Good Morning! Welcome Applicants! FRIDAY, N OVEMBER, 7 TH 2014
|
|
- Gerard Short
- 6 years ago
- Views:
Transcription
1 Good Morning! Welcome Applicants! FRIDAY, N OVEMBER, 7 TH 2014
2 Prep Question You are camping with a group of boys at a rural campground in the southeastern Unites States when one of the campers is bitten by a snake. His tent mates kill the snake (see Figure). The victim is crying and guarding his right hand. On examination of the boy s hand, you note several small, erythematous abrasions but no swelling or ecchymosis. Of the following, the MOST appropriate course of action is to: A. Apply a tourniquet above the bite B. Apply ice to the wound C. Incise and suction the wound D. Provide local wound care E. Transport the boy to the hospital for antivenom
3
4
5 Laboratory Findings CBC WBC H/H 13.8/39.9 PLT 141 Differential: Seg 48 Bands 5 Lymphs 20 Monos 25 Basos 1 Metamyelos 1 CMP Glucose: 62; Calcium 9.7 TP/Alb/AST/ALT/TB/AP/MAG: within normal limits
6 Laboratory Findings Urinalysis Specific gravity Nasal Aspirate: negative ph 7.0 Leuk esterase/nitrite: negative WBC 0-2 No blood, ketones, glucose, reducing substances, RBC s, Bacteria CSF Colorless/clear WBC4 RBC 388 Differential: Neutrophils 10 lymphocytes 17 monocytes 53 eosinophils 20 Glucose: Gram stain: no microbes, many RBC s Protein: 54
7 7 - DAY- OLD, EX / 7 W GA MALE WITH FEVER, LETHARGY, AND THROMBOCYTOPENIA R U L E O U T S E P S I S / S E R I O U S B A C T E R I A L I N F E C T I O N Febrile Neonates and Young Infants
8 Tradition dictates Neonates (<28 days old) and young infants (29-90 days of age) gives us few clues that they have serious bacterial infections (SBI). Sepsis Bacteremia Urinary tract infections Meningitis Pneumonia Bacterial gastroenteritis Osteomyelitis/SSTI Septic arthritis So we proceed with aggressive laboratory investigation and often empiric antibiotics Categories <28 days of age days of age 3-36 months of age
9 Just the Facts The incidence of SBI s in neonates (0-28 days) is % of febrile infants Bacterial meningitis is more common in the 1 st month of life than any other time. Early vs. late GBS No current established, widely-accepted guidelines for evaluation and/or treatment of neonates/young infants who have fever without a localizing source. Hib and pneumococcal vaccines introduced less occult bacteremia Antibiotic resistance rising
10 What do we do with febrile neonates??
11 How do we work them up? Thorough History and Physical Exam Fever: What if mom reports fever at home but none documented in ER? = Fever What if patient is heavily swaddled? If low-grade, unswaddle and repeat in 15 min; If high-grade = Fever CBC with differential, BMP/CMP, UA and Urine culture, Blood culture, CSF with studies Laboratories: +/- viral studies (viral panel) +/- stool studies +/- CRP/PCT Imaging: +/- CXR 38 C or F +/- other imaging as dictated by history/clinical suspicion All neonates (<28 days old) should: (1) be admitted to the hospital, (2) have blood, urine, CSF cultures taken, and (3) have empiric antibiotic started regardless of how well-appearing they may be!
12 What bugs are we worried about? Community-acquired infections Group B Strep HSV What s the most common cause of fever? Viral infection! E. Coli Listeria
13 So should we do some antibiotics? Any other medications you would consider? Ampicillin + gentamicin OR Ampicillin + cefotaxime *gentamicin resistance Better CSF penetration? Penicillin-resistant Strep peumo = vancomycn Acyclovir Indications for Acyclovir: Ill-appearing Lethargy/change in mental status Mucocutaneous vesicles consistent with HSV Seizures CSF pleocytosis Elevated liver enzymes If bacterial cultures are negative at hours but patient has no clinical improvement
14 Length of Treatment Depends on the scenario If bactermic/septic/meningitic typically days If afebrile and cultures all remain negative, treat hours at least If persistently febrile, treat longer *Virus is identified = low risk for SBI (3-10%)
15
16
17 What about the older infants?
18 CASE 1 You are seeing a 57-day-old male in the emergency department. Mom reports the patient has been vomiting for the past 12 hours and is becoming more difficult to arouse. She thought he felt warm at home but did not take a temperature. She reports fewer wet diapers today. In the ED, the patient is irritable with an axillary temperature is F, and you note a dry cough. What work-up is indicated? Hospitalize or discharge? CBC with diff, UA, Blood/Urine/CSF cultures, CSF studies, Viral Panel, CXR Hospitalize! Antibiotics or no antibiotics? Antibiotics! If yes, which antibiotics? Ampicillin +/- cefotaxime/ceftriaxone +/- Vancomycin All infants (29-90 days old) who are ill appearing should: (1) be admitted to the hospital, (2) have blood, urine, CSF cultures taken, and (3) have empiric antibiotic started!
