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Showing posts with the label Pediatrics

Determining the size of the endotracheal tube

Adults:   We must select the largest diameter ETT that can be tolerated  for adults.  A size 7.5-mm cuffed ETT is well tolerated by  most adult female patients.  A size 8.0-mm cuffed ETT is well  tolerated by most adult male patients. Pediatrics:   An uncuffed ETT should be used for children  under the age of 8 years.    The  formula most commonly used is: ETT size(mm) = (Age[yr] +16)/4 To estimate the depth of insertion for a child older than  2 years: Depth of insertion = 3× internal diameter of the ETT

Retropharyngeal abscess - X-ray

Retropharyngeal abscess is a rare condition presenting in infants (<1 year of age). Clinical symptoms include fever and drooling.  As a result of the swelling within the posterior pharyngeal wall causing upper airway obstruction, the child will typically hold their neck in extension to assist breathing.  A lateral soft tissue neck radiograph taken with the neck held in extension is indicated if a retropharyngeal abscess is suspected. If it is positive, it will demonstrate air within the swollen retropharyngeal tissues, as shown by the x-ray above. A contrast enhanced computerized  tomography (CT) examination will confirm the diagnosis.

Chickenpox - dew on rose petal appearance

Definition: Chickenpox is a benign viral disease of childhood, characterized by an exanthematous vesicular rash. It is an extremely common and contagious condition. It is caused by the varicella-zoster virus which is a herpes virus and contains a double stranded DNA in its center. Epidemiology: Age group affected- 5 to 9 years. The infection can be there at other ages too but it is less frequent. It is highly contagious and it affects all races and both sexes equally. The attack rate is around 90% among seronegative persons. Pathogenesis: Incubation period- 10 to 21 days but is usually 14 to 17 days. Patients are infectious around 48 hours from onset of vesicular rash, during the period of vesicular formation (around 4-5 days) and until all vesicles are crusted. Transmission occurs by respiratory route. The virus is believed to be localized in the nasopharynx, in the reticulo-endothelial system. It then enters the blood. This stage of viremia is characterized by diffused ski

Grading of murmur

The intensity of a systolic murmur is not always proportional to the hemodynamic disturbance. Yet murmurs are classified according to the loudness. Freeman and Levine were the first to introduce a numerical scale for grading heart murmur intensity in 1933. This grading is still used but with some modifications. Grade 1 - so faint that it can be heard only with special effort. Grade 2 - faint but can be heard easily. Grade 3 - moderately loud but no thrill. Grade 4 - very loud and thrill may be there. Grade 5 - extremely loud and can be heard if only the edge of stethoscope is in contact with skin. Grade 6 - exceptionally loud and can be heard with stethoscope just removed from skin contact. Keren, Tereschuk and Luan suggested that we can use heart sounds as an internal reference to differentiate between grades 1-3, the only limitation of the study being a small sample used. The grading is the same as above but. . . Grade 1 - clearly softer than the heart sounds. Grade 2 -

Macewen's sign / cracked pot sound

The sign was described by Sir William Macewen. The test is performed by percussing on the skull of the patient and a cracked pot sound can be heard to the naked ears of the examiner brought closed to the skull. This sound can be heard even better if percussion is done on one side while a stethoscope is placed on the other side. A positive test is indicative of separated sutures. As long as the anterior fontanel is open i.e. up to 18 months, the test will be positive. In pathological cases, it is due to a raised intracranial  tension due to hydrocephalus or an abscess.

Body surface area mesurement

Various formulas exist to estimate the body surface area, the simplest one being that published by Mosteller in the NEJM in 1987. The formula goes like this. . . The refe rence value for an adult is considered to be 1.73  m². A proteinuria of at least 3.5 g/ day/1.73  m² BSA   is considered diagnostic for nephrotic syndrome. 

Apgar scoring - table, mnemonic

 INTRODUCTION  The  Apgar score  was devised in 1952 by Dr Virginia Apgar (anesthesiologist) as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after birth.  This helps to identify those requiring resuscitation and can also be used to predict survival in the neonatal period.   MNEMONIC  A mnemonic for learning purposes includes: A - Appearance (skin colour) P - Pulse (heart rate) G - Grimace (reflex irritability) A - Activity (muscle tone) R - Respiration  Another mnemonic is also useful:  How -   Heart rate Ready - Respiration Is -        Irritability This -    Tone Child -   Colour Apgar scoring is divided into 1 and 5-min scores.  1-MIN SCORE    Sixty seconds after complete birth, the five parameters specified in the table above must be evaluated and scored. A total score of 10 indicates that the baby is in the best possible condition. A score between 0-3 me