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PEDIATRIC ISSUES IN ILAC

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Scabies. Linear burrows around: wrists, ankles, finger. and toe webs, groin, waist ... Scabies. Permethrin 5% cream or lindane lotion ... – PowerPoint PPT presentation

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Title: PEDIATRIC ISSUES IN ILAC


1
PEDIATRIC ISSUES IN ILAC
  • Stephen F. Darrow, MD
  • Chief Resident
  • Internal Medicine-Pediatrics
  • June 3, 2008

2
Pearls for the Campo
  • Most babies born in the DR are born in a hospital
  • There is a national vaccination program, so most
    kids have received their vaccines.
  • Parents want to
  • make sure that their
  • child is growing well
  • and is healthy.

3
Pearls for the Campo
  • Make sure you know (or have a chart with normal
    vital signs by age)
  • Every child should have a weight recorded
    (including kilograms) and percentile
  • Necessary for medication dosing and to assess
    growth
  • Be aware of whether your patient is able to
    swallow pills (your liquid medication options
    will be limited)

4
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5
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6
Pediatric Fever
  • Fever is defined as temperature above 100.4 F or
    38 C
  • You will have to rely on oral or axillary
    temperatures in the campo, which are frequently
    lower than the patients core body temperature.

7
Pediatric Fever
  • Any febrile infant less than one month old should
    be transported to the nearest medical facility.
  • This child will require further evaluation
    including blood and urine cultures, lumbar
    puncture, and IV antibiotics

8
Pediatric Fever
  • In children older than one month age, use your
    history and physical to assess for localizing
    signs.
  • Remember to look in the ears.
  • Examine the skin for abscess/ cellulitis.
  • If the child is toilet trained, collect urine for
    urinalysis.

9
Pediatric Fever
  • Assess the child for signs of
  • toxicity
  • Lethargy
  • Signs of shock
  • tachycardia, poor perfusion
  • Severe dehydration
  • Nuchal rigidity
  • Any infant who appears toxic should be
    transported to the nearest medical facility for
    further workup and IV antibiotics.

10
Common Pediatrics Infections
  • Otitis media
  • Strep pneumonia, H. influenzae, M. catarrhalis
  • Amoxicillin 80-90 mg/kg/day div bid or tid
  • Cefuroxime 30 mg/kg/day div bid
  • Azithromycin 10 mg/kg x 1 then 5 mg/kg/day x 4
    days
  • Treat for 10 days
  • Pharyngitis
  • Same as for otitis media. Treat for 10-14
    days.
  • Thrush Gentian violet/ nystatin (okay in
    infants)

11
Normal Ear
  • Color Pearly gray, pink
  • Position Neutral
  • Translucent
  • Mobile

12
Otitis Media
  • Color
  • White plus
  • erythema
  • Position
  • Bulging
  • tympanic membrane
  • Translucency
  • Decreased
  • Mobility
  • Decreased

13
Fluid in the Ear Infection or Not?
  • Air fluid levels are not necessarily acute otitis
    media infection
  • Look at other characteristics
  • Could be otitis media with effusion (no acute
    infection)

14
Common Pediatrics Infections
  • Wound Infection and/or Cellulitis
  • Surrounding redness, pus around wound site sign
    of infection

15
Common Pediatrics Infections
  • Cellulitis
  • Group A Strep, Staph aureus
  • Cephalexin 50-75 mg/kg/day div tid
  • Cloxacillin 50 mg/kg/day div qid
  • Clindamycin 10-30 mg/kg/day div tid or qid (side
    effect diarrhea)
  • TMP/SMX 8 mg/kg/day (TMP component) div bid
    (Stevens-Johnson side effect consider using
    this if running low on above meds)

16
Common Pediatrics Infections Urinary Tract
Infections
  • Organisms E. Coli, Proteus
  • Lab
  • Nitrites, leukocytes on urine analysis
  • Treatment
  • TMP/SMX 8 mg/kg/day (TMP component) div bid
  • Cefixime 8 mg/kg q day
  • Treat for 7-10 days

17
Parasites
  • Most GI complaints are attributed to parasites.
  • Parents are almost always concerned that their
    children do not eat enough and that this may be
    due to a parasite.
  • If you treat everyone who thinks they have a
    parasite, you will run out of medicine!

