0071643192.pdf

PEDIATRICS

SYMPTOMS/EXAM

■ Physical exam findings and historical clues are usually more reliable in

pinpointing the diagnosis in this age range. The ED workup and treatment

are usually directed toward clinically recognizable syndromes (eg, pneu-

monia, cellulitis, scarlet fever).

■ Immunization status is extremely important to note.

DIAGNOSIS

■ Children with focal infections, eg, otitis media, cellulitis, should have

workup and treatment directed as appropriate.

■ Children without focal findings or helpful historical clues should have fur-

ther workup:

■ CBC with differential

■ Blood culture for those with WBC <5000 or >15,000

■ UA and urine culture for females <2 years, circumcised males <6 months

or uncircumcised males <12 months

■ Consider LP for those with signs of meningitis (nuchal rigidity, +

Kernig’s, or + Brudzinski’s signs) or excessive irritability (especially if

paradoxical) or toxic appearance

■ CXR for those with physical exam findings suggestive of pneumonia

(mild hypoxia or tachypnea out of proportion to fever may be only clues)

TREATMENT

■ Therapy directed at the likely causative organisms

■ Patients who are well appearing but do not have a focus for infection can

generally be followed as outpatients. Those with an elevated WBC >15,000

or incomplete immunization status should usually be given a single dose

of IM ceftriaxone with close follow-up pending culture results.

Pediatric Exanthems

MEASLES

Measles is caused by an RNA virus in the Paramyxoviridae family. Humans

are only known natural hosts.

TABLE 5.11. Buzzwords for Pediatric Exanthems

BUZZWORDS DISEASE

“Cough, coryza, conjunctivitis”; Koplik’s spots Measles

“Slapped cheek rash”; aplastic crisis Fifth disease; parvovirus B19

Tender postauricular lymphadenopathy Rubella

Onset of rash occurs with resolution of fevers Roseola; HHV-6

“Dewdrops on a rose petal” Varicella

Macules, papules, vesicles on hands and feet, and Hand-foot-mouth disease;

posterior oropharynx coxsackievirus