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
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Airway
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Isolation first 24 hours of antibiotic therapy
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Antibiotics: administer asap after cultures are drawn

Monitor for hearing loss if receiving aminoglycoside antibiotics
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Hydration

Manage or control seizures through medication
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Reduce ICP
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Elevate head
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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
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
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)