Wednesday Wrap-up

Wed Wrap Up 6/11/14

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Brought to you by Dr. Andrew Grock and Dr. Carl Alsup

Special Thanks to our Grand Rounds Speaker, Dr. Christopher Doty.

 

Peds Case Conference, by Dr. Francis Youn

Neutropenic Fever

– ANC = WBC (in thousands) cells/mcL * [(neutrophil % + band %)/100]

– ANC < 1500 (and definitely < 500) is highly concerning for neutropenia

– monotherapy with cefepime, meropenem, imipenem, or zosyn

– add vancomycin for catheter related infections, skin/soft tissue infections, abx resistance, hypotension, pneumonia

(Does this information look familiar? See our Board Review series here)

 

Neonatal hyperbilirubinemia

– evaluate for sepsis

– check total and direct bilirubin

– total bili > 25 always needs admission regardless of age in hours

– concerning rate of rise: > 5mg/dl in 24 hours or > 0.2mg/dl/hr

– www.bilitool.org

More Questions? See a review article here

 

Peds Day, by Dr. Jacqueline Bober

Ideopathic Thrombocytopenic Purpura (ITP)

-autoantibodies against platelets leads to thrombocytopenia

-typically presents with petechial rash and normal exam

-treatment is controversial (IVIG, steroids, Win-Rho, nothing)

 

Hemophilia

-hemophilia A – FVIII deficient

-hemophilia B – F IX deficient

-hemophila +suspected CNS bleed = give factor before imaging!

 

Peds M&M by Dr. Andrew Grock

-Know PALS see link 

-For intractable SVT in stable patient, give Amio slowly (over 10 minutes in adults, 20- 60 minutes in children)

-Adenosine dose 0.1 mg/kg up to 6mg, then 0.2mg/kg up to 12mg

 

Peri-Natal Emergencies, Dr. Doty, summary by Dr. Andrew Grock

Shoulder dystocia = scary. Use HELPERRS

-Help, call for it (ob/gyn doctors)

-Episiotomy (try to make room, also straight cath)

-Legs (McRoberts)  McRoberts ManeuverR

-Pelvic pressure (suprapubic)

-Enter (wood’s screw/Rubin 2)

-Remove posterior shoulder

-Roll onto all fours (gaskins maneuver)

-Clavicle (break)

Do not pull on the umbilical cord!

A link with more information can be found here

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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andygrock

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