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The Initial Evaluation and Stabilization of Routine Childhood Illnesses

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Scabies = usually none. Viral = fever, cough, congestion, sore throat ... Scabies Permethrin head to toe (all in home) Viral Isolation, MD evaluation if uncertain ... – PowerPoint PPT presentation

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Title: The Initial Evaluation and Stabilization of Routine Childhood Illnesses


1
The Initial Evaluation and Stabilization of
Routine Childhood Illnesses
  • Coburn H. Allen, MD, FAAP
  • Pediatric Emergency Medicine
  • Pediatric Infectious Diseases

2
Outline
  • Review common childhood illnesses
  • Discuss key questions to ask and findings to
    evaluate for each illness
  • Know which cases can return to class and which
    need further care

3
Common Childhood Illnesses
  • Allergies
  • Asthma
  • Depression
  • Drug Abuse
  • Fever
  • Gastroenteritis
  • Lice
  • Pink Eye
  • Rashes
  • Sore Throat

4
Allergic Reactions
  • 14 y/o young man in the cafeteria begins vomiting
    violently and is noted to have a red, swollen
    face, lips and tongue and his voice sounds raspy.
    He rapidly develops hives all over while walking
    to your clinic.

5
What is this?
  • Anaphylaxis!

6
Allergic Reactions
  • What to ask?
  • What just happened?
  • Difficulty breathing/swallowing, itching?
  • History of allergies?
  • What?
  • How bad?
  • Epipen?
  • New foods, meds, stings or products?

7
Allergic Reactions
  • What to examine?
  • ABCs
  • Airway
  • Breathing (wheeze, stridor)
  • Circulation (anaphylactic SHOCK)
  • Skin
  • Hives
  • Angioedema

8
Hives (Urticaria)
9
Angioedema
10
Allergic Reactions
  • What to do?
  • Anaphylaxis
  • Epipen, if available
  • EMS if not
  • Hives
  • Antihistamine
  • Stop exposure, if possible

11
Allergic Reactions
  • Where to send them?
  • Anaphylaxis
  • EMS to nearest hospital
  • Few exceptions
  • Hives
  • Depends
  • Severity
  • Number
  • How itchy
  • H/o anaphylaxis

12
Asthma
  • A nine year old girl is rushed back to you
    complaining, I cant breath! She is a known
    asthmatic who is admitted to the hospital almost
    every year. You have given her treatments many
    times in the past.

13
Asthma
  • What to ask?
  • Count to 20 or Say ABCs
  • What was she doing right before?
  • How long has she been sick?
  • Medications (missed)?
  • Other complaint/concerns
  • Chest pain
  • Anxiety
  • Drug use
  • Exposures

14
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15
Asthma
  • What to examine?
  • Look
  • General condition
  • Quality of breaths
  • Respiratory rate
  • Listen
  • Air movement
  • Wheezing
  • Stridor
  • Crackles

16
Asthma
  • What to do?
  • Depends on what you have
  • Medications
  • Albuterol treatments
  • Nebulizer
  • Metered dose inhaler WITH spacer
  • Oxygen
  • Inhaled steroids of minimal benefit during acute
    attack
  • Preventative meds may be harmful
  • EMS if respiratory distress

17
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18
Asthma
  • Where to send them?
  • Back to class
  • If rapidly respond to single treatment without
    worsening for 1 hour after completed
  • If faking to get out of math test
  • To doctor (me)
  • Minimal or no response to treatment, or requiring
    more than one
  • History of severe asthma (multiple ICU visits)

19
Depression
  • A 13 y/o girl is found crying in the bathroom
    using a razor to cut her forearm. She has 23
    superficial wounds to the left forearm and quite
    a few old scars in the same area.

20
Depression
  • What to ask?
  • Why?
  • Wants to die?
  • If cutting, ask
  • Friends doing it?
  • Feels good?
  • Prior history?
  • Medications?
  • Drugs?
  • Abuse?

