Pediatrics

An incredibly incomplete central source of notes from my residency: only the things I learned that surprised me, interested me, or seemed worthy of memorization.

Last Updated:  August 18th, 2014..

Pediatric Advanced Life Support: PALS notes: Good summary. “Why don’t we give amiodarone in the non-shockable side of the CPR algorithm?” also includes a nice explanation of why PEA isn’t shockable.

Outpatient / Well-Child Checks: 2 weeks to regain birth-weight. 4-6 months to double it, and 1 year to triple it.

• Prevnar (13-valent vaccine) for children UNDER 2 years old (they fail to mount an appropriate response to the 23 valent. Irritating.)
• Pneumovax (23-valent vaccine) for children OVER 2 years old

Patients with progressive neurologic diseases (including uncontrolled epilepsy) shouldn’t receive DTaP until their neuro status is stable. (Not ‘cured’, just… stable.)

No hand preference until 18 months old.

1st tooth eruption (average) ~ 6 months old. Primary teeth are established by 2 years old, secondary teeth begin erupting at 6-8 years old.

• 13 months old = 3 words.
• 2 years = 2 word sentences
• 3 years = 3 word sentences

Object permanence at 9 months old.

80% of hearing loss is autosomal recessive.

• Goat’s milk –> folate deficiency.
• Cow’s milk (before 9 m.o.) –> iron deficiency.

Children with increased risk of high cholesterol still shouldn’t be screened or undergo dietary modifications until AFTER 2 years of age.

Delayed cord separation = AFTER 1 month old : Think LAD1. (dx: measure CD18 by flow cytometry).

RAPID onset pneumonia: think GBS pneumonia.

Nitric oxide is for NICU babies (“tricky” babies). Nitrous oxide is laughing gas (“laughing” at the inarticulate intern).

Most newborn reflexes should disappear at 4-6 months.

Heart Murmurs:

• ASD = fixed splitting of the SECOND heart sound.
• NO murmur but single S2 = Transposition (TGA)
• Tricuspid atresia: the only cyanotic heart lesion w/o RVH (LVH instead, of course)
• “Egg on a string” = Transposition (TGA)
• Ebstein Anomaly = S3 + S4 + Tricuspid Regurgitation
• Harsh/blowing systolic murmur = VSD, but a blowing HOLOsystolic murmur = tricuspid regurgitation (+/- mid-diastolic rumble)

Infectious Diseases:

If the vanc trough is too high, you increase your dosing interval. Not decrease the dose – increase the dosing interval. 

3rd generations cephalosporins have worse coverage for staph than 1st or 2nd gens. Just like aminopenicillins have worse staph coverage than regular penicillins.

Soft-tissue infections = 1st gen cephalosporins. Basically Ancef (cefazolin) if IV, or Keflex (cephalexin) for oral. Also the usual choice for surgical prophylaxis.

The difference between Unasyn and Zosyn is that Zosyn covers pseudomonas. So don’t go guessing “Zosyn” for a community-acquired infection, genius.

Pulmonology:

As far as inhaled corticosteroids go, try to remember that QVAR is generally less expensive as an outpatient than Flovent, because there ain’t much else distinguishing the two.

Just because the pulmonologist wants your 3 month old to go home on an albuterol nebulizer for emergencies (what), that doesn’t mean that it’s possible.  The dose will be so impossibly small that sterility will be out of the question unless you order levalbuterol instead. So try to order levalbuterol instead. (Also, try to get a different pulmonologist.)

Atrovent is ipratroprium. Duoneb is an itratroprium / albuterol combo.

Generally speaking: Croup is inspiratory stridor, bronchiolitis is expiratory stridor.