ICU 16
TX: in the following order Benzamycine: bezoyic + erythromycine gel. minocycline or doxycyline: should be used for 6 ms Retenoid local: Retin-A; Differin. Dovonex is vit D local, Retenoid PO: Accutane is new one can be given to women in child bearing age as it says in the system only 1 m
protopic: local tacrolimus (prograf) immunosupressant for severe atopic eczema for few weeks
abnormal finding on exam : Achondro plasia can be subtle presenting only as inpropertionate length Midline structural abnormalities can be subtle like flat nasal bridge
baby grows 15-30gm/day the normal newborn should double wt @ 5ms and triple @ 1 yr wt gain: 0-3 months: 15-30 gm/d; 3-6 ms: 15-20 gm/d; 6-12 ms: 10-12 gm/d; after 1 yr: 6-8 gm/d.
the hight increase by 50% @ 1 yr and double @ 3 yrs the veocity percentile shifts in the first 3 yrs and stabilizes 3-9 yrs
HC: 0-3 month: growes by 0.5 cm/w; from 3-6 months grow: 0.25 cm/w ; then 6-12 ms: grow 0.125 cm/w
basics. 1 gm glucose or protein ==> 4.5 kcal 1 gm fat ==> 9 kcal. daily. normal feeding 60% carb, 10% protein, 30% fat requirment: prot 2-2.5 gm /kg/d, requirment: fat 1 gm/ kg/ d to gain 1 gm wt: you need 6-7 kcal daily need are 100-140 kcal/kg/d daily 100 kcal: 50 BMR, 20 growth, 15 tmp, 5 stool/urine.. pts. regular formula are 20 kcal/oz. special formula can be 22, 24, 28, 30 calories intake must be increased in: 20% for resp or cardiac , 50% for infection, 100% for burns..
atelectasis. usually visilble only on one projection; either PA or lateral. unlike pneumonia.
language is the most predictive of development screening tests measure current status only and are not predictive of future developments
milestones. scales. language. gross motor. Fine motor. speech. paternal screening. IQ tests. Wechsler test. achievment test. WRAT: Wide achievement Range Test.. behavioural tests. warinings. the lack of any of these fingings:. evaulation. types. walking. climbing. sit self. stand 1 foot. hopping. kicking & throwing. tower. draw. dressing. eating. speech. receptive. intelligibility. speech understood by strangers age divided by 4. learning disability. Total IQ is normal IQ performance >> IQ verbal skills. School performance. tests reading, writing and mathematic scales. the most reliable predictor for school performance in first 3 yrs is Language.. Daily scales. for children with MR to test the daily living skills. ADHD. Conner's test. 9 ms. 12 ms. 18 ms. 2 yrs. 3 yrs. 4 yrs. 5 yrs. CLAM scale. PE. hearing test. all children with delay. genetics. can present any age can have normal newborn screening first. asymtomatic TORCH. expressive. stuttering. abnormal if started > 5 yrs or lasted for > 6 ms associtaed with pausing and stresss. Autism. Landau Kleffner. bilangual. the count of words of both languages is normal.. walk. run. tandem walk. upstairs 2 feet w assist. up and down no assits. up w 1 foot. down w 1 foot. 18 ms. 2 yrs. 3 yrs. 2 yrs. 2. 4. 6. 8. imitates vertical & circular. imitates horizontal. circle. cross. square. tiangle. take off. put on some. dress w assis; unbuttons. dress w/o assist; buttons & lace shoes. convered cup. spoon/ solid. spoon & fork. cut w kife. 2 words; immitate jargoning. try to speak in sentense but makes non sense. 6 words. 20 words; mature jargoning. 50 words; 2 pronouns. pronouns can be used wrong. telegraphic speech; pronouns appr. speech without articles pronouns are correct. 3 w sentense; present tense. 4 sentenses; past tense. 1 step w gesture. 1 step w/o gesture; 1 body part. 5 body parts; names pic of common obj. 2 steps command. know sex; name. 4 colors; count 5. 50%. 75%. 100%. no responce to name. no babling. no gesturing. shaking head; bye bye. no pointing to objects. only mama/dada. no pointing to wants. no 2 words phrases. speech not fully understood to parents. not using pronouns/verbs. persist echolalia. not fully understood to stranger. stuttering. < 8 ms. vocalized normally even if profoundly deaf look like they hear b/o responce to visual clues. MR. all MR children have delayed expressive and receptive language can be the first presentaion for MR. BAER. OAE. evoked acoustic emission. normal. with normal IQ. more in boys outgrow by adolesents but can still have reading difficulties. any language warning. loss social or language skills. screen. sudden loss of skills. not gradual loss like autism. EEG sz. tx. 15 ms. 2 yrs. 4 yrs. 18 ms. 2 yrs. 3 yrs. 4 yrs. 15 m. 18 m. 24 m. 30 m. 24 ms. 30 ms. 3 yrs. 4 yrs. 4.5 yrs. 5 yrs. 18 ms. 2 yrs. 3 yrs. 4 yrs. 15 ms. 3 yrs. 5 yrs. 7 yr. 12 ms. 15 ms. 20 ms. 2 yrs. 3 yrs. 4 yrs. 12 ms. 15 ms. 18 ms. 2 yrs. 3 yrs. 4 yrs. 2 yrs. 3 yrs. 4 yrs. CHAT. PDDST. IvIG. Steroids.
shock. def. types. tx. < 1 m. 1-12 ms. > 1 yr. septic. like hypotensive shock with low BP and tachycarida but characterized with good peripheral perfusion. caridiogenic. large heart and liver on exam if not sure try fluid bolud first, if it got worse it's likely cardiogenic. spinal shock. < 60. < 70. < 70 + 2* age. solumedrol. 30mg/kg bolus then 5 mg/kg/hr.
JRA. if < 4 joints and with systemic findings it's likely from other etiologies: infections... clinincal. labs. RF : negative except in multi joints format: 10% pos. ANA is 40% pos.. uveitis. in the oligo joint form.. sytemic. sever in the systemic form and mild in the multi joints form. absent in the oligo joints form..
HTN. def. etiology. diag. Tx. SBP. DBP. Essential. only after 10 yrs.. secondary. Renal. cardiac. endocrine. (age x 3) + 100. (age x 1.5) + 70. renal. cardiac. endocrine. neurologic. U/A; US; BMP. 2D; CBC. Renin activity; aldosterone. parnchymal. vascular. aoric coarc. renin. steroids. GBS. Inc. ICP. scars. from previous UTI and urinary reflux.. dysplastic kidneys. thrombosis. neonates. stenosis.