Problems of the neonate and young infant - Pocket Book of Hospital Care for Children - NCBI Bookshelf
This chapter provides guidance on essential newborn care and the management of problems in neonates and young infants, from birth to 2 months of age. It includes neonatal resuscitation, the recognition and management of neonatal sepsis and other bacterial infections, and the management of preterm and low-birth-weight infants. A table giving the doses of commonly used drugs for neonates and young infants is included at the end of this chapter, which also lists the dosages for low-birth-weight and premature infants.
over 5 years ago
<div class="postBody">Sepsis is a common cause of death in the intensive care unit. In this episode I present some of the statistics on septic deaths, introduce the definitions, and present the basic science. Part 2 will cover fluid and drug therapy for septic shock. </div>
Jeffrey S. Guy, MD, FACS
over 10 years ago
Epidemiological studies of acute kidney injury (AKI) and acute-on-chronic renal failure (ACRF) are surprisingly sparse and confounded by differences in definition. Reported incidences vary, with few studies being population-based. Given this and our aging population, the incidence of AKI may be much higher than currently thought. We tested the hypothesis that the incidence is higher by including all patients with AKI (in a geographical population base of 523,390) regardless of whether they required renal replacement therapy irrespective of the hospital setting in which they were treated. We also tested the hypothesis that the Risk, Injury, Failure, Loss, and End-Stage Kidney (RIFLE) classification predicts outcomes. We identified all patients with serum creatinine concentrations ≥150 μmol/L (male) or ≥130μmol/L (female) over a 6-mo period in 2003. Clinical outcomes were obtained from each patient's case records. The incidences of AKI and ACRF were 1811 and 336 per million population, respectively. Median age was 76 yr for AKI and 80.5 yr for ACRF. Sepsis was a precipitating factor in 47% of patients. The RIFLE classification was useful for predicting full recovery of renal function (P < 0.001), renal replacement therapy requirement (P < 0.001), length of hospital stay [excluding those who died during admission (P < 0.001)], and in-hospital mortality (P = 0.035). RIFLE did not predict mortality at 90 d or 6 mo. Thus the incidence of AKI is much higher than previously thought, with implications for service planning and providing information to colleagues about methods to prevent deterioration of renal function. The RIFLE classification is useful for identifying patients at greatest risk of adverse short-term outcomes.
over 5 years ago
<p><span style="color: #333333; font-size: small;">This episode covers an approach to children with altered level of consciousness. We present an approach to the initial management in these cases, with a focus on the ABC and DFG approach. Investigations and imaging are discussed. Some specific causes of altered LOC are covered. This episode was written by Peter MacPherson and Dr. Melanie Lewis. Peter is a medical student at the University of Alberta. Dr. Lewis is a general pediatrician and an Associate Professor of Pediatrics at the University of Alberta and Stollery Children's Hospital. She is also the Clerkship Director. </span></p <p><span style="color: #333333; font-size: small;">~~~</span></p <p><!--StartFragment--></p <p class="MsoNormal"><span style="font-family: Times;"><span style="font-size: small;"> <!--StartFragment--> </span></span></p <p class="MsoNormal"><span style="font-family: Verdana;">Differential Diagnosis of Altered Level of Consciousness:</span></p <p class="MsoNormal"><span style="font-family: Verdana;">1) Structural causes: cerebrovascular accident, cerebral vein thrombosis, hydrocephalus, intracerebral tumor, subdural empyema, trauma (intracranial hemorrhage, diffuse cerebral swelling, abusive head trauma/shaken baby syndrome)</span></p <p class="MsoNormal"><span style="font-family: Verdana;">2) Medical causes: anoxia, diabetic ketoacidosis, electrolyte abnormality, encephalopathy, hypoglycemia, hypothermia or hyperthermia, infection (sepsis), inborn errors of metabolism, intussusception, meningitis or encephalitis, psychogenic, postictal state, toxins, uremia (hemolytic-uremic syndrome)</span></p <div style="border: none; border-bottom: solid windowtext .75pt; padding: 0in 0in 1.0pt 0in;" <p class="MsoNormal" style="border: none; mso-border-bottom-alt: solid windowtext .75pt; padding: 0in; mso-padding-alt: 0in 0in 1.0pt 0in;"><span style="font-family: Verdana;">Adapted from: Avner J (2006) Altered states of consciousness. <em>Pediatr Rev</em></span><span style="font-family: Verdana;"> 27: 331-338.</span></p </div <p> </p>
over 10 years ago
Definitions. Before discussing SIRS along with the various sepsis syndromes, it is important to understand some basic definitions. Infection: This is the inflammatory response initiated by the presence of a micro-organisms in normally sterile tissue. Bacteraemia: The presence of live bacteria in the blood stream. This can occur in a healthy individual and present with no symptoms. Common causes include surgery, dental procedures and even tooth brushing.
almostadoctor.com - free medical student revision notes
almost 7 years ago
This is a good practical case and very useful for new clinicians. For any clinician:No foley catheter unless oliguric, anuric, obstructed since any catheter is a foreign body and increases infection risk.Rehydrate if U/A has high spec gavity, mucous membranes dry, or if BUN is >30 times the creatinine as in this case. Even CHF pts get dry if not in heart failure. If in doubt, do CXR, BNPT, listen for crackles.Start with 250cc IVF if BNPT not less than 150 or give carefully while checking lung bases posteriorly after each bolus along with pulse ox, etc as above. Half of pts in acute renal failure are septic. Look for and eliminate source such as pneumonia, foreign body, pyelonephritis, joint infections. May be afebrile/ low temp or low WBCs with sepsis. Do cultures, check lactate ASAP to detect sepsis BEFORE the BP drops. Lactic acid "the troponin of sepsis." If septic, give a lot of fluids (up to 10 liters often) since capillary leak syndrome will lead to severe hypotension. If septic expect edema to develop with IV boluses yet be aware pt is intravascularly depleted. No pressors without fluids "pressors are not your friend" as per lecturers on Surviving Sepsis campaign.
over 5 years ago
Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks' gestation. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. Speculum examination to determine cervical dilation is preferred because digital examination is associated with a decreased latent period and with the potential for adverse sequelae. Treatment varies depending on gestational age and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks' gestation. Corticosteroids can reduce many neonatal complications, particularly intraventricular hemorrhage and respiratory distress syndrome, and antibiotics are effective for increasing the latency period.
about 5 years ago
All Anaesthetics Analgesia Anatomy Conditions Emergency Medicine ICU Immunology Intubation Pharmacology Physics Physiology Renal Sepsis Techniques Vaccine #WDSD16
almost 5 years ago
In the emergency department, lumbar punctures are most commonly performed to determine the presence of an infectious process (meningitis, encephalitis, sepsis, etc.) or subarachnoid hemorrhage
American College Of Emergency Medicine
over 10 years ago