The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of...
-
Upload
avis-adams -
Category
Documents
-
view
214 -
download
1
Transcript of The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of...
![Page 1: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/1.jpg)
The Sick Infant: Five Deadly Misconceptions
Todd Wylie, MDUniversity of Florida
Department of Emergency MedicineJune 25 - 27, 2009
![Page 2: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/2.jpg)
Case 1
• 6 month female with fever to 103.6
![Page 3: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/3.jpg)
Misconception
Immunizations have eliminated the need to perform any laboratory
studies on febrile infants!
![Page 4: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/4.jpg)
Febrile InfantProtocol
![Page 5: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/5.jpg)
Febrile Infant
Immunization Status?
![Page 6: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/6.jpg)
Case 2
• 4 month male with 1 day history of high fever and lethargy
![Page 7: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/7.jpg)
Misconception
1) Kids are just small adults!
2) Kids are a totally different species!
![Page 8: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/8.jpg)
Sepsis
• What’s different?
![Page 9: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/9.jpg)
Sepsis
• What’s similar?
![Page 10: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/10.jpg)
![Page 11: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/11.jpg)
Case 3
• 3 month female– 3 days of fever, cough,
rash, conjunctivitis
![Page 12: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/12.jpg)
Misconception
Kids will read the textbook prior to presenting with a myriad of signs and symptoms!!
![Page 13: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/13.jpg)
Kawasaki Disease• Five or more days of
fever
![Page 14: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/14.jpg)
Kawasaki Disease
• 4 out of 5– Conjunctivitis– Rash– Extremity
changes– Cervical
adenopathy– Mucositis
![Page 15: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/15.jpg)
Incomplete (“Atypical”) Kawasaki Disease
• Lack sufficient clinical signs to fulfill the classic criteria
![Page 16: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/16.jpg)
Incomplete (“Atypical”) KawasakiDisease
• Age
• Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals…Pediatrics 2004; 114: 1708-1733.
• Prevalence
![Page 17: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/17.jpg)
Incomplete (“Atypical”) KawasakiDisease
• Age
• Genizi J, Miron D, Spiegel R, Fink D, Horowitz Y. Kawasaki Disease in Very Young Infants: High Prevalence of Atypical Presentation and Coronary Arteritis. Clin Pediatr 2003; 42: 263-267.
• Coronary artery abnormalities
![Page 18: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/18.jpg)
Case 4
• 8-day old female with poor feeding, fever, and grunting respirations
![Page 19: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/19.jpg)
Misconception
The sick neonate has been adequately treated with antibiotics alone
![Page 20: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/20.jpg)
Neonatal HSV
Skin-Eye-Mouth CNS Disseminated
Onset (days) 5-11 days 8-17 days 5-11 days
Clinical findings
Vesicles Irritable, Lethargy
Seizures
Jaundice
Resp. distress
Irritable
Mortality untreated
Up to 70% progress
50% 90%
Mortality treated
0 15% 54%
![Page 21: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/21.jpg)
Neonatal HSV
![Page 22: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/22.jpg)
Neonatal HSV
The Prevalence of Neonatal Herpes Simplex Virus Infection Compared with Serious Bacterial
Illness in Hospitalized Neonates
Caviness AC, Demmler GJ, Almendarez Y, Selwyn BJ.J Pediatr 2008;153:164-9
![Page 23: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/23.jpg)
Neonatal HSV
• When should we start empiric acyclovir treatment in sick neonates?
• Clear index of suspicion for HSV– Skin vesicles– Seizures– Elevated hepatic
transaminases
![Page 24: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/24.jpg)
Neonatal HSV
• When should we start empiric acyclovir treatment in sick neonates?
• Sepsis-like picture– Respiratory distress– Hypothermia– Lethargy – Appears more ill than
would be expected
![Page 25: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/25.jpg)
Neonatal HSV
• When should we start empiric acyclovir treatment in sick neonates?
• CSF pleocytosis– Mononuclear cell
predominance
![Page 26: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/26.jpg)
Neonatal HSV
• When should we start empiric acyclovir treatment in sick neonates?
• Age < 21 days and fever?
![Page 27: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/27.jpg)
Case 5
• 9 month male presents following a generalized seizure…noted to have fever to 103.4
![Page 28: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/28.jpg)
Misconception
1) You don’t have to do a spinal tap anymore!
2) You always have to do a spinal tap!
![Page 29: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/29.jpg)
Febrile Seizure and Meningitis
• What is the risk of meningitis in patients with a febrile seizure?
![Page 30: The Sick Infant: Five Deadly Misconceptions Todd Wylie, MD University of Florida Department of Emergency Medicine June 25 - 27, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022032803/56649e385503460f94b29bf4/html5/thumbnails/30.jpg)
Febrile Seizure and Meningitis
• Indications for a spinal tap