EMERGENCY MEDICINE
 Mattress (soft)
PEDIATRIC PART 1
 Neonate - Birth -> 1st 26 days
 Infant – 29 days -> 1 year of age
 Child – more than 1 year of Age
 AHA- American heart Association (BLS)
 8 below - child
 8 above – adult protocols
 Assessment:
 History
 Vital signs
 Brose’s low weight
 To know what to do during
arrest, emergency, drugs,
normal values to the child.
 Body wt. (estimated)
o 12 mos: (age in
mos/2) + 4
o 1- 12 yrs: (age in yrs
x2) + 10
o Birth: (age in yrs x2)
+70
 Hypotensive
 P5 - Allowable BP =
 Systolic - Age in year x 2 + 70
 Diastole – 2/3 of Systolic
 Fever
 Most common chief complaint
 Rise of core temperature associated
with descending body thermo stat.
 Acute: 7 days
 GET: rectal (most accurate) , axillary,
oral
 DOC: Acetaminophen, Para,
Ibuprofen
 Threshold:
 Neonate – 3 mos. – 38.0 C
 More than 3 mos. To 3 yrs
old. – 39. 0 C
 37.8 more than give Para.
 Sudden Infant Death Syndrome (SIDS)
 Idiopathic/Unknown
 “Crib syndrome”
 Check to history, Physical exam.
 Apnea – pag tigil ng hingin more than
2o sec.; change in color; and muscle
tone.
 Serotonin – sleep wake cycle
 Prone position
 Adult (nadadaganan)
 DNR (DO NOT RESUCITATE)
 Those infants who are coming in the
ER who are Rigor mortis.
 Color changes
 Anoxia – hypothermia
HEAD AND NECK
 Acute otitis media
 MC: Pain and fever
 External: middle ear
 Manifestation: infection, fluid like on
the ear
 Due to trauma
 Sever pain (tragal tenderness),
swelling and tenderness
 DOC: antibiotics
 Foreign Body
 MC: insects
 TX: immobilized (baby oil)
 Acute Mastoiditis
 Infection of mastoid process (skull)
 Erythema; tenderness; edema
 Protrusion of auricle
 Dacrocystitis
 Lacrimal sac inflammation and
infection - pus
 Periorbital & orbital cellulitis
 Tenderness and swollen of the
eyelids and periorbital of the area
 DOC: antibiotics
 Rf: sinusitis, infection (pimples)
 Infantal glaucoma
 Leading to disgenisis of aqueous
humor -> increase intra ocular
pressure
 Manifestation cornea enlarge:
cloudy – cause blindness
 Leukocoria
 Normal = Red-orange reflex
 Abnormal = White; early symptoms
of Catarcs.
 Strabismus- duling
 Nystagmus- involuntary movement of
the eye
 Nasal cavities of erythemas
 Bacterial sinusitis
 MC: URTI
 Fouls smelling discharge
 Sinusitis + orbital cellulitis
 Epistaxis
 Nose bleeding
 Anterior – back plexus and Posterior
 Look down forward – avoid aspirating
of the blood
 Geographic Tongue
 Erythema and atrophy of the tongue
surrounded by serpinginous (look like
snake), elevate white and yellow
border.
