Brought to you by Dr. Andrew Grock and Dr. Carl Alsup
Special Thanks to our Grand Rounds Speaker, Dr. Christopher Doty.
Peds Case Conference, by Dr. Francis Youn
Neutropenic Fever
– ANC = WBC (in thousands) cells/mcL * [(neutrophil % + band %)/100]
– ANC < 1500 (and definitely < 500) is highly concerning for neutropenia
– monotherapy with cefepime, meropenem, imipenem, or zosyn
– add vancomycin for catheter related infections, skin/soft tissue infections, abx resistance, hypotension, pneumonia
(Does this information look familiar? See our Board Review series here)
Neonatal hyperbilirubinemia
– evaluate for sepsis
– check total and direct bilirubin
– total bili > 25 always needs admission regardless of age in hours
– concerning rate of rise: > 5mg/dl in 24 hours or > 0.2mg/dl/hr
More Questions? See a review article here
Peds Day, by Dr. Jacqueline Bober
Ideopathic Thrombocytopenic Purpura (ITP)
-autoantibodies against platelets leads to thrombocytopenia
-typically presents with petechial rash and normal exam
-treatment is controversial (IVIG, steroids, Win-Rho, nothing)
Hemophilia
-hemophilia A – FVIII deficient
-hemophilia B – F IX deficient
-hemophila +suspected CNS bleed = give factor before imaging!
Peds M&M by Dr. Andrew Grock
-Know PALS see link
-For intractable SVT in stable patient, give Amio slowly (over 10 minutes in adults, 20- 60 minutes in children)
-Adenosine dose 0.1 mg/kg up to 6mg, then 0.2mg/kg up to 12mg
Peri-Natal Emergencies, Dr. Doty, summary by Dr. Andrew Grock
Shoulder dystocia = scary. Use HELPERRS
-Help, call for it (ob/gyn doctors)
-Episiotomy (try to make room, also straight cath)
-Legs (McRoberts) 
-Pelvic pressure (suprapubic)
-Enter (wood’s screw/Rubin 2)
-Remove posterior shoulder
-Roll onto all fours (gaskins maneuver)
-Clavicle (break)
Do not pull on the umbilical cord!
A link with more information can be found here
andygrock
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