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Viral Infections
• Viruses are parasites that cannot reproduce or meet own metabolic needs.
• Skin cells react to virus with swelling, “vesiculation,” or proliferation, sometimes warts.
• Most viruses are associated with rashes (characteristic of each disorder, such as chicken pox, rubella, roseola)
Pediatric Neurology
• Abnormal posturing is an ominous sign
• A positive Babinski is normal in children until one year of age
• Myelinization continues until adolescence
• Abnormal CSF findings include: decreased glucose, positive culture, and cloudy appearance
• Due to pharmacokinetics and dynamics, common side effect of the majority of anti-convulsants include drowsiness, ataxia, lethargy, anorexia, nausea. Sometimes dyscrasias or liver damage can occur; hence, these children need periodic tests of blood and of liver enzymes.
• Febrile seizures are generally a one-time event, though there may be a familial predisposition.
• Children are more likely than adults to have neuromuscular or extrapryamidal side effects from psychotherapeutic drugs.
• Clinical effectiveness of anticonvulsants varies with the drug’s serum level, mechanism of action, pharmacokinetics and dynamics. The effects also may vary from child to child.
• A newborn’s brain is about two-thirds the size of an adult’s, and reaches 80% adult size in one year.
• The sudden appearance of a fixed or dilated pupil is an emergency.
• The progression from decorticate posture to decerebrate posturing, and then to flaccid paralysis, indicates deterioration of neurologic function.
• Do not do any diagnostic tests that require head movement until cervical spine injury has been ruled out.
• Children with congenital neurological disabilities will often develop complications in other body systems.
• Cerebral palsy is a neuromuscular disorder. It may bring with it certain problems in perception, language, and/or intellectual function.
• Acute bacterial meningitis is a medical emergency, requiring swift action and treatment.
• The care of the unconscious child focuses on respiratory management, neurological assessment, monitoring intake and output, providing appropriate medications and evaluating outcomes.
• The primary indicator of neurological status is LOC (level of consciousness).
• Status epilepticus is an emergent situation.
• Do not restrain a child experiencing a tonic-clonic seizure, and never place anything in his mouth.
• In head trauma, the primary mechanism of injury is acceleration-deceleration accidents.
• Bleeding from the nose or ears calls for evaluation.
Pediatric Cardiovascular
• In a cardiac history, include poor weight gain, chronic respiratory infection, activity intolerance, and fatigue during eating.
• Oxygen is a drug that requires a prescription and frequent monitoring.
• Cardiac catheterization serves many purposes: diagnostic, interventional and electrophysiologic. It also monitors cardiac oxygen saturation, pressure changes and anatomic defects.
• CHF signs usually show either left or right sided heart disorders. These signs may include increased heart rate, adventitious lung sounds, cyanosis, edema, hepatosplenomegaly, and distended neck veins.
• Acquired cardiac disorders include bacterial endocarditis, acute rheumatic fever, hyperlipidemia, Kawasaki disease, and cardiomyopathy.
• Electrodes for cardiac monitoring are usually color coded: white (upper right), black (upper left), green (lower right), and red (lower left).
Pediatric Respiratory
• The principal functions of the respiratory tract are to allow air movement (ventilation) and exchange (diffusion) of oxygen and carbon dioxide.
• Children’s airways are smaller, more flexible and shorter than adult’s and are therefore more prone to obstruction than adults.
• Stridor usually indicates an upper airway concern, while wheezing indicates a lower airway disorder.
• Conditions that increase or decrease compliance and/or resistance will make breathing harder. Signs of increased breathing work are tachypnea, retractions, abnormal positioning, shortness of breath and fatigue.
• Respiratory rate is an important indicator of respiratory status.
• Central cyanosis in a newborn usually means severe hypoxia and possible cardiac etiology.
• Acrocyanosis is a common finding in a newborn.
• Asthma is not a disease but an inflammatory disorder.
• Asthma is not wheezy bronchitis.
• The incidence and severity of respiratory tract infections and disorders is related to the child’s age, size, natural defenses, underlying disorder and agent involved.
• After a tonsillectomy child may bleed for up to several weeks.
• Epiglottitis, acute tracheitis and status asthmaticus are acute medical emergencies.
• The best way to stop the spread of RSV is meticulous hand washing. RSV is transmitted by direct contact with the fomite