COMBANK PEDIATRIC Anaphylactic reaction o Management: IM epinephrine 1:1000. Obtain airway stabilization first and IV access.

s. IV epinephrine = 1:10000 dose instead. Birth Injuries: o Clavicular fx crepitus felt over clavicle o Erbs Palsy neuro findings (C5/C6 injury decrease biceps reflex, moro reflex, adduction and internal rotation of arm). o Klumpkes palsy claw hand. Weakness of wrist and finger flexors. Infantile botulism bacterial toxin blocks presynaptic vesicles, preventing the relase of NT. Initially, presents with constipation and poor feeding hypotonia, weakness, diminished eye movement, papillary paralysis, and ptosis. o Ddx: Neonatal myasthenia gravis transient form of the disease found in those whose mother has the disease. Facial diplegia more than ocular involvement. Tx: supportive care with anticholinesterase inhibitors. o Hypermagnesium (due to mom getting magnesium sulfate) blocking of Ca+2 release inhibits Ach release from presynaptic vesicles. Tx: diuresis with IV fluids to dilute the Mg concentration o Congenital myasthenia gravis: ocular mm involvement seen Arm fractures o Supracondylar fx: transverse type fx just proximal to the level of the medial/lateral epicondyles of humerus (supracondylar). Displacement of the anterior humeral line as normally the anterior humeral line should intersect the middle third of the capitellum. Usually occurs due to fall on outstretch hand o Radial head subluxation: adult pulling upwards at wrist of child hyperextension and entrapment of radial annular ligament holds arm in flexion/pronation o Humeral surgical neck fx located below the great/lesser tubercles, located on the proximal portion of the humerus. o Humeral diaphysis fx spiral fx (longitudinal fx of humeral shaft); transverse fx (perpendicular to long axis of bone); comminuted fx (with 3 or more involved bone fragments) o Elbow dislocation gross deformity seen and complete immobility of elbow joint Potty training begin between 18-24 yo (AAP guidelines) Benzodiazepine toxicity decreased mentation, delirium, HA, weakness, slurred speech. Tx = flumazenil Rett Syndrome o 4 stages: stage 1 (developmental arrest) around 6-18 mo with decreased eye contact and lack of interest; stage 2 (regression) around 1-4 yo with loss of oral communication and purposeful hand movements; stage 3 (pseudostationary) around 2-10 yo with some improvement in hand and

language skills; stage 4 (late motor deterioration) around >10yo with more motor issues (parksonism sx, hypertonia, etc) Febrile Seizures o Simple febrile seizures: children ages 6 mo 6 yo. Lasting <15 min. If patient >18 month old then can be d/c home on supportive care. If <1 yo, should do LP. Lytic bone lesions in child: o Infectious (brodie abscess from osteomyelitis) o Endocrine (hyperparathyroidism osteitis fibrosa cystica, o neoplastic (Ewing Sarcome, Langerhans histiocytosis, metastasis), o idiopathic (benign bone cyst) o Langerhans: cause solitary, lytic, long bone lesions; painful with overlying tender swelling and can cause pathologic fx. Typically resolves spontaneously. o Osteogenesis Imperfecta: defect in collagen. Blue sclerae. o Osteomyelitis: fever. No hypercalcemia. o Primary Hyperparathyroidism: hypercalcemia. Parathyroid adenoma is MC cause. Usually over 50 yo so unlikely in children. Hirschsprungs Disease: congenital aganglionosis of the distal bowel o both myeneteric (Auerbach) and submucosal (Meissner) plexus absent reduced bowel peristalsis and fxn. Area missing ganglion cells is just distal to the megacolon section which has expanded due to feces that cant be pushed passed the affected segment. o Usually fail to pass meconium within 48 hrs of life + vomiting + FTT (failure to thrive) o If less severe lesion, present later in life with chronic constipation o Barium enema for imaging. Plain film will show distended bowel w/ paucity of air in rectum o Anorectal manometry detects failure of internal sphincter to relax after distention of rectal lumen. o Rectal bx just distal to the expanded segment confirms dx - no plexus + hypertrophied nerve trunks enhanced with Acetylcholinesterase staining o