There was some good stuff going on the MICU thread so I thought I'd try to mine the collective brain of the forum.
I'm starting on Peds EM, have only done a few shifts on my aways (neither of which was particularly strong on Peds) and haven't done any Peds otherwise in over a year.
Just hoping for some pearls, words of wisdom etc -- I have yet to see a really medically sick kid.
peds EM is great! (but I'm completely biased...)
Some very general guidelines:
--Get used to calculating all meds/IVF based on weight. Harriet Lane and Uptodate are good places to look.
--If getting blood gasses, VBGs or CBGs are the norm, not ABGs.
--Acute gastro with dehydration: NS 20 mL/kg, repeat (either 10 mL/kg or 20 mL/kg) as needed. Many will also give Zofran 0.1 mg/kg IV. If trying rehydration w/o an IV, can give Zofran 0.1 mg/kg SL.
--Fever (38 or higher) in infants <4 weeks: full sepsis workup (blood/urine/CSF and cultures), antibiotics (Amp/Gent or Amp/Cefotaxime), and admission; do CXR if respiratory symptoms and consider if WBC is high (>15-20). Add Acyclovir (20 mg/kg/dose) and send CSF HSV PCR if there is any maternal HSV history or the kid doesn't look good or has neurological stuff going on (esp. seizures) or has CSF pleocytosis with a negative gram stain.
--Fever (38 or higher) in infants 1-3 months: If ill-appearing or high fever (>38.5-39)--blood/urine/CSF and cultures, CXR if any respiratory symptoms, empiric antibiotics (Ceftriaxone or Cefotaxime, 50 mg/kg IV/IM), and admission.
If well-appearing: UA/UC, CBC, blood culture. CXR if any respiratory symptoms (especially tachypnea). +/- LP (some LP all of these kids, some don't; but most will argue that if you're going to give empiric Ceftriaxone, you better get an LP before you do it). Admission and empiric antibiotics if UA/CSF abnormal or if WBC >15. If labs normal and WBC <15, +/- Ceftriaxone and f/u in 24 hours.
--Fever (39 or higher) without a source in children 3-36 months (assuming they're fully immunized with 3 doses each of HIV and PCV-7 and essentially well-appearing): For 3-6 months, do CBC, blood culture (if WBC>15), UA/UC and strongly consider Ceftriaxone for kids with WBC >15. Do CXR if there's respiratory symptoms and also consider CXR if WBC >20. For 6-36 months, obtain UA/UC in any uncircumcised boys <12 months or any girl <24 months. Many will also do CBC/blood cultures in children 6-36 months...but studies would say they're not necessary. If cultures are taken or antibiotics given, f/u with PMD or ED in 24 hours. If UA positive treat with 3rd generation Cephalosporin until cultures return (Ceftriaxone 50 mg/kg IM if sending home, Ceftriaxone or Cefotaxime 50 mg/kg IV if admitting).
--Bronchiolitis (you'll still see it in the summer, though not due to RSV): Supportive care is the norm; can try a neb (either Albuterol or Epi) to see if there's any clinical response. Criteria for admission includes young infants (<4-6 weeks of age due to risk of apnea), hypoxia requiring supplemental O2, inability to eat/drink/stay hydrated, significant vomiting, or medically complex kids with co-morbidities.
--Croup: For kids with stridor at rest or difficulty breathing: Epi neb + Dexamethasone (0.6 mg/kg either PO or IM), then observation for 1-2 hours in the ED. If stridor returns they get a 2nd Epi neb and usually admission (hopefully your hospital has a SSU---cause that's all these kids usually need---just a few more hours of observation).
--Asthma: If increased work of breathing, give 2-3 nebs back to back (Albuterol/Atrovent) and steroids asap (Oral: 2 mg/kg Prednisone or Prednisolone; IV: 2 mg/kg Methylpred). Consider baseline VBG if severe.
--Acute otitis media (AOM): For kids >2 years of age with "nonsevere" infections, "watch and wait" (counseling on the use of analgesics and providing an antibiotic Rx but asking the family not to fill it unless symptoms continue past 48 hours) is an option. High-dose Amox (80-90 mg/kg/day divided TID) is 1st line, Augmentin (use the ES-600 formulation and dose the Amox at 80-90 mg/kg/day divided BID) and 3rd generation Cephalosporins (usually Cefdinir at 12 mg/kg/day divided QD-BID) are 2nd line treatment.
--Pneumonia: Empiric treatment for presumed bacterial pneumonia:
-Outpatient: same as AOM above; or for older children, give Azithromycin 10 mg/kg on day 1, then 5 mg/kg on days 2-5
-Inpatient: 2nd or 3rd generation Cephalosporin (Cefuroxime or Ceftriaxone or Cefotaxime)
That's what I can think of off the top of my head, I hope it's helpful!
BTW, UpToDate has great reviews of all the above topics specific to pediatrics. I use UpToDate daily at work to look up various things.
