0071643192.pdf

PEDIATRICS

TREATMENT

Stabilization and diagnosis are paramount, with specific treatment directed

toward the underlying condition.

CARDIOLOGY

Murmurs

COMMONNONPATHOLOGICMURMURS

Characteristics of pathologic murmurs:

■ Grade III or higher

■ Radiation to back

■ Maximal at apex

■ Any diastolic murmur

■ Associated sounds (eg, clicks, gallops)

A 4-day-old infant born via uncomplicated vaginal delivery presents to

the ED with tachypnea and mild cyanosis. Cardiac exam reveals no heart

murmur but a single second heart sound and increased precordial activity.

Pulse oximetry reveals an O 2 saturation of 85%. What are the differential consid-

erations and next step in diagnosis?

Cyanotic congenital heart disease, likely hypoplastic left heart. Hyperoxia

test and urgent echocardiogram.

Congenital Heart Disease

Incidence of CHD estimated at ~4–10 in 1000 live births. Most common

congenital heart defect is bicuspid aortic valve. Closure of the ductus arteriosus

occurs 10–15 hours after birth functionally, and fibroses usually around 2–3 weeks

(ligamentum arteriosum); pulmonary vascular resistance declines over the

first week of life.

TABLE 5.4. Differential Diagnosis of Vomiting

Infection GI infections: Viral or bacterial

Meningitis, pneumonia, UTI, otitis media

GI inflammation Inflammatory bowel disease, pancreatitis, celiac disease

GI obstruction Malrotation with volvulus, intussusception, atresia or stenosis of

GI tract, pyloric stenosis, incarcerated hernia, appendicitis

CNS process Subdural hematoma, increased ICP

Metabolic process Inborn errors of metabolism, DKA, diabetic gastroparesis

Other processes Posttussive emesis, eating disorders, psychological conditions,

emotional distress