Blood Component Replacement
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Transcript of Blood Component Replacement
Blood component ReplacementVolume of PRBC’s = EBV (ml) x DHCT – Actual
HCT of PRBC’s (0.55)Anion Gap
[Na] – ([HCO3] + [Cl])Normal: 12 meqs/L (range: 8-16meqs/L)Increased Anion GapDKARenal FailureLactic acidosisHyperglycemic Nonketotic ComaDisorders of AA metabolismLarge amount of PenicillinSalicylate poisoningEthylene glycol/methanol ingestionDecreased Anion GapNephrotic syndromeLithium ingestionMultiple myeloma
Epinephrine
Neonate
Asystole and Bradycardia
0.01 – 0.03 mkdose 1:10,000
0.1 – 0.3 ml/kg/dose IV/ET
Infants and Children
1st dose: 0.01 mg/kg 1:10,000
0.1 ml/kg max dose: 1 mg (10ml)
ET
Uncuffed in patients ≤ 8 y/o
Age in years + 4 (uncuffed) 4 + 3 (cuffed)
16 + age/4
Depth: 3x FT size
DopamineIVRF x (dopa) x 60 800 or 400800 – 1 cc dopa + 49cc D5W400 – 0.5 cc dopa + 49 cc D5W
Amino acidEmpiric dose: 2-3g/dayPreparation: 8%/100ml*
CalciumEmpiric dose: 200-400/dayPreparation: 100mg/ml* Wt x ED = mg/d x prep 1ml/100mg
SodiumEmpiric dose:Preparation: 2.5 meqs/mL* Wt x ED 2.5
PotassiumEmpiric dose:Preparation: 2 meqs/mL* Wt x ED 2
FeedingBreastmilk: 20 cal/30ml or 1 oz.
Formula: 24 cal/3oml or 1 oz.Total Caloric Input
Amount of feeding x Frequency x Cal 30cc = Present weight
Total Fluid Requirement
Amount of feeding x frequency Present weight
CPAPCA = 100 – F102 x CPAP 79O2 = CPAP – CA
TPNCompute for electrolytes first
(Na, K, Ca, AA)AA of milk – 10.48 x volume of feeding 1000
AA of milk – AA required = AA TPN
PEFR in 6-7 y/oMALES ( Height in cm – 100 ) 5+ 175FEMALES ( Height In cm – 100 ) 5+ 170Peak flow variability = Highest Reading - Lowest reading x 100 Highest reading
Estimated Blood Volume
Age Total Blood Volume (ml/kg)
Preterm 90-105Term 78-86
1-12 mos 73-781-3 years 74-824-6 years 80-867-18 year 83-90
WHO Treatment Plan for DehydrationPlan A ORS<24 months 50-100ml 500ml/day2-10 years 100-200ml 1000ml/day10 years or more As tolerated 2000ml/dayPlan B Moderate or Some DehydrationORS to be given in the 1st 4 hours* 75ml/kg BWPlan C Severe Dehydration: IV100ml/kg PLRS or PNSS
<12 mos older30ml/kg 1 hr 30 mins70ml/kg 5 hours 2 1/2hours
TPR of NewbornsBW 1-2
days3-4 days
7-30 days
<750 g 100-250 150-300 120-180
750-1000g 80-150 100-150 120-180
1000-1500g 60-100 80-150 120-180
>1500g 60-80 100-150 120-180
MNEMONICS FOR WEIGHTInfants < 6 mos Wt. in grams= (age in mos x 600) + BW
Infants 6-12 mos Wt. in grams= (age in mos x 500) + BW
≥ 2 years Wt. in Kg= (age in year x 2) + 8
6 to 12 yrs. Wt. in Kg= ((age in year x 7) – 5)/2
GIRDextrosity x desired rate x K (0.167) WeightNormal: 4-8 mg/kg/min
MNEMONICS FOR HEIGHTHeight in 1st year = 1.5 x birth lengthHeight in 2nd year= 30 inches or ½ of mature ht.(boys)