19 Bugs? Antibiotics? Group B Strep Ampicillin E. coli Cefotaxime/Ceftriaxone Listeria +/- Vancomycin Herpes Simplex Virus +/- Acyclovir Salmonella Neisseria meningitides Streptococcus pneumonia Haemophalus influenza type B Staphylococcus aureus Most common cause of fever: viral infections! Which bugs are you most worried about?
20 CASE 2 You are seeing a 74-day-old male in the emergency department. The patient s mother thought he felt warm at home but did not take a temperature. However, her mother (the infant s grandmother) insisted she bring him to the ED for evaluation. She reports he is in his usual state of health. She denies lethargy, runny nose, cough, difficult with feeds, emesis, rash, and diarrhea In the ED, the patient with an axillary temperature is F. He smiles back at you and reaches for toys that you dangle in front of him. What work-up is indicated?
21
22 CASE 2 You are seeing a 74-day-old male in the emergency department. The patient s mother thought he felt warm at home but did not take a temperature. However, her mother (the infant s grandmother) insisted she bring him to the ED for evaluation. She reports he is in his usual state of health. She denies lethargy, runny nose, cough, difficult with feeds, emesis, rash, and diarrhea In the ED, the patient with an axillary temperature is F. He smiles back at you and reaches for toys that you dangle in front of him. What work-up is indicated? CBC with diff, UA, Blood/Urine cultures, +/- CSF studies and culture* Hospitalize or discharge? Consider discharge IF ALL LABS REASSURING! Follow-up in 24 hours!!! Antibiotics or no antibiotics? +/- Antibiotics!* If yes, which antibiotics? Ceftriaxone If this patient tested positive for RSV, would it change your management plan? May do close outpatient follow-up without antibiotics
23 Infants days of age
24 Case 3 You are seeing a 7-month-old male in the emergency department. The patient s mother thought he felt warm at home and reports an axillary temperature of F. She brings him to the ED for evaluation because of the fever. The patient has not had lethargy, runny nose, cough, difficult with feeds, emesis, rash, or diarrhea In the ED, the patient with an axillary temperature is 98.9 F. He sits unsupported and smiles back at you as you examine him. What work-up is indicated?
25 3-36 Month Old Infants Risk Factors for Occult bacteremia Temperature 39 C WBC count 15,000/µL Elevated absolute neutrophil count or band count Elevated erythrocyte sedimentation rate Elevated CRP C-reactive protein Immunization Status*
26
27 Case 3 You are seeing a 7-month-old male in the emergency department. The patient s mother thought he felt warm at home and reports an axillary temperature of F. She bring him to the ED for evaluation because of the fever. The patient has not had lethargy, runny nose, cough, difficult with feeds, emesis, rash, or diarrhea In the ED, the patient with an axillary temperature is 98.9 F. He sits unsupported and smiles back at you as you examine him. What work-up is indicated? Any other history needed? Hospitalize or discharge? Antibiotics or no antibiotics? CBC with diff*, CRP/ESR*, UA*, Urine cultures* Immunizations Status Consider discharge IF ALL LABS REASSURING! Follow-up in 24 hours!!! No antibiotics
28 Bugs? Antibiotics? E. coli Ceftriaxone Listeria +/- Vancomycin Salmonella Neisseria meningitides Streptococcus pneumonia Haemophalus influenza type B Staphylococcus aureus Most common cause of fever: viral infections! Which bugs are we most worried about?
29 Case 4 You are seeing a 7-month-old male in the emergency department. The patient s mother thought he felt warm at home and reports an axillary temperature of 103 F. She bring him to the ED for evaluation because of the fever. The patient has not had lethargy, runny nose, cough, difficult with feeds, emesis, rash, or diarrhea In the ED, the patient with an axillary temperature is F. He sits unsupported and smiles back at you as you examine him. Does the increase in temperature change your management plan? Yes! If Yes, why? Threshold to search for occult bacteremia 39 C (102.2 F) How would you treat this patient? CBC with diff, Blood culture and EITHER -Empiric antibiotics (Ceftriaxone) -Outpatient observation *Urine studies
30 Bugs? Antibiotics? E. coli Ceftriaxone Listeria +/- Vancomycin Salmonella Neisseria meningitides Streptococcus pneumonia Haemophalus influenza type B Staphylococcus aureus Most common cause of fever: viral infections! Which bug(s) are you most worried about?
31 What if a culture comes back positive?!? Depends on the age, clinical situation If CSF is positive treat (inpatient) If urine culture is positive treat (inpatient or outpatient) Proceed with work-up for VUR accordingly If blood culture is positive repeat it! Assess organism (is this a contaminant) AND assess patient proceed accordingly Strep pneumonia in older infants (>3 months) can potentially be treated outpatient It even spontaneously resolves in 30-40% of patients!
