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week 3 lecture notes

No OTC cough medications in children less than s years old.
Acute Rhinosinusitis
Start with URI severity and duration determine treatment
Treat with Amoxicillin or Augmentin
 URI symptoms 10 days with no improvement and/or worsening symptoms
 Congestion with fever
 7 days with worsening symptoms
High Fever 102-103
Nasal congestion
Exanthem subitem (lacey rash) : typically starts on chest to outward after fever breaks late sign
Most common between 6-24 months
 Runs course in about 7 days rash is end 5-15 day incubation period
 Once rash appears, viral process is ending
 Supportive cares with rest, fluids, and acetaminophen or ibuprofen
Strep Throat
 streptococcus pyogenes, also known as Group A, Streptococcus (GAS)
Clinical Manifestations
 Erythematous tonsils and posterior pharynx, dysphagia, exudate, anterior cervical
lymphadenopathy, fever, lack of URI symptom, N/V, petechiae to palate
 Children with sore throat plus 2 or more of the following features should have rapid test
 Absence of cough
 Presence of tonsillar exudates or swelling
 History of fever
 Presence of swollen and tender anterior cervical lymph nodes
 Age <15
 Primarily a disease of children 5-15 years old, rare in children < 3 years
 Amoxicillin (50mg/kg/day for 7 days up to 2-3 times per day) or Penicillin V (250mg 2-3
times/day for 7 days)
 Acetaminophen or ibuprofen
 Replace toothbrush after 24 hours
 Important to prevent development of Rheumatic Fever is untreated
Ear infection
Ottis Externa “Swimmers Ear”: Outer ear infection
 Caused by moist environment that lends to fungi or bacterial growth
 Clinical Manifistations: Swollen, reddened external ear, may have purulent drainage in ear
canal, very painful with movement of pinna and tragus enlarged lymph nodes, pruitis, White
exudate, itchy
 Treatment:Keep ears dry; 2% Acetic acid otic solution (VoSoL) with hydrocortisone, 3-4
drops, 4 times a day for 5-7 days; NDSAIDs
Ottis Media: Infection of the middle ear
Most commonly causing bactieria are streptococcus pneumonia, Hameopilus influenzae
(NTHi), and Moraxella catarrhalis
Clinical Manifestations: Otolgia, fever, hearing loss, red, bulging TM, loss of light reflex,
Risk Factors: Allergies, lack of breastfeeding (positioning), passive smoke exposure,
daycare attendance, lower socioeconomic status, family history of recurrent AOM in
parents or siblings
Treatment: Acetaminophen or ibuprofen for pain; antibiotic therapy vs watch and wait
 Mild cases with unilateral symptoms in children 6-23 months of age with
unilateral or bilateral symptoms in children >2 years may be appropriate for
watchful waiting based on shared decision-making
 First line treatment: High dose amoxicillin (80-90 mg/kg/day)
 Penicillin allergy: AAP recommends azithromycin as a singles dose of 10mg/kg
or clarithromycin (15mg/kg/pers day in 2 divided doses), (14 mg/kg per day in 1
or 2 divided doses), cefpodoxime (10mg/kg per day once daily) or cefuroxime
(30mg/kg per day in 2 divided doses)
 Treatment failure last 3 months: Augmentin Cefinder, ceftriaxone injections 3
days in a row.
Urinary Tract infections:
 85% caused by E. Coli
 Clinical manifestations: frequency, urgency, dysuria, fever, crying, accidents
 Diagnosis: UA reveals WBC with nitrates
 Treatment: Antibiotics; TMP/SMX, Augmentin, cefixime, cefpodoxime, ceprozil, or cephalexin for
7-14 days
 Febrile infants should have imaging with renal and bladder ultrasonography
 Caused by Epstein-Barr virus
 Clinical Manifestations: fatigue, fever, malaise, lymphadenopathy, acute pharyngitis, tonsillar
exudate, splenomegaly
 Diagnosis: CBC with atypical lymphocytes >20%, viral capsid antigen (VCA), early antigen,
 Treatment: Comfort cares with fluids, acetaminophen, ibuprofen, refrain from contact sports
Laryngotrachebronchitis or Croup
 Rapid acute airway obstruction at the subglottic space characterized by a harsh, barky cough and
inspiratory stridor.
 Affects young children with the fall and early winter
 Most commonly affects children birth to 6 years of age; males > females
 Common Sources: parainfluenza virus serotypes #1 cause, adenovirus, RSV, Rubeola virus,
Influenza A and B
 Clinical Manifestations: URI symptoms followed by the development of the “barky cough” and
inspiratory stridor, symptoms worse at night, possible fever (usually <102), stridor, depending on
severity (as obstruction worsens stridor occurs at rest & if severe air hunger, retractions &
 Differential Diagnosis: Foreign body, retropharyngeal abccess, tumors, trauma, angioedema,
asthma, epiglottitis. \
 Diagnosis: clinical presentation and physical examination, CBC usually normal or low
 Treatment: hospitalization 92% or below
 Mild: supportive cares with oral hydration and minimal activity. Cool mist may help.
 Moderate croup with stridor at rest: requires active interventions with oxygen if
Nebulized racemic epinephrine (2.25% sol; 0.05ml/kg to maximum of 1.5 ml diluted in
sterile saline) rapid action within 10-30 minutes
Dexamethazsone 0.6mg/kg IM in one dose improves symptoms and permits early
discharge from eD or oral dexamethasone (0.15mg/kg) may be equally effective
Inhaled budesonide (Pulmicort) 2-4 mg) also improves symptoms & reduces hospital
stay. Onset of action within 2 hours.
 Inflammation and swelling of the supraglottic structure-epiglottitis
 Can develop rapidly and lead to life threatening upper airway obstruction
 Affects children between 2-7 years of age
 Rare occurrence since development of the HIB vaccine
 Common sources: Haemophilus Influenza B, Group A & C Streptococcus, streptococcus
pneumoniae, injury
 Clinical Manifestations: Sudden onset of fever, dysphagia, sore throat, drooling, muffled voice,
inspiratory retractions, cyanosis, stridor, tripod position, irritability or restlessness, hot potato
 Physical Exam: rapidly progressive respiratory obstruction, cherry-red epiglottis, tachypnea,
tachycardia, stridor, “thumb sign” on x-rya
 Treatment: Hospitalization
Community Acquired Bacterial Pneumonia (CAP)
 Infection of the lung that causes inflammation
 Common sources for pediatrics is viral (most common) or bactieral
 Viral: RSV, Influenza A&B, parainfluenza, adenovirus, rhinovirus
 Bacterial: S. Pneumoniae, S. Aureus
 Clincal Manifestations: fever, cough, wheezing, tachypnea >40-50 with cough can be diagnostic,
crackles, diminished breath sounds over consolidation or pleural effusion, oxygen saturations
may be decreased
 Diagnosis: clinical findings, elevated WBC, chext x-ray
 Bacterial: airspace or consolidation in a lobar distribution
 viral: Interstitial or parabronchial infiltrates
 Treatment
 Viral: symptomatic treatment, outpatient nebulizer treatment similar to croup treatment
 Bacterial:
 <5 yo Amoxicillin 80-90 mg/kg/day for 7-10 days 2nd generation cephalosporin or
macrolide if PCN
 >5 yo, macrolide (like axithromycin- day 1 10mg/kg, days 2-5 5mg/kg)
 Inpatient: Most <4 months are hospitalized, oxygenation equal/less than 92%,
average stay of 3 days oxygen, hydration