Height in 3rd year = 36 inches (3 ft)Height in 4th year = 40 inches or 2 x birth lengthHeight in 13th year = 3 x birth lengthHeight in cm = (age in years x 5) + 80
Z-SCORESLength/Height for AGE
Weight for AGE
Weight for
Length/Height
BMI for Age
Above 3
Very tall
Use weight for
length, BMI for age chart
OBESE
Above 2
NORMAL OVERWEIGHT
Above 1
POSSIBLE RISK OF OVERWEIGHT
MedianNORMALBelow
-1Below -2
STUNTED Underweight WASTED
Below -3
Severely Stunted
Severely Underweight
Severely Wasted
VITAL SIGNS AT VARIOUS AGE
AGE HR BP RRPremature 120-170 55-75/ 35-45 40-70
0-3 mos 100-150 65-85/ 45-55 35-553-6 mos 90-120 70-90/ 50-65 30-45
6-12 mos 80-120 80-100/ 55-65 25-401-3 yrs 70-110 90-105/ 55-70 20-30
3-6 yrs 65-110 95-110/ 60-75 20-25
6-12 yrs 60-95 100-120/ 60-75 14-22
12 (*) yr 55-85 110-135/ 65-85 12-18
IMMUNIZATIONS
BCG
Intradermal
< 12 months: 0.05 ml
> 12 months: 0.1 ml
HBV
Intramuscular
1st dose: at birth (within 24 hours): 0.5ml2nd dose: 1 month
3rd dose: 6 months
4th dose: 3rd dose given < 6 months; No birth dose given; Preterms, < 2 kgMeasles Vaccine
Subcutaneous
9 months but can be given as early as 6 monthsMMR
12 months
Booster: 4-6 years old
Given earlier: 4 weeks apart
MMR + Varicella
Subcutaneous
12-15 months
Booster: 4-6 years old
Provided that last dose is 3 months apart from last doseInfluenza
Intramuscular or Subcutaneous
February – June
2 doses separated by 4 weeks
HAV
Intramuscular
Recommended at 12 months
2nd dose: 6-12 months from 1st dose
Rotavirus
Monovalent: oral, 2 doses, 3 weeks – 14 weeks (<15weeks), minimum interval: 4 week, not later than 24 weeksPentavalent: oral 3 doses
Typhoid
Intramuscular
History of travel
Exposure to Salmonella typhi
2 years old, repeat every 2-3 years
MODIFIED GLASGOW COMA SCALE FOR INFANTS AND CHILDRENInfants Children Score
Eye Opening
spontaneously 4
verbal stimuli 3
pain 2No response 1
Verbal Coos and babbles
Oriented, appropriate
5
Irritable cries
Confused 4
Cries to pain Inappropriate words
3
Moans in response in pain
Incomprehensible words or nonspecific sound
2
No response 1Motor Response
Moves spontaneously and purposefully
Obeys commands6
Withdraws to touch
Localizes painful stimuli
5
Withdraws to pain 4
Responds to pain with decorticate posturing
Responds to pain with flexion
3
Responds to pain with decerebrate posturing
Responds to pain with extension
2
No response 1
HOLLIDAY SEGAR METHOD0-10 kg 100ml/kg10-20 kg 50ml/kg>20kg 20ml/kg** total ml/kg divided by 24 hours< 10y/o or < 40kg: D5IMB> 10y/o or >40kg: D5NM
DEFICIT THERAPY (DT)MILD MODERATE SEVERE
<2 y/o or <15kg
5%Wt x 50
10%Wt x 100
15%Wt x 150
>2 y/o or > 15kg
3%Wt x 30
6%Wt x 60
9%Wt x 90
X1 X1.3 X1.5** Run DT for 6 hours then re –assessSevere Dehydration
Two of the following signs:-Lethargic or unconscious-Sunken eyes-Not able to drink or drinking poorly-Skin pinch goes back very slowly
