Handbook of Pediatric and Neonatal Emergencies S Sushamabai
INDEX
ABCDEFGHIJKLMNOPQRSTUVWXYZ
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table
A
AACI See Acute adrenocortical insufficiency
ABC See Airway, breathing and circulation
Abdominal injuries, blunt 328
Abdominal pain 227, 298
ABG See Arterial blood gas
Abscess, epidural 192
Accidents 421
ACE See Angiotensin-converting enzyme
ACEI See Angiotensin-converting enzyme inhibitor
Acetaminophen 217, 447, 564
poisoning 308
Acetazolamide 555
Acetylsalicylic acid 418, 555
ACHD See Acyanotic congenital heart diseases
Acid 447
Acid-base
disurbances, interpretation of 77fc
gases 72
Acidosis
causes of 291
correction of 294
Acinetobacter 371
Acquired immunodeficiency syndrome 273
Acute adrenocortical insufficiency 232, 234
differential diagnosis 233
etiology 232
management, algorithm of 234fc
Acute laryngotracheobronchitis 95, 99
Acute respiratory distress syndrome 89, 124, 339, 356, 423, 427, 434
causes 124
chest skiagram 125
clinical presentation 125
clinical stages 125
CT scan chest 126
investigations 125
management 126
pathophysiology 125
Acyanotic congenital heart diseases 146
Acyclovir 555
Addison disease 131, 232, 248, 250, 292
Adenosine 38, 47, 555
Adherent labia 300
Adrenal hyperplasia, congenital 251, 252, 292
Adrenal insufficiency 246
Adrenaline 47, 56, 106
Adrenergic stimulation, late phase of 458
Adrenocorticotropic hormone 555
Advanced life support 24, 31
pediatric 31
steps in 31
AED See Automated external defibrillator
AEP See Asthma education program
Airway 32, 178
breathing, circulation 234, 327, 443, 445
disease 91
laryngeal mask 32
nasopharyngeal 32
obstruction, treatment of 97
oropharyngeal 32
positioning of 45
protection of 44
Albendazole 555
Albumin 555
Alkalis 448
ALS See Advanced life support
ALTB See Acute laryngotracheobronchitis
Aluminum phosphide rat poison 451
Amanita poisoning 308
Ambu bag 61, 61f
Amikacin 118
sulfate 555
Amino acidopathy 262
Aminomethane 74
Amiodarone 38, 47, 432
Amitriptyline 218
Amlodipine 164, 555
Ammonium chloride 556
Amoxicillin 154, 556
clavulanate 556
Amphotericin B deoxycholate 556
Ampicillin 111, 505, 556
sulbactam 556
Anaphylaxis 54, 57, 397
differential diagnosis 55
etiology 54
investigations 55
manifestations 54
onset 55
patient approach 55
treatment, algorithm for 56fc
Anemia 289, 413 414, 514
in newborns 514
clinical presentation 515
common causes 514
treatment 515
mild 237
moderate 237
severe 236, 237, 276, 393
Anesthesia 434
bags 62
Angioedema 95, 96
Angiotensin-converting enzyme 150, 152
inhibitor 143, 146
Anion gap metabolic acidosis
increased 76
normal 76
Antibiotic 47
Acute Illness Observation Scale
Anticoagulant protein 389
Anticoagulant therapy 416
Anticonvulsants 47
Antifungal agents 372
Antiganglioside antibodies 193
Antihistamines 448
Antimicrobial prophylaxis 300
Antinuclear antibody 198
Antituberculosis 306
Aorta, coarctation of 143
Aplastic crisis 406
Apnea 222, 496
in newborns 509
common causes 509
management 510
of prematurity, treatment of recurrent 511fc
test 222
Apneic neonate, clinical approach to 510fc
ARDS See Acute respiratory distress syndrome
Areflexia 191
Arsenic 450
Artemether 354
Artemisinin combination therapy 352, 355, 357
Arterial blood gas 32, 51, 74, 121, 126, 132, 143, 425, 444, 487, 536
analysis 63, 74
indications for 74
Artesunate 354, 556
Arthritis 368, 464
Ascites 332
abdominal distension 333
clinical presentation 333
common causes of 332b
fluid examination 334
subsequent treatment 334
Ascitic fluid tap 545, 546f
complications 546
diagnostic 545
indications 545
procedure 545
requirements 545
therapeutic 545
Aseptic meningitis 358
Aspergillosis 364, 366
Aspiration 118
Aspirin 217, 416, 418
Assist-control mode 86, 86f
Asthma 341
acute 100
life-threatening 100, 103
pathophysiology 100
patient approach 101
education program 104
exacerbation 101
management, algorithm for acute 104fc
triad of 100
Asystole 36f
management of 37fc
Atenolol 556
Atracurium 432
Atrial fibrillation, treatment of 141
Atrial flutter, treatment of 141
Atropine 37, 43, 432
