Distributive shock
Distributive shock is a critical condition characterized by inadequate blood flow that leads to poor tissue perfusion and thus inadequate oxygen delivery. It is an umbrella term that includes common pediatric conditions, including sepsis and anaphylaxis, and requires prompt recognition and intervention to prevent morbidity and mortality. This article provides an overview of the epidemiology, […]
Diabetic Ketoacidosis
Ketoacidosis is responsible for the initial presentation of insulin dependent diabetes (IDDM) in up to 25% of children. It is the triad of hyperglycemia (above 200mg/dL), systemic ketosis (with ketones present in the urine or a beta-hydroxybutyrate (BOHB) over 3mmol/L), and acidosis (pH of <7.3 or bicarb <15mmol/L). It can be classified as either mild, […]
Dehydration
Dehydration is a common and potentially serious condition encountered in hospitalized pediatric patients. It occurs when there is an imbalance between fluid intake and loss, leading to a deficit in body water. Recognizing and managing dehydration effectively is crucial to prevent significant morbidity and even mortality in children. This guide will cover the common causes, […]
Community-acquired pneumonia
There are >100,000 hospitalizations of patients < 18 years old that can be attributed to community-acquired pneumonia (CAP). There is great variation in the care of these patients based on where they present (children’s hospital versus community hospital), with a common issue being over-utilization of antibiotics but also overuse of broad-spectrum antibiotics. Note This guideline […]
Cardiogenic shock
Cardiogenic shock is a critical condition characterized by the heart’s inability to pump sufficient blood to meet the body’s needs, leading to inadequate tissue perfusion and oxygenation. This article provides an overview of the epidemiology, etiology, pathogenesis, pathophysiology, clinical features, differential diagnosis, diagnosis, and treatment of cardiogenic shock in infants and children, tailored for pediatric […]
Brief resolved unexplained event (BRUE)
Brief Resolved Unexplained Events (BRUE) refers to an episode in infants characterized by sudden, brief, and unexplained changes in breathing, color, tone, or responsiveness. If the cause is identified, the event is no longer considered a BRUE. While often alarming to caregivers and clinicians, these events typically resolve spontaneously and are usually not associated with […]
Bronchiolitis
Bronchiolitis is an extremely common lower respiratory tract infection in infants and young children. Symptoms can include fever, coughing, and signs of lower respiratory tract obstruction such as tachypnea, nasal flaring, belly breathing, retractions, head bobbing, and in young infants, apneas. Epidemiology Bronchiolitis is the most frequent cause of hospitalization for respiratory illness in infants […]
Anaphylactic shock
Anaphylactic shock is a severe, life-threatening allergic reaction that can occur rapidly and requires immediate medical intervention. This article provides an overview of the epidemiology, etiology, pathogenesis, pathophysiology, clinical features, diagnosis, and treatment of anaphylactic shock in children, tailored for pediatric residents. Epidemiology Anaphylaxis is a relatively rare but serious condition in children, with an […]
Acute asthma
Pathophysiology Asthma involves the triad of: Airway edema/inflammation that leads to mucosal swelling. Excess mucus production and subsequent mucous plugging. Bronchospasm/bronchoconstriction that leads to: Increased airways resistance: Causes increased work of breathing. Atelectasis and ventilation: Perfusion (V:Q). Mismatch: Causes hypoxemia. Image credit: Encyclopedia Britannica. Symptoms Occur after trigger exposure and resolve with trigger avoidance or […]
Guide to systems-based assessments and plans for inpatient pediatric clerkship
On the pediatric ward and in ICU environments, having a systems-based approach to the assessment and plan ensures comprehensive patient care by systematically evaluating each organ system, and other important domains of care that may otherwise be overlooked. In working through the encounter of a newly admitted patient, we use our clinical reasoning to collate […]