18
Parasites
  • Evaluate for any signs of infection
  • Abdominal pain
  • Chronic diarrhea
  • Poor Growth
  • If you treat one patient, treat the whole family.

19
Grippe
  • Grippe encompasses all upper respiratory
    symptoms
  • Differential diagnosis includes
  • Allergies
  • Upper respiratory infection
  • Sinusitis
  • Cold medications are generally not recommended in
    children due to poor efficacy.

20
Grippe
  • Treat for allergies if associated with itching,
    sneezing, or atopic sequelae on exam (pale
    mucosa, allergic shiners)
  • Treat for sinusitis if associated with headache
    or sinus pain, fever, or prolonged course
  • Remember to look for foreign body!

21
Cough
  • Cough may be a symptom of a mild URI or may
    indicate a more serious problem.
  • Think asthma if associated with wheezing or
    shortness of breath or if it is worse at night.
  • There is often a history of eczema or allergies
    in the patient, or a family history of asthma or
    allergies.

22
Cough
  • Think pneumonia if associated with fever or with
    signs of consolidation on exam (dullness to
    percussion)
  • Think TB if cough is chronic and if other family
    members have a chronic cough.

23
Dehydration
24
Dehydration
  • Mild- Moderate Dehydration can be treated with
    oral rehydration therapy
  • Pedialyte or WHO oral rehydration solution
  • Administer small volumes (5-10 ml at a time)
  • Replace deficit over 4 hours
  • Replace ongoing losses

25
Infestations
  • Scabies
  • Linear burrows around
  • wrists, ankles, finger
  • and toe webs, groin, waist
  • In infants and toddlers
  • head, neck, trunk,
  • palms and soles are affected
  • Very pruritic

26
Infestations
  • Scabies
  • Permethrin 5 cream or lindane lotion
  • Apply to entire body below neck and leave on
    overnight bathe in am
  • Treat entire household
  • Wash all clothing and linen

27
Infestations
  • Head Lice
  • Pediculosis humanus capitis
  • Acquired by close physical contact, sharing hats/
    brushes
  • Nits are oval, white 0.5 mm dots stuck on hair
    shafts 1-3 cm from scalp. Found especially above
    and behind ears.
  • Lice are six legged insects visible to the
    unaided eye.

28
Infestations
  • Head Lice
  • Pruritis is the principle symptom
  • Occipital adenopathy is common
  • Lindane shampoo leave on scalp for five minutes
    before rinsing, then comb hair with a fine-tooth
    comb. Repeat in 7 days.
  • Use Permethrin 5 cream in infants
  • Treat entire household
  • Wash all bedding, clothing, hats

29
Asthma Emergency Treatment
  • Assess ABCs
  • Oxygen as needed
  • Inhaled beta-agonist
  • Ipratropium bromide
  • Corticosteroids, po or IM (2 mg/kg load, then 1
    mg/kg bid)
  • Epinephrine SC, 0.01 ml/kg
  • Terbutaline SC, 0.01 ml/kg

30
Asthma Attack
  • Retractions (indentation of chest)
  • Accessory muscle use (neck muscles to breathe)
  • Nasal flaring

31
High Blood Pressure
  • Coarctation of the aorta can lead to high blood
    pressure
  • Avoid ACE inhibitors in pubescent teenagers

32
Take Home Points
  • Common Things Are Common
  • Colds
  • Stomach Pain
  • Parasites
  • Constipation
  • Ear infections
  • Skin infections
  • Scabies/ Lice
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