  • +(Arthris/Gntiis/Gi bleed)
  • 1-Diet (antiallergy)
  • 2-NSAID
  • 3-analgesics
  • 4-supportive
  • (>5 FEver)
  • +(CRASH) (strawberry tongue) (conugviits)
  • +(ESR/CRP)
  • -GCD
  • -Methotraxate
  • Strep infection
  • +M (Caridits) (Polyarth) (chorea) (Eryth marginatum) (nodules
  • m: (Fever) (Ecg) (ESP CRP)
  • Strep+2M/1M1m
  • -Peniccilin14D
  • -NSAID
  • -aspirrin
  • -Halopridol(chorea)

ESR(+) all

RF(-) all excpept Poly

CRP+WBC in systemiatic

ANA(+) Oligo/Poly

SLE

-4 out of 11 is enough in Children The RED POINTS Are more often seen in Children

ClinicalImmunology

1-Cutanous Lupus

2-OP/Nasal Ulcer

9-Arhtritis

3-Serositis

8-Renal Sx

4-Neruolgoical Dx

5-HA

6-Leukopenia

7-Tpenia

-ANA(+)

-Anti-DNA(+)

-Anti-Sm

-Antiphospholid Ab

-High ESR + CRP

-Low complement (C3+C4)

-Direct Coombs

GI

Gastrointestinal Disorders

C-PationHirshsprung’s DiseaseRectal ProlapseAnorectal PainMalabsorption
ENEMA

Non X:

  • Fiber+H2O
  • behavior
  • toiler train

X:

  • Tx cause
  • Polythylele
  • Disimpact
  • Laxatives
-visible peristalil-rectum 0

resect

+

(anastomeses)

^^Dx:

-inspection

-DRE

-rectoanal manometry

Tx:

-Manual Reduction

-Circumferential injection

-Thiesch operation

-Fissue-Dermatits-Paracrotitis-Trauma-coccigodyniaTx:
  • -softening stool
  • -Warm bath
  • -Nitoglycerine
1-elementin blood2-72 stool3-Biopsy

Anal atresia with anocutaneus fistula

Anorectal agenesis with rectovestibular fistula

Anorectal Malformations

MaleFemale
I-High:
  • -ARAgnesia ( Rurethra.,Rvesiculat)
  • -ARA without fistula
  • -Rectal Atresia
II-Middle:
  • -ARAgenia (Rectubadlubular)
  • -Ana agenses (no fistula)
III-
  • -Anal Membrane
  • -Anal Stensosis
  • -Anacutanous fitua
I-High:
  • -ARA (Rectovaginal)
  • -ARA (without fistula)
  • -Rectal Atresia
II-
  • -ARA (rectovaginal) (rectovestibular)
  • -Anus Agensis (no fistula
III-
  • + anovestibular
Cloaca

Dx:

inspect

urine Test

invertogram

Inflammatory Bowel Disease (IBD)

Crohn’s Disease (CD)Ulcerative Colitis (UC)Treatment
All layerAll GIAbd Pain-__-Malnutrition-FISTULAErythema/Pyoderma/Ucveitis…
  • -An/ESR+CRP
  • -ANCA(+)

Biopsy:

  • -Tranmural,
  • -Granuloma

M+SM

-LI

-__

-Bloody

PSC

An/ESR+CRP

pANCA

Biopsy:

M+SM

Crypt

Tx:

I-Mesalmine derivative (ASA):II-Biologics:
  • -Monoclonal Ab
  • -”Infliximab”
IV- Steroid :
  • -MethylPrednisolone
V-Surgery

Common GI Issues

Alarm SymptomsGERDUlcerColicFunctional DyspepsiaIrritable Bowel Syndrome (IBS)
  • Fever
  • anorexia
  • RLQ pain
  • Delay growth
  • HSmegaly

^^Dx:

  • -Endo+biopsy
  • -24H Ph test
  • -Barium test (upper GI)

Tx:

nonX(positioning)

X:

  • -H2blockers
  • -PPI(omeprazole)
  • -Maloxane

(Hpylori)

(NSAID)

^^Dx:

  • 1-CBC(Hb/Ht)
  • 2-Gastroednocopy
  • 3-Hypolri (Urease Test) (C Breath Test)

Tx:

  • -remove NSAID
  • -small meales
  • -PPI+Clari+meto

^^Dx:

exclusion

Tx:

  • swing
  • massage
  • change meals
  • sedatives

(ulcer-like)

(dysmotlity like)

^^Dx:

  • -CF
  • -Pain score
  • -CBC
  • -US/Xray…

Tx:

Diet

Excercise

Spasmolytic

(tensemus)

Tx:

  • -Diet(Prtand fiber)
  • -StresS(-)
  • -X: spasmolutcs

Surgery

Surgical Conditions

AHOViteelineDiaphragm HerniaAppendixPeritonitis

^^Dx:

1-CF

T↑,

(Limbing,Red)

2-Lab

(ESR+CRP ↑)

3-Rad:

Sci99

MRI

Xray(2W)

Tx:

I-Ax:

-Oxa/Meticilin

-G1 Cephalo

II-Surgery:

Open/Drain/Local antiseptic

I-Omplaoenteric

persistant:

  • -US
  • -If Fistula=Resect

II-Mickel

  • -Hemmorhage
  • -Perofration
  • -intssecption
  • ->Diverticulotomy!

III-Cyst

Removal

  • Cyanosis
  • Dyspnea
  • mediastinal shift
  • MRI

^^DX:

I-CBC,ESR,WBC

II-US

(>6mm)

(Free Fluid)

(Non compressable)

(appendix mass)

III-CT

^^Tx

Ax:

  • -Metronidazole
  • -Gentamicin (1hour pre surgery) (7 Day Post)

Surgery (open/laparsocopicy)

I-Perforative: (Necoritc Enteroclitis

II-Non perforative

^^

1-Xray:

  • -Fixed loop sign
  • -Pnperitoneum

2-Lab

CRP/WBC

3-US:

Edema

^^Tx:

I-Non perforative (Non Ope) (Ax:Genta/Metro/Amp) (infusion)

II-Perforative: -Surgery -irrigtion -Fluids!

Early AdhLate AdhOmphaloceleGastochysis

D–>W

Not Severe

Obstructibe

Soft

Conservative 6 H

Operation

  • -Severe
  • -Stragulative
  • -fibrous ahesion
  • conservatibe3H
  • operative

SAC

No inflammtion

(GI = WORKING)

Tx:

Mosit gazue

Operate

Risk:

  • Dry
  • Infection
  • Perforation

No SAC

inflammation

Tx:

Moist Guaze (antiseptic)

Operate

Risk:

peritonitis!

HemiangiomaAngiomatosis (Michelline)LN AngiomaTeratoma (sacrococcyxyl) +Nephroblastoma
  • -Self Resolving
  • -Compression Therapy
  • -Lazer
  • -Cryotherapy

Extipration surgery

or

Slcero

crto

electrocoagulation

laser

Sacroilliac region

Tx:

Nephrotomy

+chemo

+Ratio

Anorectal Malformations (Detailed)

MaleFemaleDiagnosis
  • -Anorectal Agenisi (Fistula)
  • -…No Fistula
  • -Rectal Atresia
  • -Rectobulbar
  • -Rectal Ageniss (No Fistula)
  • -Anocutnous
  • -Anal Stenosis
Same
  • Rectvaginal
  • Rectivestivbular
  • Rectal aensis(no fist
+Anovestibular

Dx:

1-Inspect

2-UA

3-investogram

4-colostorgram

5-abd US

High Anorectal Anomaly

Analatresia+Anocutnaous fitula(M)

Anorectal agensis with Rectovesibular Fistula(F)

Low anal Atreisa/High Anal Atrseia

Anorectal agesis+3 possiblie

Gastrointestinal Bleeding

surgicalTherapic
  • -Volvulus
  • -Meckel
  • -Polyp
  • -Tumour
  • -intussesciption
  • Polyp
  • Fissure
  • Tumour
  • Duplocatin
  • -Henonch
  • -HUR
  • -Enterocolitis!
  • UC
  • Esophagitis
  • Gastritis!