Some Dehydration
Two of the following signs:-Restless, irritable-Sunken eyes-Thirsty, drinks eagerly-Skin pinch goes back slowly
No Dehydration Not enough of the above signs to classify as some or severe dehydration
DEHYDRATIONSYMPTOMS MINIMAL MILD NTO SEVERE
NORMAL
OR NONE(<3% Loss of BW)
MODERATE(3-9% Loss of BW)
(>9% BW)
Mental Status
Well; alert
Normal, fatigued
or restless, irritable
Apathetic, lethargic, unconscious
Thirst Drinks normally, might refuse liquids
Thirsty; eager to drink
Drinks poorly;
unable to drink
Heart Rate
Normal to increased
Tachycardia with
bradycardia in most
severe casesQuality of Pulse
Normal to decreased
Weak, thread, or impalpable
Breathing Normal; fast
Deep
Eyes Slightly sunken
Deeply sunken
Tears Present Decreased AbsentMouth and Tongue
Moist Dry Parched
Skinfold Instant recoil
< 2 secs >2 secs
Capillary refill
Normal Prolonged Prolonged, minimal
Extremities
Warm Cool Cool; mottled, cyanotic
Urine Output
Normal to decreased
Decreased Minimal
GLASGOW COMA SCALE FOR <5 years oldBEST MOTOR RESPONSE (6) Spontaneous Localizes Normal Flexion Abnormal Flexion Abnormal Extension Flaccid
654321
VERBALIZATION (5) Appropriate for age Social smile Cries but consolable Persistently irritable Restless/Lethargic None
5
4321
EYE OPENING (4) Spontaneous To voice To pain Not at all
4321
MILD 14MODERATE 9-13SEVERE 3-8
KRAMER JAUNDICE SCALEFace TSB ~ 5 mg/dlMid-abdomen TSB ~ 15 mg/dlFeet excluding soles and palms
TSB ~ 20 mg/dl
Including soles and palms
TSB ~ 25 mg/dl
Grade 0 NoneGrade 1 Face and neck onlyGrade 2 Chest and backGrade 3 Abdomen below
umbilicus to kneesGrade 4 Arms and legs
below kneesGrade 5 Hands and feetRECOMMENDED ENERGY and NUTRIENT INTAKE PER DAY (RENI) From 0-18 years old
Population Group
Weight (kg)
Energy (kcal)
Protein (g)
Infants,mos Birth - <6 6- <12
69
560720
914
Children, 1-3 4-6 7-9
131924
107014101600
283843
Males, yrs 10-12 13-15 16-18 19-29 30-49 50-64 65+
34505859595959
2140280028402490242021701890
54717367676767
Females, yrs 10-12 13-15 16-18
354950
192022502050
496359
PRIMITIVE REFLEXESREFLEX APPEARS AT DISAPPEARS ATSuck Birth 3 mosRoot Birth 3 mosMonro Birth 4-6 mosTonic Neck Birth 6-7 mosBabinski Birth 2 yearsLandau 3 mos 12 mosParachute 7-9 mos Persists
throughout life
Walking/ Stepping
Birth 6 weeks
Palmar grasp Birth 5-6 mosGalant Birth 4-6 mosSwimming Birth 4-6 mosBabkin BirthPalmomental Present in various neurologic
conditions such as Down’sShout/ pouting
Infancy 1 year
FINDINGS: INTRACRANIAL HEMORRHAGECSF Color: Bloody CSF with xanthocromiaCSF Glucose: Normal or decreasedCSF Protein >45CSF Leukocytes: IncreasedCSF Opening Pressure: increased >200
TREATMENT of TYPHOID FEVER in CHILDRENOPTIMAL THERAPY ALTERNATIVE EFFECTIVE DRUGSSUSC. AB’ (mk/
day)D AB’ (mk/
day)D
UNCOMPLICATED TYPHOID FEVERFully Sensi
