1. “Chance favors the prepared mind.”
Louis Pasteur

2. Pediatrics On Call G. Waldon Garriss, III, MD, MS, FAAP, FACP
Vanderbilt University Medical Center

3. Outline Five common calls to see the patient Summary
Signs of respiratory distress
Recognizing sepsis/shock
Rashes
Seizures
Fever
Summary
Bonus: Essential calculation
Questions

4. “I was wondering if you could come and take a look at this child. . . .”
He/she’s working hard to breathe.

5. Airway, Airway, Airway (Quickly recognize signs of respiratory distress!)
Tachypnea
Wheezing
Grunting
Nasal flaring
Retractions
Suprasternal
Intercostal
Subcostal
Head bobbing
Abdominal breathing
Drooling
Stridor
Poor feeding
Lethargy

6. Respiratory Distress Oxygenation Ventilation Stridor Wheezing
How do you evaluate it?
Rx?
Ventilation
Stridor
Wheezing
Characteristic coughs
Croup
Pertussis
Asthma

7. “I was wondering if you could come and take a look at this child. . . .”
He/she looks bad.

8. Recognize Sepsis/Shock “What are plausible reasons for the patient to be so sick?”
General appearance
Pulse (early changes)
BP (changes occur late – maybe too late)
Capillary refill
Volume status – including UOP

9. Treatment of Sepsis/Shock “What are plausible reasons for the patient to be so sick?”
20 cc/kg = bolus (NS or LR)
If sepsis, culture(s) and empiric antibiotics
Reassess often
If worsened by bolus, do not repeat it
I/O access, if needed
Pressors, if needed (NICU/PICU)

10. “I was wondering if you could come and take a look at this child. . . .”
He/she has a rash.

11. Rash (Usually, blanchable is good!)
Drug induced
Erythema multiforme
Stevens-Johnson Syndrome (EM major) – must include two mucosal surfaces
Petechiae – always think of RMSF, DIC, meningococcemia
Purprua – always think of HSP (JARS), meningococcemia
Vessicles – always think of herpetic lesions

12. “I was wondering if you could come and take a look at this child. . . .”
He/she is having a seizure.

13. Seizures Prior seizures?
Febrile seizures (T >38o, < 15 min, if multiple – not > 30 min, not focal)
Generalized tonic-clonic seizures
Absence seizures (Petit mal)
Partial (focal) seizures
Tonic states (Sandifer’s Syndrome)

14. Seizures - Treatment Don’t forget the rectum for Rx delivery
Diazepam dose depends on the age/wt.
Protect the airway
But not by putting something in the child’s mouth
Rescue position
Immediate work up
Glucose, BMP, Ca++, ?LP, O2, neuroimaging, UDS?

15. “I was wondering if you could come and take a look at this child. . . .”
He/she is having a fever.

16. Fever (Think about the child’s age.)
Less than weeks old
Less than 6 months old*
Need to do further work up?
Neonate
Chemotherapy
Recently cultured
Urine or other unrecognized source
Tylenol dosing mg/kg po/pr q 4 h
Ibuprofen* 10 mg/kg po q 6 h
*For use in children > 6 mo old

17. Summary/Review
Airway – recognized increased WOB and respiratory distress early
Sepsis/Shock – don’t wait for the BP to fall
Rashes – respect petechiae, purpura, and vessicles
Seizures – protect the airway; don’t forget rectal delivery of benzodiazepines
Fever – age matters; no Ibuprofen if under 6 months old

18. Bonus: Essential Calculations
Pediatrics: On Call
4/7/2019
Bonus: Essential Calculations
16 oz/lbs
lbs/2.2 = kg
5cc/tsp
in x 2.54 = cm
Approximately 30 cc/oz
G. Waldon Garriss, III, M.D., M.S.