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Toronto Notes 2019 Common Pediatric ED Presentations
Abdominal Pain
• seePediatrics,P39
History
• neuro,infections,autoimmune,hematology,trauma,abuseHxquestions • natureofpain,associatedfever
• associatedGI,GUsymptoms
• anorexia,decreasedfluidintake
Physical Exam
• HEENT,respiratory,abdominalexamincludingDRE,testicular/genitalexam
Table 39. Differential Diagnosis of Abdominal Pain in Infants/Children/Adolescents
Emergency Medicine ER59
Medical
Colic
UTI
Constipation
Gastroenteritis
Sepsis
Henoch-Schönlein purpura IBD
Hemolytic uremic syndrome Pneumonia
Strep throat
Sickle cell disease crisis DKA
Functional
*Remember to keep an index of suspicion for child abuse
Common Infections
• seePediatrics
Table 40. Antibiotic Treatment of Pediatric Bacterial Infections
Red Flags for Abdominal Pain
• Significant weight loss or growth retardation (need growth chart)
• Fever
• Joint pain with objective physical findings • Rash
• Rectal bleeding
• Rebound tenderness and radiation of pain
to back, shoulders, or legs
• Pain wakes from sleep
• Severe diarrhea and encopresis
• Trauma or suspected trauma patient <1 yr
of age with a large, boggy scalp hematoma requires U/S or CT
Surgical
Malrotation with volvulus Hirschsprung’s disease Necrotizing enterocolitis Incarcerated hernia Intussusception Duodenal atresia Appendicitis Cholecystitis Pancreatitis
Testicular torsion Ectopic pregnancy Trauma
Pyloric stenosis
Infection
MENINGITIS SEPSIS Neonatal
1-3 mo
>3 mo
OTITIS MEDIA 1st Line
2nd Line Treatment Failure
STREP PHARYNGITIS UTI
PNEUMONIA 1-3 mo
3 mo-5 yr >5 yr
Pathogens
GBS, E. coli, Listeria, Gram-negative bacilli Same pathogens as above and below
S. pneumoniae, H. influenzae type b (>5 yr), meningococcus
S. pneumoniae, H. influenzae type b, M. catarrhalis
Group A β-hemolytic Streptococcus
E. coli, Proteus, H. influenzae, Pseudomonas,
S. saprophyticus, Enterococcus, GBS Viral, S. pneumoniae, C. trachomatis,
B. pertussis, S. aureus, H. influenzae
Viral, S. pneumoniae, S. aureus,
H. influenzae, Mycoplasma pneumoniae
As above
Treatment
ampicillin + cefotaxime
ampicillin + cefotaxime + vancomycin ceftriaxone + vancomycin
amoxicillin 80-90 mg/kg/d
clarithromycin 15 mg/kg/d bid (for penicillin allergy)
90 mg/kg/d amoxicillin and 6.4 mg/kg/d clavulanate divided into bid dosage
penicillin/amoxicillin or erythromycin (penicillin allergy)
Oral: cephalexin (older children) IV: ampicillin and aminoglycoside
cefuroxime ± macrolide (erythromycin) OR ampicillin ± macrolide
ampicillin/amoxicillin or cefuroxime
ampicillin/amoxicillin + macrolide or cefuroxime + macrolide