32 Summary Lesson 1: Babies are TRICKY! But don t let em scare ya! Any TOXIC-appearing child 0-36 months with temperature >38 C needs a full, rule-out sepsis work-up AND antibiotics. <28 day-old, REGARDLESS OF APPEARANCE admit, full workup, antibiotics Any TOXIC-appearing child 0-36 months with temperature >38 C needs a full, rule-out sepsis work-up AND antibiotics days old If ill-appearing admit, full work-up, antibiotics If well-appearing may consider outpatient close follow-up +/- antibiotics If prescribing empiric antibiotics, gather cultures first! 3-36 month old Threshold for occult bacteremia source search/empiric antibiotics: Temp of 39 C/ WBC 15,000 Immunizations must be considered May consider outpatient follow-up if low-grade temp and normal CBC May consider outpatient (or inpatient) antibiotic treatment (after blood cultures) if clinically stable!
33 CSF HSV1/HSV PCR: Negative CSF culture: No growth Blood culture: No growth Urine culture: No growth Ultimately Discharged to home with diagnosis of viral syndrome
34 Have a great day! Noon conference: Intern Lecture Series Introduction to EBM
Fever in the Newborn Period
Fever in the Newborn Period 1. Definitions 1 2. Overview 1 3. History and Physical Examination 2 4. Fever in Infants Less than 3 Months Old 2 a. Table 1: Rochester criteria for low risk infants 3 5. Fever
More informationFever Without a Source Age: 0-28 Day Pathway - Emergency Department Evidence Based Outcome Center
Age: 0-28 Day Pathway - Emergency Department EXCLUSION CRITERIA Toxic appearing No fever Born < 37 weeks gestational age INCLUSION CRITERIA Non-toxic with temperature > 38 C (100.4 F) < 36 C (96.5 F) measured
More informationFever in neonates (age 0 to 28 days)
Fever in neonates (age 0 to 28 days) INCLUSION CRITERIA Infant 28 days of life Temperature 38 C (100.4 F) by any route/parental report EXCLUSION CRITERIA Infants with RSV Febrile Infant 28 days old Ill
More informationBeyond the Reflex Arc: An Evidence-Based Discussion of the Management of Febrile Infants
Beyond the Reflex Arc: An Evidence-Based Discussion of the Management of Febrile Infants Cole Condra, MD MSc Division of Emergency Medical Services Children s Mercy Hospital October 1, 2011 Disclosure
More information1. Introduction Algorithm: Infant with Fever 0-28 Days Algorithm: Infant with Fever Days...3
These guidelines are designed to assist clinicians and are not intended to supplant good clinical judgement or to establish a protocol for all patients with this condition. MANAGEMENT OF FEVER 38 C (100.4F)
More informationHot Hot Tot:! The Hot Tot. Fever in KIds <90 Days 5/26/10
Hot Hot Tot:! Fever in KIds
More information4/14/2010. Theoretical purpose of fever? Andrea Marmor, MD, MSEd Assistant Clinical Professor, Pediatrics UCSF April 13, 2010
Andrea Marmor, MD, MSEd Assistant Clinical Professor, Pediatrics UCSF April 13, 2010 Parental touch? Absence of fever more reliable than presence. Axillary and tympanic Vulnerable to environmental and
More informationThe Febrile Infant. SJRH ED Rounds Dec By: Robin Clouston
1 The Febrile Infant SJRH ED Rounds Dec 11 2018 By: Robin Clouston 2 Objectives Discuss the risk of serious bacterial infection (SBI) in the neonate or young infant (
More informationFever Phobia and the ED Doc Ran Goldman, MD (rgoldman@cw.bc.ca) BC Children s Hospital, Professor, University of British Columbia SLIDES ON : www.clinicalpeds.com/whistler Define Fever 38.0 o Doesn t
More informationFevers and Seizures in Infants and Young Children
Fevers and Seizures in Infants and Young Children Kellie Holtmeier, PharmD Pediatric Clinical Pharmacist University of New Mexico Hospital Disclosure I have no conflicts of interest 1 Pharmacist Objectives
More informationFaculty Disclosure. Stephen I. Pelton, MD. Dr. Pelton has listed no financial interest/arrangement that would be considered a conflict of interest.
Faculty Disclosure Stephen I. Pelton, MD Dr. Pelton has listed no financial interest/arrangement that would be considered a conflict of interest. Advances in the management of fever in infants 0 to 3 and
More informationgreater than 10 will be considered ill appearing; a score of 10 or less will be considered well appearing.
1 Use the Yale Observation Scale to assess whether the patient is ill or well appearing. A score greater than 10 will be considered ill appearing; a score of 10 or less will be considered well appearing.
More information+ Objectives. n Define who is at risk for SBI. n Clarify risk stratification. n Provide treatment guidelines. n Bust some myths
Objectives n Define wo is at risk for SBI n Clarify risk stratification n Provide treatment guidelines Neonatal Fever Benjamin B. Constance, MD, FAWM n Bust some myts Based on Case wat do you want to know?