21
Depression
  • S I G- E- C A P S
  • S - Suicidal thoughts, sadness
  • I - Interest (loss of interest)
  • G - Guilt feelings
  • E - Energy decline
  • C - Concentration problems
  • A - Appetite changes
  • P - Psychomotor retardation
  • S - Sleep disturbances

22
Depression
  • What to examine?
  • Wounds
  • Evidence of substance abuse
  • Neurologic exam
  • Eyes
  • Gait
  • One sidedness (bad)

23
Depression
  • What to do?
  • First aid
  • Build confidence

24
Depression
  • Where to send them?
  • EMS
  • Suicidal
  • Homicidal
  • Medical emergency
  • Toxidrome (drugs on board)
  • Back to class
  • Known depression, mild symptoms
  • No drugs involved
  • Home rarely an option (back to class or to ER)
  • All need f/u confirmed

25
Drug Abuse
  • Tripp Assyd, a 15 y/o young man, got in a fight
    with the gym teacher and is acting very
    bizarre. His heart is racing and he seems to be
    seeing things you dont seem to see. Your sight
    is fine.

26
Top 10 Street Drugs
  • TOBACCO biggest killer (400,000 deaths/year)
  • ALCOHOL most widely abused legal substance
  • PRESCRIPTION DRUGS dangerously addictive,
    rising in popularity
  • METHAMPHETAMINE labeled an epidemic problem by
    the press
  • MARIJUANA most widely abused illegal substance
  • MDMA (ECSTASY) little research on long term
    effects, still popular
  • CRACK COCAINE cheap, destructive drug making a
    comeback
  • HEROIN highly addictive drug making a comeback
    in some areas
  • STEROIDS horrible side effects, the toll
    they're taking on athletics
  • INHALANTS abuse is on the rise among youth
    again
  • www.streetdrugs.org

27
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28
Drug Abuse
  • What to ask?
  • What did you take?
  • Often dont know
  • Have them describe it
  • Home made?
  • Street name(s)
  • Call Poison Center to help identify
  • How much?
  • When?
  • Source?
  • Medical history
  • Medications
  • Conditions
  • Depression/psychiatric conditions

29
Drug Abuse
  • What to examine?
  • ABCs
  • Smells
  • Eyes
  • Pupils (big or small)
  • Nystagmus
  • Speech
  • Gait

30
Drug Abuse
  • What to do? Where to go?
  • Provide calm environment
  • Police if aggressive/severe
  • If any impairment, must be seen
  • Significant via EMS
  • Mild may be ok with family

31
Fever
  • A 5 y/o girl with a history of epilepsy is found
    shaking on the floor of the outside art room
    closet with a fever of 105.4.

32
Fever
  • What to ask?
  • Recent illness?
  • Heat exposure?
  • Medications?
  • Associated symptoms?
  • Stiff neck
  • Confusion
  • Rash

33
Fever
  • What to examine?
  • Core temperature
  • Vital signs
  • HEENT
  • Neck
  • Chest
  • Abdomen
  • Skin

34
Fever
  • What to do?
  • Dont panic Fever Phobia
  • Do
  • Cool them
  • Remove excess clothing
  • Luke warm sponge bath
  • Antipyretics, if allowed
  • Call home

35
Fever
  • Where to send them?
  • Doctor
  • Ill appearing
  • Seizure
  • Overheated
  • Home
  • Most
  • Parents can discuss with PCP

36
Gastroenteritis
  • Little Johny Stinkith, an 11 y/o boy, pooped his
    pants during recess and has vomited twice since.
    He is escorted to your office moaning and
    groaning saying my tummy hurts.

37
Gastroenteritis
  • What to ask?
  • When started?
  • Describe the pain?
  • How much V/D? Blood/Bile?
  • Food poisoning/ill exposure?
  • Dehydration?
  • PMHx/Associated symptoms?

38
Gastroenteritis
  • What to examine?
  • General
  • Abdomen
  • RLQ, CVA, SP or diffuse pain
  • Guarding/rigid
  • Bowel sounds
  • Dehydration

39
Gastroenteritis
  • What to do?
  • Hydrate- Slow and steady
  • Gatoraid
  • Sprite
  • Water
  • Call home

40
Gastroenteritis
  • Where to send them?
  • Doctor
  • Localized pain
  • Moderate to severe dehydration
  • Underlying conditions
  • Home
  • Most
  • Teach how to rehydrate

41
Lice
  • The Principals 8 y/o daughter, Princess
    Purrfect, complains of her head itching like
    crazy! Your head starts to itch a bit too, come
    to think of it.

42
Lice
  • What to ask?
  • Where does it itch?
  • How long?
  • Exposures to lice?
  • Treatment started?
  • Other medical conditions?