Chloram 50-75
14-21
Fluoroq Oflox or Cipro
15 5-7
Amox 75-100
14
MDR Fluoro or cefixime
15 5-7 Azithro 8-10
7
15-20
7-14
Cefixime 15-20
7-14
Quin resist
Azithro or Ceftri
8-10
7 Cefixime 20 7-14
75 10-14
SEVERE TYPHOID FEVERFully Sensi
Ampi or Ceftri
10060-75
1410-14
Oflox or cipro
15 10-14
MDR Fluoro 15 10-14
Cefrti or cefotax
60
80
10-14
Quin resist
Ceftri 60-75
10-14
Fluoro 20-30
14
ANTIBIOTICS USED for BACTERIAL MENINGITISNEONATES INFANTS and CHILDREN
DRUG 0-7 days 8-28 daysAmikacin 15-20
days20-30 divided q8h
20-30 divided q8h
Ampicillin 200-300 divided q8h
300 divided q4h or q6h
300 divided q4-6h
Cefotaxime 100 divided q12h
150-200 divided q8h or q6h
200-300 divided q8h or q6h
Ceftriaxone 100 divided q12h or q24h
Ceftazidine 150 divided q12h
150 divided q8h
150 divided q8h
Gentamicin 5 divided q12h
7.5 divided q8h
7.5 divided q8 h
Meropenem 120 divided q8h
Nafcillin 100-150 divided q8h or q12h
150-200 divided q8h or q6h
150-200 divided q4h or q6h
Penicillin G 250,000-450,000 divided q8h
450,000 divided q6h
450,000 divided q4h or q6h
Rifampicin 20 divided q12h
Tobramycin 5 divided q12h
7.5 divided q8h
7.5 divided q8h
Vancomycin 30 divided q12h
30-45 divided q8h
60 divided q6h
RECOMMENDED ERADICATION THERAPIES for H. pyloriMedications Dose Duration of
TreatmentAmoxicillin 50 mg/kg/day in 2
divided doses14 days
Clarithromycin 15 mg/kg/day in 2 divided doses
14 days
PPI 1 mg/kg/day in 2 divided doses
1 month
orAmoxicillin 50 mg/kg/day in 2
divided doses14 days
Metronidazole 20 mg/kg/day in 2 divided doses
14 days
PPI 1 mg/kg/day in 2 divided doses
1 month
orClarithromycin 15 mg/kg/day in 2
divided doses14 days
Metronidazole 20 mg/kg/day in 2 divided doses
14 days
PPI 1 mg/kg/day in 2 divided doses
1 month
FINDINGS: BACTERIAL MENINGITISSee Nigrovic Clinical Decision RuleCSF Color: Cloudy CSFCSF Glucose much less that 50CSF Protein much greater that 45CSF Leukocytes: Markedly inc.NeutrophilsCSF Opening Pressure: increased >200
FINDINGS: FUNGAL MENINGITISCSF Color: Clear to Cloudy FluidCSF Glucose <50CSF Protein >45CSF Leukocytes: Monocytes increasedCSF Opening Pressure: increased
FINDINGS: VIRAL MENINGITISCSF Color: Clear to Cloudy FluidCSF Glucose: NormalCSF Protein >45CSF Leukocytes: Increased CSF LymphocytesCSF Opening Pressure: Normal or increased
FINDINGS: GUILLAIN-BARRECSF Color: Clear to Cloudy FluidCSF Glucose: NormalCSF Protein much greater than 45CSF Leukocytes: Lymphocytes N’ or inc.CSF Opening Pressure: Normal
FINDINGS: NEUROSYPHILIS1. CSF Color: Clear to Cloudy Fluid2. CSF Glucose: Normal3. CSF Protein >454. CSF Leukocytes: Monocytes inc.5. CSF Opening Pressure: N’ or inc.
FINDINGS: TUBERCULOSIS MENINGITIS1. CSF Color: Cloudy Fluid2. CSF Glucose <503. CSF Protein >454. CSF Leukocytes
a. Early: Neutrophils inc.
b. Later: Lymphocytes inc.
