ACUTE PEDIATRIC INFECTION PATIENTS AT CENTRAL HOSPITAL Helena Ruotsalainen

FEVER AND SEIZURES anticonvulsants:per rectum diatzepam 0.5mg/kg ad 10mg;to buccal mucus midatzolamin 0.25mg/kg ad 10mg;iv loratzepam 0.1mg/kg ad 2mg Parasetamol 15mg/kgx1-4/d po, p.rect.,iv Lab:WBC,CRP,blood culture (glu, Ca)urine specimen, spinal tap, x-ray Iv-connection : fluids, drugs

F E V E R Consciousness, reacts to speech, open eyes, movements? Hypotension, saturation, pulse Neck stiffness / floppy Dislike of being handled Respiration: tachypnea Skin: purpura/ petecchia

MENINGITIS Meningococcus ad 1/10 dies, pneumococcus Purpura, restlessness, head extension Spinal tap:white cell count, protein high, glu low, bacteria Th: iv-cephalosporin; iv penicillin+ gentamycin Dexametason 0,15mg/kg:4, furesis (?) Herpes encephalitis: iv-aciclovir

FLUIDS (brain infection, septichemia) Reduced fluids (75-80%) for avoiding brain odema but take also care of extra losses:fever, vomiting, diarrhea. Follow up blood pressure, urine excretion (least 1ml/kg/h – 2-3ml/kg/h), weight Viral meningitis: symptomatic care (fluids, pain killers for headache)

RESPIRATORY INFECTIONS Laryngitis: inspiratory stridor, barking cough.Th:metylprednisolon po/im, adrenalin im/inhalation Bronchiolitis,bronchitis:wheezing,retractions.Th:s ymphatomimetic-inhalations, mucus suction Whoopingcough(pertussis):apnoe, paroxysmal cough.4-6weeks.Th:eythromycin Tonsillitis: penicillin, iv-fluids (difficulties to eat)

P N E U M O N I A Fever, cough, pain when breathing Tachypnea /min, low saturation Auscultation:rales, silent Lab: WBC, CRP, blood culture Thx-x-ray: lobar, pleuritis, emphyema, tbx( upper lobes, hilar nodes) Th:iv-penicillin, po ampicillin,azithromycin, cephalosporin,+gentamycin, iv-fluids

G A S T R O E N T E R I T I S Bacterial: salmonella, shigella (tourism), yersinia,campylobacter(soil,meat); enterohaemorrhagic e.coli=EHEC (cattle, milk,water).Blood in stools, oligouria. Kidney problem. Intensive ward, dialysis. But sometimes needs no therapy.-Fluids (iv-ORS) Viral:rota, adeno, entero, noro. Th: ORS ml/kg 4-6t, then 5ml/kg/every stool

URINARY TRACT INFECTIONS Pyelonephritis ac: fever, nausea, vomitis, pain in kidneys, abdominal pain urine culture, microscopia, WBC, crp, krea th: cephalosporin, TMP-SMZ, iv-fluids? Lower urinary tract infections: dysuria, low fever th: po at primary ward

SKIN, SOFT TISSUE, BONE INFECTIONS Pemphigus (infants), impetigo,erysipelas Lympadenitis, abscesses, cellulitis Osteomyelitis, arthritis cause: from skin injuries / dry atopic skin;from respiratory tract bacteries Th:cephalosporin,kloxacillin,klindamycin,penic local therapy;in some cases surgery