sulfate 47, 556
Autoimmune
disease 232, 305, 328
encephalitis 195
hepatitis 308
Automated external defibrillator 23, 24
Azathioprine 328
Azithromycin 109, 154, 360, 361, 556
B
Baby inside oxygen hood 61f
Back blows, method of 27, 28f, 29f
Baclofen 556
Bacterial dysentery 317
Bacterial infection, antibiotic for 158
Bacterial meningitis 185, 187
acute 185
differential diagnosis 186
empirical antibiotic therapy 187
pathophysiology 185
Bacterial peritonitis, spontaneous 332
Bacterial pneumonia, antibiotic therapy of 116
Bacterial tracheitis, acute 95, 96
Bag and mask ventilation 32–34
Barbiturates 448
Barium study 121
Bartter and Gitelman syndrome 253
Basic life support 23, 24, 31
Bee and wasp stinging 461
Belladona alkaloids 448
Benzathine penicillin IM 157
Benzoate therapy 260
Benzodiazepines 178
Benzyl benzoate 448
Benzylpenicillin 114
Beta blockers 145, 448
Betamethasone 556
Bicarbonate 294
Biliary system, injury to 552
Biopsy bit 552
Biotin 267, 556
Birth asphyxia 482
Bisacodyl 556
Bleeding
disorders 205
severity of 296
time 236
types of 411
Blood
and blood
component therapy 387, 404
products 344
gas 72, 211
abnormality 487
derangement, therapy in 78
glucose 211, 425
loss 286
oxygen saturation 106
pressure 252
sample, collection of 75
sugar, random 132, 233, 323, 425
transfusion 207
urea 425
BLS See Basic life support
Body ammonia, elimination of 263, 263t
Body mass index 236
Body surface area 428
Bone marrow suppression 414
causes 414
manifestations 414
Botulism 197, 198
Bowel infarction 332
Bowel sterilization 313
BP See Blood pressure
Bradyarrhythmias 138, 141
Bradycardia 168
Brain
abscess 167, 183
death 221
edema, development of 260
functions of entire 221
herniation 173b
injury, severe acute 222
insults, prevention of secondary 214
ischemia 423
parenchyma 182
inflammation of 184
tumors 167, 205
Brainstem 195
auditory evoked response 522
reflexes 172
absence of 222
Breastfeeding 471
Breath holding spells 147
Breathing 68, 162, 178
irregular 168
trial, spontaneous 92
British anti-Lewisite 556
Bronchiolitis 106
grading of severity in 107t
Bronchiolitis, acute 106, 144
clinical presentation 106
complications 109
differential diagnosis 107
indications for hospitalization 108
investigations 108
monitoring 109
pathogenesis 106
patient approach 107
treatment 108
Bronchopneumonia 144
Budd-Chiari syndrome 332, 334
Budesonide aerosol 556
Bulging fontanel 260
Burn injuries 427
investigations 429
management 428, 430
pathophysiology 428
prevention 430
C
Caffeine citrate 509, 556
CAH See Congenital adrenal hyperplasia
Calcium 291
channel blockers 448
gluconate 47, 557
Camphor 448
Campylobacter 315
Candida 365
glabrata 365
krusei 365
Candidiasis 364
clinical presentation 365
diagnosis 365
specific treatment 365
Capillary refill time 68, 135
Captopril 557
Carbamate 448
poisoning 446
Carbamazepine 557
Cardiac arrest 427
Cardiac arrhythmia 137, 142, 150, 244, 268, 270, 382, 427, 544
clinical presentation 138
etiology 137
investigations 138
types 138
Cardiac failure 161, 243
evidence of 488
Cardiac irregularities 426
Cardiomyopathy 159
Cardiopulmonary resuscitation 23, 24, 27, 31, 37, 38, 222, 423, 438
steps in 24fc
Cardiovascular system 51, 127
Carnitine 263, 267
Catch-up growth 277
Catecholamines, dose and administration of 133t
Cathartics 443
Catheter ablation 139
CBC See Complete blood count
CCHD See Cyanotic congenital heart diseases
Cefaclor 557
Cefadroxil 557
Cefepime 557
Cefixime 557
Cefoperazone 557
Cefotaxime 360
sodium 557
Cefpodoxime proxetil 557
Ceftazidime 557
Ceftriaxone 114, 118, 187, 348, 405, 557
Cefuroxime 557
Celecoxib 218
Central nervous system 240, 367, 378, 381, 457
aspergillosis 367
Central venous access 532
catheter care 535
complications 535
equipment 532
indications 532
procedure in general 533
technique 533
Central venous pressure 135
Cephalexin 154, 557
Cephalosporins, third-generation 347
Cerebellar ataxia, acute 195
Cerebellar tumors 195
Cerebral blood flow 221
Cerebral edema 230
treatment of 313
Cerebral malaria 171
Cerebrospinal fluid 183, 188, 189, 191, 262, 359, 529