 LOC: anterior 2/3 of the tongue
 NO TX
 Mucocele
 Swelling of sublingual
 Small blush descerete
 NO TX
 Apthous ulcer
 AKA - Singaw, “CANKUR SORE”
 Most common recurrent ulcers
 Painful, shallow ulcers on the mucosa
 TX: Antimicrobial (topical,
Mouthwash)
 Herpangina
 LOC: Soft Palate & rinse of the tonsils
 Cause: Enterovirus
 Painful oval-shaped lesion
 TX: supportive
Rashes
 Hand, foot & mouth disease
 MC: Coxsackie Virus A16
 Viral that starts w/ low grade fever
lasting 2-3 days followed lesions on
the oral cavity, palm of the hands,
soles of the feet and buttocks
 Admission? Due to severe pain
cannot feed -> dehydration
 DOC: antipyuretic, hydration &
analgesics
 Herpes Simplex Gingi Vostomatitis (HSV1)
 HSV1 – above belt ; HSV2 – Below
belt
 abrupt high grade fever, irritability,
decrease oral intake drooling due to
pain, swollen, erythematous, friable
gingiva
 Doc: analgesics, antipyuretic, antiviral
therapy
 Uvulitis
 Osiolated inflammation of the uvula
appears erythematous, enlarge &
edematous
 Fever, drooling (cannot feed), sore
throat, dysphagia(difficulty of
swallowing), odynophagia,
respidistress
 Lymphadenitis
 Drainage
 Infectious process is a leading cause
of inflamed lymph nodes
 DOC: Antibiotic
 TX: supportive; I&D (incision &
Drainage) if with abscess -> cut and
express the secretion (pus)
 Thyroglossal Duct cyst
 Embryonic part of the Neck
persistent segment of the throglossal
duct
 MC: Midline Neck Massess in the
children
 Painless fluctuant mass that moves
during swallowing or protrusion of
the tongue
 Lymphangioma (cyctic hygroma)
 Lymphatic channel
 Painless; soft
 LOC: neck
 Enteroviruses
 Head, foot, mouth disease
 Symptomatic: fever, anorexia,
malaise
 Vesicular oral lesion -> red papules
on palms, soles, buttocks
 Measles
 “First Disease”
 Highly Contagious
 Upper respiratory symptoms ->
malaise, fever
 Photophobia & 3C’s (Conjunctivitis,
Cough, coryza (sipon))
 Behind the ear @ hairline(head to
feet progression)
  Koplik Spots- Discrete spots with Red
base first appear on the mucisa
opposite the lower molars & then
spread to involving entire buccal
mucosa
 TX: Symptomatic
 Rubella (german Measles)
 “3rd Disease”
 Rashed on the face of the neck, trunk
& arms coalesces on the face of
eruption reaches on lower
extremities
 Distinct presence of
lymphadenopathy suboccipital and
posterior auricular (marami kulani)
 Forscheimer Spots – pin point
petechiae involving the soft palate
 Lymphadenopathy is the clinical
manifestation
 TX: symptomatic
 Erythema Infectiosum
 “5th disease”
 Abrupt appearance of the rashed
with “Slap cheeks” appearance
(butterfly appearance)
 Rosseola Infantum (exanthema subitum)
 “6th disease”
 Rashes, immediately fail on non-
specific symptoms; 3-5 days of illness
 Most prominent neck, trunk,
buttocks
 Herpes Virus
 Herpes labial/ Cold Sores
gingivostomatitis – painful vesicles in
the oral cavity
 Eczema Herpeticum – dev’t vesicles
eruption
 VESICLES – small lesion with clear
fluid
 Varicella (chicken Pox)
 Pruritic generalized vesicular lesion
with mild systemic infection
 TX: asymptomatic
 DOC: azyclovir
 Non – Bullous Impetigo
 Impetigo: a big vesicle; cigarette burn
 Non-bullous – vesicles that ride to
form golden yellow crust; Dry
 Bullous – separation of the skin giving
rise to bullae that local @ site of
infection; toxin mideated
erythadermes; formed bullae filled
fluid
 Staphylococcal Scalded Skin Syndrome (SSSS)
 4th disease
 Nickolsky signs – separation of
dermis when in pressure
 Malaise; fever
 DOC: antibiotics
 Scarlet fever
 2nd disease
 Strawberry tongue
 Fever; sore throat; abd pain; rash
 Sand paper rashes
 Erysipelas
 “St Anthony fire”
 MC: lesion on face
 Cellulitis & lymphangitis skin
associated with fever; chills; malaise;
vomiting & headache
 Erythematous plaque (peripheral)
 Erythema Nodosum
 MC site : shin (leg part)
 Associated tender nodules; OCP –
oral contracentive pills
 Erythema Multiforme
 Virus; burning sensatation then
abrupt onset of rash frequently
involving palm & soles
 “target lesion”
 Steven-johnson Syndrome
 “hypersensitivity of the medicine”
 Widespread blisters usually less than
10% BSA (body surface area)
 Toxic Epidermal Necrolysis – more
than 30 % BSA
 Toxic Epidermal Necrolysis
 Kawasaki Disease
 “Mucocutaneous lymph nodes
syndrome”
 Can lead sudden death due to
coronary artery aneurysm
 Fever (5day day more than),
conjunctivitis, mucous membrane
changes, changes in extremities, rash,
cervical adenopathy
  TX: IVIG (immunoglobulin) given by
wt
 Henoch – schonlein purpura
 MC: Vasculitis in childhood
 Palpable purpura in buttocks
 Cause: renal dse and abd pain
 No specific TX
Respiratory
 NORMAL Respiratory Rate (RR)
 New Born = 50
 Above 6 months = 40
 Above 1 year = 30
 Assessment:
 Vital sings must be accurate: 1 full
minute
 Stridor
 High – pitched, harsh sound
produced by turbulent air flow thru a
partially obstructed airway
 Less than 6months –
laryhngotracheomalacia (vocal cord
paralysis
 More than 6 month – croup;
epiglottitis; bacterial tracheitis;
foreign bodies
 Larygnomalacia
 MC: congenital stridor
 Developmentally weak larynx
 stridor worsen when crying &
agitation
 often improves whne neck extend &
prone position
 obstruction – MC: tongue
 Viral croup
 “Laryngotracheobrinchitis”
 MCC: Stridor outside of neonatal
period
 MC Etiology: parainfluenza virus
 Mild respiratory symptoms 1-2 days;
harsh cough “barkin” or “seal-like”
hoarse voice & stridor worsen @
night
 Steeple signs – subglottic narrowing
 TX: nebulizing, steroids, epinephrine
 Epiglottitis
 Supraglotic
 May progress rapidly to life
threatening airway obstruction
 MCE: before: H. influnezae -> NOW:
streptococcus pneumonae
 Abrupt onsent of fever; drooling;
sore throat; hot potato voice (paos)
 Assumes tripod position & sniffing
position
 Thumb signs- enlarge epiglottitis
 TX: aiway mngt (can cause: inubate),
nebu, epi, antibiotic.