FINDINGS: NEOPLASM
CSF Color: Clear to xanthochromic
CSF Glucose: Normal or decreased
CSF Protein: Normal or increased
CSF Leukocytes: Normal or inc. lymphocytes
CSF Opening Pressure: increased >200
INFECTIVE ENDOCARDITISStrep Viridians – most common, use Pen G and gentamycinStaph Aureus – 2nd most common, use Methicillin and gentamycin
RHDRevised jones criteriaMajor CriteriaArthritis most commonCarditisErythema MarginatumSydenham’s ChoreaSubcutaneous nodulesMinor CriteriaArthralgiaFever < 39CElevated acute phase reactants ESR, CRPProlonged PR intervalDiagnosis via 2 major or1 major + 2 minorPrevious grp A strepRHDMitral regurg/stenosis on PELV/ RVH on ECGIrregular cardiac borders on X-ray
PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA CLASSIFICATION
pCAP A or B
Non-Severe
pCAP C
ISEVERE
pCAP D
Pneumonia IIVERY SEVERE
VARIABLESCLINICALDehydration NONE MILD MODERATE SEVEREMalnutrition NONE MODERATE SEVEREPallor NONE PRESENT PRESENTRespiratory rate3 to 12 mos1 to 5 y/0> 5 y/o
≥50- ≤60≥40/ ≤50≥30/ ≤35
>60 - ≤70>50>35
>70>50>35
Signs of respiratory failureRetractionHead bobbingCyanosisGruntingApneaSensorium
NONENONENONENONENONENONE
IC/ SubcostalPRESENTPRESENTNONENONENONEIRRITABLE
Supraclav/IC/SCPRESENTPRESENTPRESENTPRESENTLethargic/ Stuporous/Coma
Diagnostic aidChest X-ray findings of any of the ff: effusion, abscess, air leak, or lobar consolidation
NONE PRESENT PRESENT
Oxygen saturation (RA) 95% <95% <95%
ACTION PLANSite-of-care OP Admit to Ward Admit to ICUFollow-up End of
treatment
ACTIVE RF1.Joint symptoms2. Murmurs3. Inc. heart size4. CHF5. Subcutaneous Nodules6. Sleeping pulse rate of > 100/min7. + C-reactive protein8. Consecutive fever for 3 daysTreatment for RFPen G/ Benzathine given once (ED: 100K-400K)Penicillin V/Phenoxy methyl Penicillin 2-3
times per day given for 10 daysErythromycin 2-4 times per day given for 10 daysDiagnosis via 2 major or 1 major + 2 minorPrevious grp A streptococcal infection
GENERIC BRAND PREP ED FREQAl OH + Mg OH MAALOX <6mos=o.5ml
>6mos: 1mlQID
Al OH + Mg OH + simethicone
MAALOX PLUS
<6mos:o.5ml>6mos: 1ml
QID
Ambroxol Hcl
AMBROLEX
30mg/5ml15mg/5ml7.5mg/1ml
Wt x 0.2 TID
Amoxicillin HIMOXGLOBAPEN
250mg/ 5ml100mg/1ml
30-50 mkd TID at lowest doseBID at high dose
Azithromycin PEDIAZITH
200mg/5ml100mg/1ml
10mkd OD
BPM + PPA PEDIATAPPZEDITAPP
Wt x 0.2 TID
Bacillus clausii ERCEFLORA
1-2 plastic tube
BID
Betamethasone + Gentamycin +Clotrimazole
TRIDERM
BID for 2 weeks
Bromhexine BISOLVON
2mg/ 1ml4mg capsule
Wt x 0.2
Cefaclor RITE MED
250mg/ 5ml125mg/5 ml50mg/ml
20-40mkd Q8
Cefalexin CEFALIN 250mg/ 5ml125mg/5ml100mg/1ml
25-100mkd Q6
Cefixime TERGECEF
100mg/5ml20mg/1ml
Infant: 8mkd
Acute UTI: 16mkd
8mkd
Q12
Q12 for 1st
day
Q24 for 13 days
Ceftriaxone XTENDA 1gm + 10ml vial
1-5mos: 100-200mkd
>/=6mos-child: 150-200mkd
Q6
Q6
Cefuroxime KEFOX 750mg/vial
250mg/vial
Neonates: 50-100mkd
Children: 75- 150mkd
Q12
Q8Cetirizine diHcl ALNIX 5mg/
5ml<6y/o: 2.5mkd