More informationEvidence-based Management of Fever in Infants and Young Children
Evidence-based Management of Fever in Infants and Young Children Shabnam Jain, MD, MPH Associate Professor of Pediatrics Emory University Medical Director for Clinical Effectiveness Objectives Understand
More informationDisclosures. Background. Definitions. Why Worry about these Infants? Goals. Bacterial infection in the neonate and young infant: a review
Disclosures Bacterial infection in the neonate and young infant: a review Russell J. McCulloh, MD Med-Peds Infectious Diseases August 8, 2017 I have no financial interests to disclose Funding: Eva and
More informationDr. Bob Wilson Golden BC
Fever in Infants Under 3 Mon. Dr. Bob Wilson Golden BC What is the risk of serious bacterial infection in a febrile 2 A. 5% B. 10% C. 25% D. 50% E. 100% month old infant? What is the most common congenital
More informationFever in Babies. Too much testing or not enough testing? Martin E. Weisse, M.D. Pediatric Infectious Diseases
Fever in Babies Too much testing or not enough testing? Martin E. Weisse, M.D. Pediatric Infectious Diseases Disclosures I have nothing to disclose Learning Objectives At the end of the talk, participants
More informationFever in Young Infants 7 90 days of age
Fever in Young Infants 7 90 days of age Derek Zhorne, MD Clinical Assistant Professor of Pediatrics Pediatric Hospitalist Disclosures I have no actual or potential conflicts in relation to this presentation.
More informationJudith Klein, MD 2011 FEVER IN THE FIRST 36 MONTHS OF LIFE
Judith Klein, MD 2011 FEVER IN THE FIRST 36 MONTHS OF LIFE Objectives A short history of the kiddie fever business Vaccinations Rapid viral testing Biomarkers Month-by-month approach to fevers in these
More informationRebecca T Slagle, MN, APRN, NNP-BC. Speak up!!
Rebecca T Slagle, MN, APRN, NNP-BC Speak up!! Objectives: Understand the incidence and prevalence of sepsis in the newborn period Identify the risk factors for neonatal sepsis List the most frequent causative
More informationGUIDELINE FOR THE MANAGEMENT OF MENINGITIS. All children with suspected or confirmed meningitis
GUIDELINE FOR THE MANAGEMENT OF MENINGITIS Reference: Mennigitis Version No: 1 Applicable to All children with suspected or confirmed meningitis Classification of document: Area for Circulation: Author:
More informationEPG Clinical Guidelines
Guidelines for the Management of Febrile Young Children Neonate age 7 days Temperature > 38 C, documented at home or in the ED Complete blood count with manual differential (CBCD), urinalysis (UA), urine
More informationENCEPHALITIS. Diana Montoya Melo
ENCEPHALITIS Diana Montoya Melo 4 yo female patient, brought to the ED after having a GTC seizure 30 mins ago, which lasted up to a min. Mom reports that he has a ho 3 days of fever and runny nose, associated
More informationCASE-BASED SMALL GROUP DISCUSSION MHD II
MHD II, Session 11, Student Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD II Session 11 April 11, 2016 STUDENT COPY MHD II, Session 11, Student Copy Page 2 CASE HISTORY 1 Chief complaint: Our baby
More informationPediatric Mysteries (including FWS / FUO) 13 June 2017 Tony Moody MD Duke Pediatric Infectious Diseases
Pediatric Mysteries (including FWS / FUO) 13 June 2017 Tony Moody MD Duke Pediatric Infectious Diseases Disclosures Advisory board member for GSK (for belimumab pregnancy registry). Co-founder of Grid
More informationFEVER. What is fever?