 Bacterial trachaetis
 2nd infection
 Membranous bacterial group
 MC: S. Aerus (staphylococcus aerus)
 URI(upper respi infxn) – sudden
worsening; increase fever; stridor,
cough, productive THICK Sputum
 CXR (chest xray): subglottic
narrowing, irregular trachea
narrowing
 Airway Foreign Bodies
 MCE: Food and toys
 Consider in young children w/
respiratoy symptoms regardless of
duration of sympoms
 Sudden coughing & choking – Most
predictive S/S
 Laryngotracheal – stridor &
hoarseness, bronchial wheezing &
decrease
 LOC: bronchi (R mas Malaki enlarge
lumen)
 CXR: unilateral obstructive
emphysema, atelectasis
 TX: airway mngt.
 Wheezing
 High pitched sound caused by flow
prominent during expiration
 Bronchiolitis (child)
 Inflammation of airway & production
of mucous
 Etiology: PSV – respiratory syncial
virus
 Asthma (adult)
 Chronic inflammation disorder of the
airways; irreversible
 Acute exacerbation – worsening
wheezing; cough; associated w/
decrease expiratory airflow
  Status asthmaticus – acute severe
asthma progressive unresponsive
asirway obstruction. (ET. Intubation)
 Hypercarbia – hall mark of ventilation
of o2
 TX: oz nebu, b2 agonist, steroids
 Pneumonia
 Infection of lungs decrease of larynx
 Neonates – aquire of NSVD
- chlamediaclomatis
 Infant & child – les 2 yrs old – RSV
 Child 2-5 yrs old – RSV , viral
 5 to adolescent – M. penumoniae
(bacteria)
 Tuberculosis – upper lobe infiltrates
& hilar lymphadenopathy
 Cystic fibrosis – decrease mucous
clearance
Heart Disease
 Fetal circulation -> o2 placenta
 Shunts:
 Ductus Arteriosus - Aorta –
pulmonary artery
 Formaen ovale – R- L Atrium
 Vein – back to the heart
 inferior vena cava – drain lower
extremities; unoxygenated
 superior vena cava – upper
extremities; unoxygenated
 Arteries – Oxygentaed blood (EXCEPT:
pulmonary artery )
 Veins – unoxygentaed (EXCEPT: Pulmonary
vein)
 First cry of the baby – adult circulation
 Pre-load – amount of blood that heart
receives to distribute to the body.
 Afterload – resistance to the blood flow out
of the heart.
 Contractility or inotropy – which is the ability
of the cardiac muscle to pump blood
 Cardiac rate- which is the ability of the
cardiac muscle to pump blood per unit of
time
 Chronotrophy - heart rate; muscle pump in
the unit of time.
 Cyanotic – blue baby
 Tetralogy of fallot (infancy)
 Transposition of the great arteries
(Newborn)
 Total Anomalies pulmonary venous
return (TAPUR)
 Tricuspid Atresia
 Truncus Arteriousus
 Acrocyanotic
 Ventricular septal defect (VSD)
(overall)
 Atrial septal defect
 Bluish discoloration –bluish discoloration of
the skin; deoxygenated HGB (hemoglobin);
3-5 mg/dl; o2 saturation = 70-80% (no face
mask, intubate. Etc.)