>6y/o: 5-10mkd
OD
Cetirizine + phenylephrine
ALNIX PLUS
5mg/5ml
<6y/o: 2.5mkd>6y/o: 5-10mkd
OD
Chloramphenicol palpitate
CHLOROCAIRE
125mg/5ml
</= 2kg: 25mkd
>2kg: 50mkd
OD
Q12CPM + phenylephrine
DISUDRIN
WT X 0.2
CPM + Dexa + Guia + PCT+ PPA
DYNATUSSIN
WT X 0.2
Cloxacillin RITE MED
125mg/5ml
25-50mkd QID
Co-amoxiclav (Amoxicillin + Clavulanic Acid)
NATRAVOX/AUG
MENTIN
250mg/
625mg/5ml
625mg/tab
<3mos: 30mkd
>3mos: 20-40mkd
25-45mkd
BID
TIDBID
Domperidone VOMETA 5mg/5ml
5mg/1ml
Wt x 0.2
Ferrous sulfate + Folic Acid + B complex
Ferlin dropsFerlin syrup
15ml120ml
Premature: 2-4mkd
Child: 3-6mkd
OD-BID
OD-TID
Gentamycin + Betamethasone + Clotrimazole
COMDIDERM
BID for 2 weeks
Gentiane Radix SINUPRET
Wt x 0.2
Leviteracetam
KEPPRA 100mg/5ml500mg/tab
10-30mkd
BID
Mupirocin Ointment
FOSKINA TID for 7 days
Mupirocin + Betameth
FOSKINA-B
BID for 2 weeks
Monmtelukast
MONTAIR
4mg5mg10mg
6mos-5yrs: 4mg6-14yrs: 5mg>14yrs: 10mg
OD
Mometasone furoate
ELICA OD
Racecadotril
HIDRASEC
10mg/sach30mg/sach100mg/cap
1.5mkd TID
Racemic Epinephrine
2.25% 0.5ml via nebulizer
<4yrs: 0.05mkd + 3ml NSS over 15 min PRN
>4yrs: 1amp +3ml NSS over 15 mins PRN
Q1-2
Q3-4
RifampicinIsoniazid +
KIDZKIT 3 (1st 2
200mg/5ml200mg/5ml
10mkd10mkd
OD
Pyrazinamide
mos) 250mg/5ml 15mkd
RifampicinIsoniazid
KIDZKIT2 200mg/5ml200mg/5ml
10mkd10mkd
Salbutamol + Guiafenasin+ Bromhexine
PECOF WT X 0.2
Zinc Oxide + Calamine
Calmoseptine
TID for 3-5 days
Zinc Sulfate E-Zinc 55mg/5ml27.5mg/1ml
Zinc Sulfate + Vitamin C
PEDZINC <6mos: 10 elem zinc>6mos: 20 elem zinc
DRUGS PREP EMPIRIC FREQAmikacin IV / IM: 15-22.5
mkdQ8
Amoxicillin 50/1100mg/ml - drops125/5250/5 - suspension
30-50 mkd40-80 mkd40: for virgin PN cases
TID
Ampicillin 125/5250/5
100-200 mkd Q6
Cefaclor 125/5 187/5250/5 375/5
20-40 mkd BID-TID/Q8
Cefalexin 125/5250/5
25-100 mkd Q6
Cefixime 100/520/1
6-8 mkd BID
Ceftazidime IV: 90-150 Q8Ceftriaxone IM/IV: 50-75 mkd BIDCefuroxime 125/5
(750mg/vial)250/5
O: 20-40I: 75-150
BID/Q12Q8
Cetirizine 2.5/ml5/5
<6y: 0.25>6y: 5-10
OD
Chloramphenicol
125/5 O: 50-75 QID
Clarithromycin
125/5250/5
O: 15 mkd BID
Cotrimoxazole
400/80/5200/40/5
6-8 BID
Cloxacillin 125/5 O: 50-100IV:100-200
QIDQ4/Q6
Co-amoxiclav
156.25/5228/5ml312.5/5 – 250mg Amox457/5 ml
30-50 mkd20-40 mkd25-40 mkd
Q12BIDTIDBID
Diazepam 1/15/1
IV: 0.04-0.2PO: 0.12-0.8 mkdRectal: 0.5
Q2-4Q6-8
Diphenhydramine
6.25/512.5/5
1mkd5 mkd
StatQ6
Diloxanide 20-40 mkd TIDErythromycin
30-50 mkd Q6-8
Furosemide 1-2 mkdGentamicin 10/1
40/17.5 mkdIV: 5-8
Q8
Ibuprofen 100/5200/5
5-10 mkdose Q6
INH 50/5 10-15 QIDMeropenem 60Metronidazole
125/5 35-5015-20 Giardia
TID
Oxacillin 250/5 50-100 mkdIV: 100-200
Q6Q4/Q6
Paracetamol 100/1 -drops120/5250/5
10-20 Q4
Pen G Na 100,000-400,000 ukd300,000-400,000 ukd – meningitic dose
Q4-6
Piperacillin-tazobactam
<6y: 150-300 mkd IV>6y: 300-400 mkd IV
PPA (Phenyl-propanolamine)
12.5/5250/5
12 BID-TID
Pyrazinamide
15
Ranitidine O: 2-4IV: 2-6