FEVER What is fever? Fever is defined as a rectal temperature 38 C (100.4 F), and a value >40 C (104 F) is called hyperpyrexia. Body temperature fluctuates in a defined normal range (36.6-37.9 C [97.9-100.2
More informationNeonatal Sepsis. Neonatal sepsis ehandbook
Neonatal Sepsis Neonatal sepsis ehandbook Sepsis Any baby who is unwell must be considered at risk of sepsis 1 in 8 per 1000 lives births The consequences of untreated sepsis are devastating - 10-30% risk
More informationAn Intriguing Case of Meningitis. Tiffany Mylius MLS (ASCP)
An Intriguing Case of Meningitis { Tiffany Mylius MLS (ASCP) A 4yo male presents with 2wk history of URI symptoms. On the day of admission, the patient woke up with a HA in the morning, took a nap later
More informationFever in Infants: Pediatric Dilemmas in Antibiotherapy
Fever in Infants: Pediatric Dilemmas in Antibiotherapy Jahzel M. Gonzalez Pagan, MD, FAAP Pediatric Emergency Medicine Associate Professor, UPH Medical Advisor, SJCH June 9 th, 2017 S Objectives S Review
More informationEvaluating Fever in Infants. Derek Zhorne, MD Clinical Assistant Professor of Pediatrics Pediatric Hospitalist
Evaluating Fever in Infants Derek Zhorne, MD Clinical Assistant Professor of Pediatrics Pediatric Hospitalist Disclosures I have no actual or potential conflicts in relation to this presentation. I will
More information4/11/2017 COMMUNITY ACQUIRED PNEUMONIA. Disclaimer. A Review of How to Treat Common Infections in a Pediatric Patient. Objectives for Technicians
Disclaimer A Review of How to Treat Common Infections in a Pediatric Patient Tara Bergland reports that she has no actual or potential conflict of interest in relation to this presentation. Off label use
More informationYour first patient of the day
Your first patient of the day 1 month old male with 2 days of fussiness Decreased stool output for 3 days Poor latch during breastfeeding noted at 3AM on day of arrival to the ED Started spitting up later
More informationMICROBIOLOGICAL TESTING IN PICU
MICROBIOLOGICAL TESTING IN PICU This is a guideline for the taking of microbiological samples in PICU to diagnose or exclude infection. The diagnosis of infection requires: Ruling out non-infectious causes
More informationFever and Infections in Pediatrics
Fever and Infections in Pediatrics Dr. Todd Twogood 2019 update Big Sky Conference Pediatric Fever and illness The most common reason for children to be taken to the doctor for acute illness Major concern
More informationThe McMaster at night Pediatric Curriculum
The McMaster at night Pediatric Curriculum Community Acquired Pneumonia Based on CPS Practice Point Pneumonia in healthy Canadian children and youth and the British Thoracic Society Guidelines on CAP Objectives
More information4/11/2017. A Review of How to Treat Common Infections in a Pediatric Patient. Disclaimer. Objectives for Pharmacists
A Review of How to Treat Common Infections in a Pediatric Patient Tara Bergland, Pharm D. PGY2 Pediatric Pharmacy Resident Tara-bergland@uiowa.edu Disclaimer Tara Bergland reports that she has no actual
More informationNEONATAL SEPSIS. Dalima Ari Wahono Astrawinata Departemen Patologi Klinik, FKUI-RSCM
NEONATAL SEPSIS Dalima Ari Wahono Astrawinata Departemen Patologi Klinik, FKUI- Background Neonatal sepsis : Early-onset Late-onset Early-onset : mostly premature neonates Within 24 hours 85% 24-48 hours
More informationBurrowing Bugs in a 5 week-old that Mite be Difficult to Diagnosis
Burrowing Bugs in a 5 week-old that Mite be Difficult to Diagnosis Farbod Bahadori-Esfahani,MD Pediatrics LSU Health Shreveport Louisiana Chapter AAP Red Stick Potpourri Disclosure I have nothing to disclose
More informationFever in Children. Dr Shane George Staff Specialist - Emergency Medicine & Children s Critical Care Gold Coast University Hospital
Fever in Children Dr Shane George Staff Specialist - Emergency Medicine & Children s Critical Care Gold Coast University Hospital Update on Children s services @ GCUH Dedicated Children s Pod in the Emergency
More informationRational Evaluation of the Febrile Infant
Disclosures Rational Evaluation of the Febrile Infant Samir S. Shah, MD, MSCE Professor, Department of Pediatrics University of Cincinnati College of Medicine Director, Division of Hospital Medicine Attending
More informationID Emergencies. BUMC-P Internal Medicine Edwin Yu
ID Emergencies BUMC-P Internal Medicine Edwin Yu Learning Objectives Bacterial meningitis IDSA guidelines: Clin Infect Dis 2004; 39:1267-84 HSV encephalitis IDSA guidelines: Clin Infect Dis 2008; 47:303-27
More informationEVALUATION OF A SICK CHILD WITH FEVER
EVALUATION OF A SICK CHILD WITH FEVER Learning objectives At the conclusion of this learning activity, participants should be able to; Discuss the different etiologies of acute illness in a child Identify
More informationTurkish Thoracic Society
Türk Toraks Derneği Turkish Thoracic Society Pocket Books Series Diagnosis and Treatment of Community Acquired Pneumonia in Children Short Version (Handbook) in English www.toraks.org.tr This report was
More informationID Emergencies. BGSMC Internal Medicine Edwin Yu
ID Emergencies BGSMC Internal Medicine Edwin Yu Learning Objectives Bacterial meningitis IDSA guidelines: Clin Infect Dis 2004; 39:1267-84 HSV encephalitis IDSA guidelines: Clin Infect Dis 2008; 47:303-27
More informationFever in children aged less than 5 years
Fever in children aged less than 5 years A fever is defined as a temperature greater than 38 degrees celsius Height and duration of fever do not identify serious illness. However fever in children younger
More informationExam 1 Review. Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies
Exam 1 Review Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies WBC Count Differential A patient had been admitted to the hospital for acute shortness of breath. A CXR examination
More informationFever. National Pediatric Nighttime Curriculum Written by Debbie Sakai, M.D. Institution: Lucile Packard Children s Hospital
Fever National Pediatric Nighttime Curriculum Written by Debbie Sakai, M.D. Institution: Lucile Packard Children s Hospital Case 1 4-month-old well-appearing girl admitted for croup and respiratory distress.