 Tetralogy of fallot
 R ventricular hypertrophy, R VSD,
pulmonary stenosis, overriding of
aorta
 Clinical symptoms – depends on the
situation on the above – Obstruction
on the R going to ventricle
 CXR: But shaped heart
 Transposition of the great arteries
 Normal = aorta rises form the LF and
pulmonary originates of Right
ventricle
 Abnormal = Aorta rises from the RV
and pulmonary originates on the left
ventricle
 EGG shaped = shape of the heart
 Total Anomalies pulmonary venous return
(TAPVR)
 Pulmonary vein Emptying in the RA
(bumabalik) instead of LA
 Tricuspid Atresia
 No tricuspid valve (valve bet. RA& RV)
and the dev’t of the RV & pulmonary
artery is interrupted
 Mitral valve – LA & LV
 Truncus Arteriousus
 All pulmonary arteries system and
coronary circulation originates from
the single arterial
 Mixed blood
 Coartion of the Aorta
 Narrowing in the aorta (kink) near
ductus arteriousus in upper thoracic
aorta
Renal
 Rib notching
 Narrow blood flow in the body
 Decreased pulses in the BP in the
lower extremities and higher in the
upper extremities
 Hypoplastic left heart syndrome
 Hyperplasia of the left ventricle
 Atrial Ventricular Septal Defect
 L->R shunting of the blood causing
pulmonary circulation
 Patent Ductus Arteriousus
 Ductus arteriosus fails to close
spontaneously
 Normal = DA closes w/in 15 hours of
birth & seals completely @ 3 weeks
of age, becoming ligamentum
arteriosum
 PG (prostaglandin) E1 – restore
patency for duct depend lesion
 DX; CXR; ECG; Echocardiography
(most definitive)
 Assessment: history; check VS;
murmur; pulses, heaves; lifts; thrills
 Myocarditis
 MC: End stage of cardiography
 Viral infection
 Dx: biopsy- check layers of the heart
 Pericarditis
 Chest pain – worsening in supine;
improves in leaning forward
 CXR: With water bottle shape heart
 Infective Endocarditis
 Damage endocardium is exposed to
circulation bacterial cause vegetation
(focus on infxn)
 High risk PTX: Prosthetic valves &
grafts
 HR Procedure: Dental Procedure
 Manifestation: fever (MC)
tachycardia, murmur, airway lesion;
osler nodes
 Duke Criteria –
 DOC: antibiotic - penicillin

 Cardiomyopathy
 Dilated- all four chamber
 Left side involve
 Hypertrophic – 1 or 2 chamber
 Hematuria
 Increase +5 RBC microliter of uterine
 Can be macro hematuria – can be
seen
 Transient micro hematuria – lab
studies
 DX: KUB ( kidney reter bladder;
urinalysis; more than 20 CT Scan
 Urinary Tract infection – UTI
 Bacterial infection in children
 MCE: E. coli
 In toilet: polyuria, dysuria, onset of
enuresis, back pain, discharges, fever
 Dx: urine culture, urinalysis (fever –
morethan 40. C), sympubic aspiration
 DOC: antibiotic
 Admitted – less than 1 month
 Acute Renal Failure - ARF
 Decrease function of the kidney
 Pre-renal – before entering kidney
- shock, interruption of blood
flow
 Intra-renal – direct cause to renal
- drugs, toxin
 Post-renal – obstruction
- stone, enlrge prostate
 Extreme muscle injury/hazing – decrease
myoglobin – Renal Failure
 End- stage Renal Failure (ESRD)
 Less than 10% GFR
 MC: congenital renal disease, reflex
nephropathy
 CMPLX: DM (adult)
  Common problem: fever; abd pain;
dyspnea; chest pain; syncope; HPN;
acid base
 TX: hemodialysis
 FXN:
 Sodium & h20 remove – fluid
overload
 Waste removal – increase in
urea, creatinine, potassium =
cardiac dysrthmias
 Hormone production – blood
pressure; RBC production
(Erythropoietin, Anemia);
decrease in CA
 Emergecny - Jugular vein
 Normar – subclavian (NO BP check
always)
 Acute Glumerulonephritis
 Hematurial proteinuria; edema; HPN
 Pharyngeal infextion
 Cause: GABHS – group A beta
hemolytic streptococcus
 TX: steroids
 Nephrotic Syndrome
 Pretenuria; hypopreteinuria, HPN,
hyperlipidemia; edema (more
prominent)
 Hemolytic Uremic Syndrome
 MC: ARF in children
 Multisystem disorder leading to ARF
 ARF, Thrombocytopenia,
microandiopathic anemia