Rifampicin 10-20SMX-TMP 200/40/5 6-8 mkd BIDZinc 55/5 10: < 6 months old
20: > 6 months oldOD
KAWASAKI DISEASEDiagnostic criteria:Remittent fever (41C) persisting for more than 5 daysBilateral conjunctival infection without exudatesStrawberry tongue, erythema and cracking of the lipsErythema and edema od the hands and feetPolymorphous exanthemsUnilateral CLAD > 1.5 CMTreatment: IVIG-treatment of choice -2 g/kg/day Aspirin 80-100 mg/kg/dayDiagnosis: serial 2d echo aneurysm seenACUTE STAGE
Intravenous immunoglobulin 2 g/kg over 10-12 hr
AND
Aspirin 80-100 mg/kg/day divided every 6 hr orally until patient is afebrile for at least 48 hr
CONVALESCENT STAGEAspirin 3-5 mg/kg once daily orally until 6-8 wk after illness onset
LONG-TERM THERAPY FOR PATIENTS WITH CORONARY ABNORMALITIES
Aspirin 3-5 mg/kg once daily orally
Clopidogrel 1 mg/kg/day (max 75 mg/day)
• Most experts add warfarin or low-molecular-weight heparin for those patients at particularly high risk of thrombosis
ACUTE CORONARY THROMBOSIS• Prompt fibrinolytic therapy with tissue
plasminogen activator or other thrombolytic agent under supervision of a pediatric cardiologist
IES EXPOSURECATEGORY EXPOSURE MANAGEMENTCATEGORY 1
Feeding or touching an animalLicking of intact skinExposure to patients with s/sx of rabies by sharing or eating or drinking utensilsCasual contact to patients with s/sx of rabies
Wash exposed skin stat w/ soap & H2ONO VACCINES OR RIG NEEDEDMay opt to give pre-exposure prophylaxis
CATEGORY 2
Nibbling or nipping of uncovered skin with bruisingMinor scratches or abrasions without bleedingLicks on broken skin
COMPLETE VACCINATION UNTIL DAY 30(If animal is rabid, died, killed, or unavailable for 14 day observation or died w/in 14 days)
CATEGORY 3
Transdermal bites or scratchesMucous membranes contamination with salivaHandling of infected carcass or ingestion of raw infected meatCategory II on head and neck areaExposure to rabies patient contamination of mucous membranes with saliva or fluid through platerring
START VACCINE AND RIG IMMEDIATELY
STRICT
DENGUE PRECAUTIONS
Throw cans or tires to avoid breeding grounds for mosquitoesCover water containersUse insecticides to kill the vectorUse mosquito repellants and mosquito nets
STRICT
ALLERGIC PRECAUTIONS
Avoid exposure to cold air, smoke, and pollensAvoid hair sprays, gel, strong perfume, fabric softener, powders, cosmetic, and chalk dustWear warm clothingUse hypoalleregenic sheets and pillowsDo not use wool blankets and furry stuffed toysKeep child away from dogs, cats, hamsters, mice and other petsWash curtains and shampoo rugsClean child’s room regularly
STRICT
ENTERIC PRECAUTIONS
Proper hand washing before eating and after using the toiletProper hand washing before handling and preparing food and cleaning utensils used for preparation and cooking of foodBoil drinking water for 15 minutes or moreCook food thoroughlyWash all fruits and vegetables to be eaten rawKeep fingernails clean and short