More informationDilemmas in the Management of Meningitis & Encephalitis HEADACHE AND FEVER. What is the best initial approach for fever, headache, meningisums?
Dilemmas in the Management of Meningitis & Encephalitis Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine HEADACHE AND FEVER What is the best initial approach for fever,
More informationEmergency Neurological Life Support Meningitis and Encephalitis
Emergency Neurological Life Support Meningitis and Encephalitis Version: 2.0 Last Updated: 19-Mar-2016 Checklist & Communication Meningitis and Encephalitis Table of Contents Emergency Neurological Life
More informationPediatric Potpourri: What do we now?
Pediatric Potpourri: What do we now? April 19, 2013 Robert Wittler, MD 1 Disclosure I have no relevant financial relationships with the manufacturer(s) of any commercial products(s) and/or provider of
More informationCleaning for Additional Precautions Table symptom based
for Additional Precautions Table symptom based The need to wear personal protective equipment () for Routine Practices is dependent on the risk of contact or contamination with blood or body fluids. should
More informationWHEN IS CHILD MOST CONTAGIOUS? Variable, often from the day before symptoms begin up to 5 days after onset
Childhood Infectious Illnesses (Communicable Disease Recommendations) adapted from Childhood Infectious Illnesses poster 2008 edition Children's Healthcare of Atlanta DISEASE, ILLNESS, EYE, EAR, NOSE,
More informationCommunity Acquired Pneumonia. Abdullah Alharbi, MD, FCCP
Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent
More informationCNS INFECTIONS MENINGITIS
CNS INFECTIONS MENINGITIS Learning Objectives: 1. Describe patient risk factors,signs and symptoms that may indicate meningitis 2. Identify tests and significant laboratory values used to diagnose meningitis
More informationPNEUMONIA IN CHILDREN. IAP UG Teaching slides
PNEUMONIA IN CHILDREN 1 INTRODUCTION 156 million new episodes / yr. worldwide 151 million episodes developing world 95% in developing countries 19% of all deaths in children
More informationHot Stuff: The Febrile Child
Hot Stuff: The Febrile Child Dr. Shannon MacPhee, Department of Emergency Medicine, Division Head Pediatric Emergency Medicine. IWK Health Centre. Dalhousie University November 2017 Know when to suspect
More information5/5/2010. Phil Bernard, MD. 2 week old presents to your office with fever to F HR 150 RR 40
2 week old presents to your office with fever to 101.5 F HR 150 RR 40 BP not obtained obtained Sats 95% Phil Bernard, MD Baraff LJ, Bass JW, Fleisher GR, Klein JO, McCracken GH, Powell KR, et al. Practice
More informationPEDIATRIC INFECTIOUS DISEASES UPDATE. Neonatal HSV. Recognition, Diagnosis, and Management Coleen Cunningham MD
Neonatal HSV Recognition, Diagnosis, and Management Coleen Cunningham MD Important questions Who is at risk? When do you test? What tests do you perform? When do you treat? What is appropriate therapy?
More informationSPECIFIC DISEASE EXCLUSION GUIDELINES FOR CHILDCARE
See individual fact sheets for exclusion and other information on the diseases listed below. Bed Bugs Acute Bronchitis (Chest Cold)/Bronchiolitis Campylobacteriosis Until fever is gone (without the use
More informationCNS Infections. Philip Gothard Consultant in Infectious Diseases Hospital for Tropical Diseases, London. Hammersmith Acute Medicine 2011
CNS Infections Philip Gothard Consultant in Infectious Diseases Hospital for Tropical Diseases, London Hammersmith Acute Medicine 2011 Case 1 HISTORY 27y man Unwell 3 days Fever Headache Photophobia Previously
More informationMousa Suboh. Zaid Emad. Anas Abu -Humaidan
1 Mousa Suboh Zaid Emad 1 P a g e Anas Abu -Humaidan In this lecture we will talk about the microbiology of the central nervous system The central nervous system is supposedly sterile, so there is no micro
More informationCritical Review Form Clinical Prediction or Decision Rule
Critical Review Form Clinical Prediction or Decision Rule Development and Validation of a Multivariable Predictive Model to Distinguish Bacterial from Aseptic Meningitis in Children, Pediatrics 2002; 110:
More informationAntibiotic Protocols for Paediatrics Steve Biko Academic Hospital
Antibiotic Protocols for Paediatrics Steve Biko Academic Hospital Respiratory tract infections in children Uncomplicated URTI A child with a cold should not receive an antibiotic Paracetamol (15 mg/kg/dose
More informationJ of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 66/ Aug 17, 2015 Page 11432
BLOOD CULTURE AND BACTEREMIA PREDICTORS IN INFANTS LESS THAN ONE YEAR OF AGE WITH FEVER WITHOUT SOURCE (FWS) Y. G. Sathish Kumar 1, A. Udayamaliny 2, S. Ankitha 3 HOW TO CITE THIS ARTICLE: Y. G. Sathish
More informationIDPH ESF-8 Plan: Pediatric and Neonatal Surge Annex Sample Pediatric Admission Orders 2015
Purpose: To provide guidance to practitioners caring for pediatric patients who need inpatient hospital care during a disaster. Disclaimer: This guideline is not meant to be all inclusive, replace an existing
More informationHelp protect your child. At-a-glance guide to childhood vaccines.
