HYPOXIC-ISCHEMIC BRAIN INJURY
Males > females usually less than 4 years
Related to developmental age
• Infants drown in bathtub
• Toddlers - toilet bowl
Definition: survival 24 hours after incident
• Swallow water, vomit, gasp, aspirate
• Hypoxia leads to brain damage
Managment: hospitalize and monitor for at least 24 hours
PREVENTION : TEACH TEACH TEACH
MENINGITIS SIGNS AND SYMPTOMS
Nuchal rigidity
Fever
Lethargy/irritability
Abrupt onset
Poor feeding
Hypothermia or
fever
Seizures
Shrill cry
Vomiting
Bulging fontanel
DIAGNOSING MENINGITIS
Test for Kernig and Brudzinski signs
Septic work-up--UA, CBC, Lumbar Puncture
Lumbar Puncture
CSF collected and sent to lab for analysis
Analysis consists of glucose, protein, cell count, and bacterial culture
MENINGITIS
TREATMEN
T
Airway
Isolation first 24 hours of antibiotic therapy
Antibiotics: administer asap after cultures are drawn
Monitor for hearing loss if receiving aminoglycoside antibiotics
Hydration
Manage or control seizures through medication
Reduce ICP
Elevate head
Reduce external stimulation
Dark room
Limit visitation
VIRAL MENINGITIS
Presentation less toxic than bacterial (look less sick)
Signs / symptoms: fever, irritable, lethargy
Treatment: symptom support
Spontaneous resolution 3-10 days
Hospital if fever & meningeal signs, full work up with ATB tx until proven viral
Prognosis good with full recovery over several weeks
ENCEPHALITIS
This Photo by Unknown author is licensed under CC BY-ND.
ENCEPHALITIS
Inflammation of the brain usually caused by a viral infection, but also can be caused by other agents.
Childhood viruses most common cause:
Measles, mumps, varicela, rubella
Other viruses are less frequently the cause
Bacteria, spirochetes, fungi, protozoa, helminths
Enteroviruses, herpesviruses, and West Nile virus
Initial symptoms are usually – fever & altered mental status
SYMPTOMS
Febrile illness with
neurologic signs is the
classic manifestation of
encephalitis
Severe headache
Malaise
nausea & vomiting
hyperactivity
Nuchal rigidity
Speech problems
SYMPTOMS
CONTINUED
Other neurologic signs may vary such as personality changes
Hallucinations,
Disorientation
Ataxia
Seizures Coma
REYE
SYNDROME
Recent hx of viral illness
Acute encephalopathy
• Association with use of aspirin
for tx of viral illness or varicella
• Inflammation, anoxic insult,
cerebral edema
Enlarged non- functioning
liver r/t elevated ammonia
and short chain fatty acid
level ↑AST & ALT, liver
biopsy
Bleeding and poor
coagulation
High mortality
w/multisystem failure;
neurologic sequeala
Hypoglycemia
Shock, cerebral edema
Meds:Vitamin K subQ.,
mannitol IV (osmotic
diuretic)
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