43
Lice
  • What to examine?
  • Scalp
  • Live lice
  • Hair shafts
  • Eggs (Nits)
  • Just above the scalp
  • Use magnifying glass, gloves

44
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45
Lice
  • What to do?
  • Scratch your head, its natural.
  • Live lice
  • Need treatment
  • Rid (over the counter)
  • Malathion
  • Home remedies
  • No nit policies should be abolished
  • Nits only do not need treatment

46
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47
Lice
  • Where to send them?
  • Live lice
  • Home for treatment
  • Educate
  • How contacted Head to head, shared hats/brushes
  • How to treat
  • Resistance exists, if failure see PCP
  • No live lice ? back to class
  • Unsure ? PCP

48
Pink Eye
  • Your two-time All-State Heavyweight Wrestling
    Champion, Penn Yufast, is seen wearing an
    eye-patch at practice and tries to hide when you
    approach him. The patch is stained with
    yellow-green goo. The big rivalry match is
    tomorrow, and his mom is your best friend. Oh
    yeah, and his dad is president of the school
    board. You pin him down, remove his patch and

49
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50
Pink Eye
  • What to ask?
  • How long?
  • Injury?
  • Itching vs. burning/pain?
  • Visual changes?
  • Associated symptoms?
  • Fever, sore throat, cough, both eyes viral
  • One sided, pus, exposure history bacterial

51
Pink Eye
  • What to examine?
  • Eye
  • Pus
  • Redness
  • Visual status
  • Foreign bodies
  • Lymph nodes
  • Nose and throat

52
Pink Eye
  • What to do?
  • Cover if trauma
  • Irrigate if chemical exposure
  • Wash your hands, twice
  • Call home

53
Pink Eye
  • Where to send them?
  • Back to class
  • Minor trauma/foreign body removed
  • No visual changes
  • Home
  • Most
  • Viral pink eye, use artificial tears
  • Doctor
  • Pus, significant pain, retained foreign body
  • Visual changes

54
Rashes
  • A 12 y/o recent immigrant from Maldovia, Eechy
    Scratchovich, is brought to you because an itchy
    rash has popped up all over his body. After he
    greets you in traditional fashion (big hug with
    kiss to each cheek), he lets you know, no worry,
    this very common in my country

55
Scabies!
56
Rashes
  • What to ask?
  • Vaccine status?
  • Ill exposures?
  • Others itching?
  • Associated symptoms/history
  • Scabies usually none
  • Viral fever, cough, congestion, sore throat
  • Contact dermatitis exposed areas, linear

57
Rashes
  • What to examine?
  • Skin
  • Scabies burrows around hands/feet
  • Viral diffuse, symmetric
  • Exposure/heat localized, patterns
  • Eyes
  • Red with viruses
  • Mouth (viral, strep)
  • Lungs (viral pneumonia)

58
Prickly Heat
59
Rubella
60
Measles
61
Chickenpox
62
Contact Dermatitis
63
Rashes
  • What to do? Where to go?
  • Depends on cause
  • Benadryl if itching
  • Call home if suspect contagious disease
  • Scabies ? Permethrin head to toe (all in home)
  • Viral ? Isolation, MD evaluation if uncertain

64
Sore Throat
  • A 19 y/o 10th grade girl who is just a little
    misunderstood shuffles into the office
    complaining of a sore throat and a few other
    parts.

65
Sore Throat
  • What to ask?
  • How long?
  • Associated symptoms?
  • Strep fever, headache, neck pain, stomache
  • Viral fever, cough, congestion, V/D,
  • GC GU complaints, arthritis, rash
  • Allergies itchy/scratchy, rhinitis, exposure
  • Social issues?
  • Medications?

66
Sore Throat
  • What to examine?
  • Throat
  • Neck
  • Nose
  • Eyes
  • Lungs
  • Skin
  • Other parts?

67
Strep Throat
68
Mononucleosis
69
Herpangina
70
Sore Throat
  • What to do?
  • Depends on cause
  • If strep suspected, need to test.
  • Viral
  • Symptom control (pain meds, cough drops)
  • Remove from class until afebrile 24 hours
  • Suspected GC/HSV ? STD clinic

71
Sore Throat
  • Where to send them?
  • Suspected strep?PCP
  • Viral
  • Usually home
  • Dehydration, pneumonia ? PCP
  • STD ? Clinic referral

72
Thank You!
73
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