Help protect your child. At-a-glance guide to childhood vaccines. Why vaccines matter. Thanks to widespread vaccination programs, several diseases that can infect our children have been eliminated. But
More informationHelp protect your child. At-a-glance guide to childhood vaccines.
Help protect your child. At-a-glance guide to childhood vaccines. Why vaccines matter. Thanks to widespread vaccination programs, several diseases that can infect our children have been eliminated. But
More informationCNS Infections. GBS Streptococcus agalactiae. Meningitis - Neonate
CNS Infections GBS Streptococcus agalactiae Bacterial meningitis - Pathophysiology - general Specific organisms - Age Hosts Treatment/Prevention Distinguish from viral disease Common commensal flora childbearing
More informationCRACKCast E167 Pediatric Fever. Key Concepts. CrackCast Show Notes Pediatric Fever April 2018
CRACKCast E167 Pediatric Fever Key Concepts Fever is the #1 kids are brought to the ED! Vaccination (for Haemophilus influenzae type b and Streptococcus pneumoniae) has dropped the rates of serious bacterial
More informationHelp protect your child. At-a-glance guide to childhood vaccines.
Help protect your child. At-a-glance guide to childhood vaccines. 40976_CDCupdate.indd 1 Why vaccines matter. Thanks to widespread vaccination programs, several diseases that can infect our children have
More informationPediatric Case Studies. Case 1
Pediatric Case Studies James Naprawa, MD Assistant Clinical Professor Pediatric Emergency Medicine Children s Hospital, Columbus Case 1 Almost 4 year old AA girl PMH UTI x 2 with abdominal pain and fever
More informationDAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES
DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health
More informationFever in Children. Sue Moore APRN, ENP-C (almost retired)
Fever in Children Sue Moore APRN, ENP-C (almost retired) Topics Definiton Taking the temp Function of fever Reasons for treating fever How antipyretics work Fever: Temperature over 38 C Taking the Temp
More informationPneumococcal Meningitis Meningitis is an inflammation of the lining around the brain and spinal cord. Most severe cases
Pneumococcal Meningitis Meningitis is an inflammation of the lining around the brain and spinal cord. Most severe cases are caused by bacteria. Pneumococcal bacteria (Streptococcus pneumoniae) are the
More information1.3 What is the mechanism of action of adrenaline in anaphylactic shock? (20 marks)
DCH Examination -Short Answer Questions Time - Two and half hours Model paper 1.1 A 10 month old child presented with urticaria within one hour following ingestion of an egg. Mother claims that a week
More informationLeukocytosis. dr. Erdélyi, Dániel 2 nd Department of Paediatrics Semmelweis University
Leukocytosis dr. Erdélyi, Dániel 2 nd Department of Paediatrics Semmelweis University My first day at work in 1997 3y with fever, cough Is this bronchitis, pneumonia, pharyngitis, sinusitis, else? Is this
More informationUTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys.
UTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys. 1-3% of Below 1 yr. male: female ratio is 4:1 especially among uncircumcised males,
More informationOnline Video Library Pediatric Emergency Room Puzzlers
Outreach Education Online Video Library 2009-2010... Pediatric Emergency Room Puzzlers.... Program Handouts This information is provided as a courtesy by Children's Health Care System and its related organizations
More informationHealthStream Regulatory Script
HealthStream Regulatory Script [Transmission-Based Precautions: Contact and Droplet] Version: [April 2005] Lesson 1: Introduction Lesson 2: Contact Precautions Lesson 3: Droplet Precautions Lesson 1: Introduction
More informationANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS
ANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS Version 4.0 Date ratified February 2009 Review date February 2011 Ratified by Authors Consultation Evidence
More informationenter the room. Persons immune from previous varicella infection may enter the room without a mask. Those immune by adenoviruses, influenza viruses.
All clients admitted to the hospital automatically are considered to be on standard precautions. The diseases listed below require standard precautions plus additional precautions that are noted in the
More informationStudent Guide Module 5: Management of Prevalent Infections in Children Following a Disaster
Student Guide Module 5: Management of Prevalent Infections in Children Following a Disaster Objectives for this session Section I - Integrated Management of Childhood Illness (IMCI) Understand the IMCI
More informationNeonatal Herpes Infection: Case Report and Discussion
BRIEF REPORT Neonatal Herpes Infection: Case Report and Discussion Jordan C. White, MD, and Susanna R. Magee, MD, MPH Neonatal herpes simplex virus (HSV) infections are often life-threatening. Although
More informationViral Meningitis. 2. Use the information on the Possible Diseases sheet to complete the other four columns in the chart.
