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


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



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


Metronidazole 20 mg/kg/day in 2 divided doses

14 days


1 month

orClarithromycin 15 mg/kg/day in 2


Metronidazole 20 mg/kg/day in 2 divided doses

14 days


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

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Blood Component Replacement