CLASSIFICATION of SEX MATURITY STATES in GIRLS
SMR STAGE
PUBIC HAIR BREASTS
1 Preadolescent Preadolescent2 Sparse, lightly
pigmented, straight, medial border of labia
Breast and papilla elevated as small mound; diameter of areola increased
3 Darker, beginning to curl, increased amount
Breast and areola enlarged, no contour separation
4 Coarse, curly, abundant, but less than in adult
Areola and papilla form secondary mound
5 Adult feminine triangle, spread to medial surface of thigh
Mature, nipple projects, areola part of general breast contour
BOYSSMR STAGE
PUBIC HAIR SCROTUM
1 None Preadolescent2 Scanty, long,
slightly pigmented
Enlarge scrotum, pink, texture altered
3 Darker, starting to curl, small amount
Larger
4 Resembles adult type, but less quantity, coarse, curly
Larger, scrotum dark
5 Adult distribution, spread to medical surface of thigh
Adult size
AlbuminPremature 1 dayFull term <6 days<5 years old5-19 years
1.8-3.0 g/dl2.5-3.4 g/dl3.9-5.0 g/dl4.0-5.3 g/dl
SodiumNewbornInfantChildThereafter
134-146 mmol/L139-146 mmol/L138-145 mmol/L136-146 mmol/L
Potassium<2 months2-12 months>12 months
3.0-7.0 mmol/L3.5-6.0 mmol/L3.5-5.0 mmol/L
ChlorideCord bloodNewbornThereafter
96-105 mmol/L97-110 mmol/L98-106 mmol/L
Bicarbonate (HCO3)ArterialVenous
21-28 mmol/L22-29 mmol/L
Carbon Dioxide Partial Pressure (PCO2)NewbornInfantThereafter MThereafter F
27-40 mmHg27-41 mmHg35-48 mmHg32-45 mmHg
GlucoseCord bloodPrematureNeonateNewborn1 day>1 dayChildAdult
45-96 mg/dl20-60 mg/dl30-60 mg/dl
40-60 mg/dl50-90 mg/dl60-100 mg/dl70-105 mg/dl
CreatinineCord bloodNewbornInfantChildAdolescentAdult MAdult F
0.6-1.2 mg/dl0.3-1.0 mg/dl0.2-0.4 mg/dl0.3-0.7 mg/dl0.5-1.0 mg/dl0.6-1.2 mg/dl0.5-1.1 mg/dl
Creatinine clearance: newborn 40-65
ml/min/1.73 m2 | <40 yr,M: 97-137, F: 88-128Calcium TotalCord bloodNewborn (3-24 hours)24-48 hours4-7 daysChildThereafter
9.0-11.5 mg/dl9.0-10.6 mg/dl7.0- 12.0 mg/dl9.0-10.9 mg/dl8.8-10.8 mg/dl8.4-10.2 mg/dl
Calcium IonizedCord bloodNewborn (3-24 hours)24-48 hoursThereafter
5.0-6.0 mg/dl4.3-5.1 mg/dl4.0-4.7 mg/dl4.8-4.92 mg/dl
BUNCord bloodPremature (1 wk)NewbornInfant or childThereafter
21-40 mg/dl3-25 mg/dl3-12 mg/dl5-18 mg/dl7-18 mg/dl
Hematocrit1 day2 days3 days2 months6-12 months12-18 months M12-18 months F18-49 years M18-49 years F
48-69%48-75%44-72%28-42%35-45%37-49%36-46%41-53%36-46%
Hemoglobin1-3 days2 months6-12 years12-18 years M12-18 years F18-49 years M18-49 years F
14.5-22.5 g/dl9.0-14.0 g/dl11.5-15.5 g/dl13.0-16.0 g/dl12.0-16.0 g/dl13.5-17.5 g/dl12.0-16.0 g/dl
WBCBirth12 hours1 month1-3 years4-7 years8-13 yearsAdult
9.0-30.0 x 1,000/mm39.4-34.0 x 1,000/mm35.0-19.5 x 1,000/mm36.0-17.5 x 1,000/mm35.5-15.5 x 1,000/mm34.5-13.5 x 1,000/mm34.5-11.0 x 1,000/mm3
MyelocytesNeutrophils-bandsNeutrophils-segmentersLymphocytesMonocytesEosinophilsBasophils
0%3-5%
54-62%
25-33%3-7%1-3%0-0.75%
Plt ct NEWBORN: 84-478 x 10^6 (after 1 wk, same as adult)
Plt ct ADULT: 150-400x10^6