Cancer (add to cancer list)

Benign Tumour

r—>Risk icnreases in Down And undescended Testis

—->Overgrow the organ

—->Bleeding

—->Malignisation

Malignant:

—->Slow grwoth

—->intact capsule

URT

Upper Respiratory Tract Infections

Cold (Rhinovirus)Pharnygutis (Adeno/corny)Tonsilitis (GABS) (EBV/SMV)AdenotitsRhino (S-PN) (50% Otitis) (Pressure)Otitis media (SPn) (ottorhea)CROUP (Up Obstruct) (Stridor) (Influenza)
  • Rhinrohea
  • Cough
  • Soar throat

Dx:Clinical

Tx

supp(anal/antipyr)

  • -Delay Cough
  • -Red uvula

.Dx+Tx…

  • -T>40
  • -Rhinrrhea(0)
  • -Headache
  • -Myalgia

^Dx:

  • Blood
  • Swab+culure
  • serology

^Tx:

  • GABHS(Pencillin)
  • (Cefalospon)
  • (Mcrolide)
  • Mouth breath
  • Snoring

^Dx:

Nasopharscopy

^Tx:

  • -Ax/Decongest
  • -Adenectomy!

Dx

  • ->10 D Cough
  • -Tranlumination
  • -Culture aspirate
  • -CT

Tx:

  • -Penicclin-Amox
  • -Clavacid
  • -Decongest
  • -Saline H2O

Comp:

  • -Periorbatal cellulits
  • -Abscess
  • -thrombosis

Dx:

  • -Otoscopy

Tx:

  • -Pencillin
  • -Amoxillin
  • -Decongest
  • -antihist
  • -analgesics
  • -antipyretic

I-Larnygitis (BARK) Gradual Fever N/H Bark Ok condition

II-Epiglotitis: (No Sound) (suddent) (Fever) (Bad Condition)

Tx:

  • -Air humidy
  • -Nebulizers
  • -CSD!

Larygitis Hospitalization(Cyanosis/Consiouness/Accesory muslce/stridor!!

**supportive:

Fluids

Antipyretics

Analgesics

decognestion( sometimes)

saline

Clear Nose

-Ax if bacterial!!

Stridor vs. Wheezing

StridorWheezing

Insrpiration

Upper Obstruction

CROUP

expeiraiton

Lower OBstruction

  • Blits
  • Bronchitis
  • Pn
  • Asthma

LRT

Lower Respiratory Tract Infections

BlitisBchitis
  • -RSV
  • (>39+crackels=PN)!!

”URT–>Cough—>Distress

  • -Dx Clinical
  • -Tx supp

I-Mild(Home):

  • -RR
  • -Feed(+)
  • -Po2>92%

II-Mod:(hospital)

  • -RR:50-70
  • -DH

III- Severe(ICU):

  • -Apnea
  • -RD
  • >2YO
  • (Adenovirus/SPn)
  • (Salbutamol+)

^Tx(Both)

  • -Antipyretic
  • -Salbutamol
  • -CS
  • -Clear Nose

what determines Hostpializization:

  • -SpO2
  • -RR> 50
  • -Apnea

Pneumonia

TypicalAtypical
  • -Sudden
  • -T(++)
  • -P Cough

Bacteria:

  • -Rapid(HR)
  • -T>39
  • -Sick

I-Pulse oximetry

II- LAB

( ↑ :CRP, ESR, WBC)

-Culture

III Rad

-Xray or CT

Tx:(+Supp)

  • -Amoxilin
  • -Clavuniolic Acid
  • -Gradual
  • ->
  • -non Productive (HA/Soart throat)

Virus:

  • Low Fever
  • -HA/Myalgia
  • -2-3 prodrome

^^hosp:

  • RR
  • SpO2
  • Apnea

Hosp:

  • -Benyzylpen
  • -Clarithrommycin

Asthma

Asthma Symptoms

  • ”COUGH”
  • ”Intermitten Dyspnea”
  • -Allergy
MildSevere
  • -Persistant Dry cough
  • -Dyspnea
  • -Chest tightness
  • -Severe dysnea
  • -Hypoxemia
  • -accesory muslce use

^^Dx:

1-Spiromtery

>80% mild..

2-allergy Test

3-Sensization:IgE+Esonophilia

4-Ausculation

^^Tx:(exacerbation)

I-Avoid Cause:

Steps

1-O2+SABA (alberatol) evey 20 min

2-Low Dose ICS

3-Low Dose ICS + LABA /Meduim Dose ICS

4-Medeuim dose ICS + LABA

5-High Dose ICS+ LABA / Omalizumab

6-High Dose ICS+LABA+ OMALIZUMAB

Tuberculosis (TB)

ActiveLatent
  • -Sx
  • -Spread
  • -Xray
  • Skin test
  • IGRA

-Latent

-(+)Pul Smear+ve

-Smear-ve

-Extrapul

-X(r)

Tx:

(Intensive2M,4X)

(Constion 4M,2X)

-ISonaized(also latent)

-Ridampcin(also latent)

-ethambul

-Pyrazinamide

ICU

Shock

CompensatedUncompensated

-Early

-BP is N

-HR (+)

-Late

-BP is low

-Organ Damage

Fever in Spetic

Tachycardia

BP is low (uncompensated), N in COmpensated

Altered mental tatus


Hypovolemic shockCardiogenic shockDistributive shock
Septic shockNeurogenic shockAnaphylactic shock
Cardiac output / Cardiac index↓↓↑↓↓
Heart rate↑↑↑↓↑
Central venous pressure↔︎ or ↓↔︎ or ↑↔︎ or ↓↔︎ or ↓↔︎ or ↓
Pulmonary capillary wedge pressure(PCWP)↓↑↓↓↓
Left ventricularend-diastolicpressure(LVEDP)
Peripheralvascular resistance↑↑↓↓↓
Mixed venous oxygen saturation (SvO2) ↓↓↑↓↓
Hypovolemic
(CO ↑)
SepticDistruptive(Vasodilative)Cardiogenic(arrythmia)(CHD)Obstrutive:Tension Pn
DHFluid LossBleeding-Sepsis-NeurogenicCHDCardiac Tamponase
-O2/intubate
-fluid Resusctation
-Hemotais
-Blood Transfusion
I-Fluids
II-Vasopresor(NE)
III-Ax:
Neonate:
-Ax(Amoxiccilin)
-Gentamicin
>28day:
Vacno
Cefotaine
I-Cardiopul resusctation
II-rest depend on Cause

***Meningitis:
BacteriaTBViral
1- G3 Cephalosporine + AMpicllin(Ceftriaxone 50-100mg/kg IM /IV)(Cefotaxime 50mg/kg )2- >3M:G3 Cephalosporine+vanco?14-21 Dneeds 4-6 Ax(Mane/Isonizied/ridampicin /Streptomycin)-Self limiting-Suppotive Tx (Diazepam For seuzures )(Antipyretic)(Iv Fluids)



***Meningcocemia!!!

-IV Fluids -Vasopressors=NE/E-IV Ax (Pencillin Ceftriaxone)-CSD ( For inflammation)-Sx Tx
^^Prophylaxis:
I-Exposure Regiment(24 H after contact):-Rifampicin 10 mkdose  oral; bid x 2 day (maximum-Ciprofloxacin: 500 mg oral-Cetriaxone: 125 for children, 250mg for adalts        II-Vaccine:-Meningococcal group B vaccine



2M=Tonic3M=Grasping3-4M=Moror/Rooting/sucking7M=Swim12M=Babinskisigh=3.5Mspeech 12-16M

***hematology:



Fe DefSpherocytocisAcute LeukemiaITPHemophilia
-Stomatits
-hairloss
-dry skin
-Kolinychia
-Family hxAD
-An/Jaunice/spleen ↑
-Anemia(N,N)
-Hemmorhage
(platlet/Rash)
-LNpathy/Spleen↑
-Bruising
-Hemmorhagic rash
-Petechia
-All N except
Platlets
”Bleeding;
;;Chronic Hemmorah
arhtropathy
↓ Hb/MCV/MCH/Ferritin↑RD(11-14.5↑Reticul/MCH↓MCV
Tx:(Chemo)
-Induction
-Consolidation
-Suppotive
-Tx Relapse
^^Dx:
-Platlet↓
-All N
Dx:
-All N
-APTT(20-30)↑
-CF↓

nonS:
-phototherapy
-Folic Acid
-RBC
Splenctomy

Tx:
>30×109 Observe
-IV Immglob
-CSD
(Predinoslone/dexa)
-Replace
-RICE
***Nephro:
Pyelonpheritis
PSGN
”Coca Cola urine”
MCD
-T>38
-Flankpain
-US
-Pyuria
-Bacteriura
-Nitic
(Hematuria)
(oliguria)
(HBP)
-Notic
-Pale
-abd pain
Tx:
fluquonalone(Op/IV)
Cystitis
T
ESR
Freque /urgency
trimethrpim3-5D
Tx:
-Edema
(low NA/Prt/Loop)
-HBP
(ACE- /CCB)
-Ax(pencillin)
-GCD(severe)
Tx:
Steroid therapy
3-5 day
–>no imrp
Do Biopsy