Disease Detectives Part 1: What is wrong with Mike? Yesterday, Mike Wright developed a severe headache, a high fever, and a stiff neck. Then, he became nauseated and began vomiting. He just wanted medicine
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A AAP. See American Academy of Pediatrics (AAP) Acyclovir dosing in infants, 185 187 American Academy of Pediatrics (AAP) COFN of, 199 204 Amphotericin
More informationDisease Transmission( Spread) Symptoms Infectious Period/ Exclusion. Should see physician as antibiotic treatment may be required
Management of Communicable Diseases Adopted April 26, 05 These guidelines, based on those developed by With the assistance of the Canadian Pediatric Society, these Guidelines have been developed to assist
More informationComplete Blood Count PSI AP Biology
Complete Blood Count PSI AP Biology Name: Objective Students will examine how the immunological response affects molecules in the blood. Students will analyze three complete blood counts and create diagnoses
More informationDiphtheria. Vaccine Preventable Childhood Diseases. General information
Diphtheria General information Caused by the bacterium Corynebacterium diphtheria. Transmission is most often person-to-person spread via respiratorydroplets. The word diphtheria comes from Greek and means
More informationWelcome to Big Sky Country. Pediatrics Infectious disease update. Todd TwogoodMD
Welcome to Big Sky Country Pediatrics Infectious disease update Todd TwogoodMD My kid is always sick!! We have to deal with parents Snotty nose kids Average number of colds in children from Oct to March
More informationA Practical Approach to Leukopenia/Neutropenia in Children. Vandy Black, M.D., M.Sc., FAAP OLOL Children s Hospital August 24, 2014
A Practical Approach to Leukopenia/Neutropenia in Children Vandy Black, M.D., M.Sc., FAAP OLOL Children s Hospital August 24, 2014 Disclosures EPIC trial MAST Therapeutics SUSTAIN trial Selexys Pharmaceuticals
More informationCold & Flu Information
Cold & Flu Information We urge you to keep children with symptoms of cold or flu at home. Please read guidelines below to help you decide if you should keep your student home. Consider keeping children
More informationInfection Control Manual Residential Care Part 3 Infection Control Standards IC6: Additional Precautions
IC6: 0110 Appendix I Selection Table Infection Control Manual esidential Care IC6: Additional Legend: outine Practice * reportable to Public Health C - Contact ** reportable by Lab D - Droplet A - Airborne
More informationMy kid is always sick!!
Welcome to Big Sky Country My kid is always sick!! Pediatrics Infectious disease update Todd Twogood MD We have to deal with parents Snotty nose kids Average number of colds in children from Oct to March
More informationThe Value of C-Reactive Protein in Children with Meningitis
Helmy A. Qurtom, MRCP; Qusay A. Al-Salah, MRCP; Mahmoud M. Lubani, MD; Kamel I. Doudin, MD; Dinesh C. Sharda, FRCP; Areckal I. John, MD From the Department of Pediatrics, Farwania (Drs. Qurtom, Al-Saleh,
More informationFeverish illness: assessment and initial management in children younger than 5 years of age
Feverish illness: assessment and initial management in children younger than 5 years of age NICE guideline Draft for consultation, November, 2006 If you wish to comment on this version of the guideline,
More informationOCCUPATIONAL HEALTH DISEASE SPECIFIC RECOMMENDATIONS
Herpes simplex virus (HSV) Cold sores Genital herpes Herpetic whitlow OCCUPATIONAL HEALTH DISEASE SPECIFIC RECOMMENDATIONS contact with primary or recurrent lesions, infectious saliva or genital secretions
More informationDiseases of Absence. Disclosures
Diseases of Absence Meg Fisher, MD Medical Director, The Unterberg Children s Hospital Long Branch, NJ Disclosures I have no disclosures I do not intend to mention off label uses of drugs I have way too
More informationIMPACT #: Local Inventory #: form 04. Age at admission: d. mo yr. Postal code:
- Date of birth: birth: Date of admission: year month day year month day Age at admission: d mo yr Postal code: Ethnic code: Hospital: Gender: 1 = male 2 = female 1 = Impact 2 = Other local, specify: Code
More informationThe McMaster at night Pediatric Curriculum
The McMaster at night Pediatric Curriculum Robinson, J, et al. and the Canadian Pediatric Society. Urinary tract infection in infants and children: Diagnosis and management. Pediatr Child Health 2014;
More informationCentral Nervous System Infection
Central Nervous System Infection Lingyun Shao Department of Infectious Diseases Huashan Hospital, Fudan University Definition Meningitis: an inflammation of the arachnoid membrane, the pia mater, and the
More information