Cervical
spinal cord 434
spine, protecting 213
Cetirizine 56
Chaotic breathing 168
Charcoal, activated 555
Chemistry tests 72
Chest
retraction 106
skiagram 106, 108
indications for 113
Child
choking 27
on ventilator, care of 89
Childhood pneumonia
classification of 113t
treatment of 113t
Chloral hydrate 557
Chloramphenicol 557
Chloromycetin 347, 361
Chloroquine 557
resistant Plasmodium falciparum malaria 354
sensitive
group, therapy in 354t
malaria 353
Chlorpheniramine maleate 456, 558
Chlorpromazine 218, 558
Chlorthiazide 557
Cholecystitis 407
Cholelithiasis 405, 407
Cholera 318
Choline magnesium salicylate 218
Cholinergic crisis 200
Cholinergic stimulation 458
Cholinesterase 445
Ciprofloxacin 347, 558
Circulatory dysfunction 129
Citrate solution 558
Clarithromycin 361, 558
Clindamycin 558
Clinical brain death, components of 221
Clinical scoring systems 70
Clonazepam 558
Clonidine 558
Clostridium 371
Clotting time 236
Cloxacillin 118, 558
Coagulase-negative staphylococci 370
Coagulation profile 211
Cold injuries 438
clinical presentation 439
pathophysiology 438
Cold stress 439
Coma 161, 171, 182, 244
common causes of 173
grading of 171
irreversible 221
Comatose child 171
algorithm for management of 175fc
continuing treatment 175
monitoring 175
Compartmental syndrome 270, 455fc
Complete blood count 32, 118, 132, 168, 183, 206, 211, 214, 223, 235, 425
Compression syndromes 415
Congestive cardiac failure 137, 288, 378
Congestive heart failure 143, 150, 273
cardiac 143
chronic 146
critically ill 146
diagnosis of 144
differential diagnosis 144
disease-specific drug therapy in 146t
drug therapy for 145
etiology 143
investigations 144
noncardiac 143
recovering 146
signs 144
therapy in 146t
treatment 144
Connective tissue disorders 375
Conscious child 27
Constipation 300
Continuous positive airway pressure 87f, 106, 110, 478, 479, 482, 483, 511
complications of 485
contraindications to 483
protocol for 484t
types of ventilators for 483
Convulsions 161
Copper sulfate 448
Coronary artery disease 377
Corticosteroid 47, 188, 190
Cotrimoxazole 558
Cough 161
Counseling family 53
Cow's milk protein 325
Coxiella burnetii 361
CPR See Cardiopulmonary resuscitation
Cranial computed tomography 214
C-reactive protein 132
Creatine phosphokinase 193
CRFT See Capillary refill time
Cricoid pressure 44f
Critically ill children 150
Crohn's disease 326
Cromolyn sodium 558
Cryoprecipitate 387, 390
indications 390
Cryptococcosis 364, 365
clinical presentation 365
diagnosis 365
specific treatment 366
Cryptococcus neoformans 365
Cryptosporidium parvum 315
Cushing's syndrome 162, 251
Cushing's triad 168
Cutaneous reaction 462, 463
CVP See Central venous pressure
Cyanosis 496
Cyanotic congenital heart diseases 146
Cyproheptadine 558
Cytomegalovirus 494
D
Dalfopristin 565
Damp cold, exposure to 441
Dapsone 449
Datura 449
Decompressive craniotomy 215
Deferoxamine mesylate 558
Deficit therapy 280
Dehydration 227, 272, 274, 286, 314, 316
assessment of 316t
correction of 294
signs of 299
Delirium 243, 268
Delivery room, care in 471
Demyelination 194
acute 205
Dengue 352, 359
illness 340f
severe 342
shock 131
shock syndrome 130, 278, 339, 345, 389, 393
severity classification 339
with fluid overload 344
with organ dysfunction 344
with warning signs, fluid therapy in 342fc
Dermatological disorders 395
Dermatomyositis 192
Desipramine 218, 558
Dexamethasone 47, 185, 187, 558
Dextran 40 559
Dextrose 47, 178
normal saline 234
ringer lactate 427
water 480
Diabetes 341
insipidus 239
acute central 241
diagnostic criteria 239
diagnostic features of 240
differential diagnosis of 239b
management 241
nephrogenic 241
permanent central 241
mellitus 240, 273
Diabetic ketoacidosis 227, 252
clinical presentation 227
diagnostic criteria 227
in children, severity grading of 228t
treatment 230
Dialysis
indications for 289
types of 289
Diaphoresis 268
Diarrhea 286, 298, 314, 399
acute 314
chronic 314
drug therapy in 317
persistent 318
clinical presentation 318
etiopathogenesis 318
indications for hospitalization 319
Diarrheal disease, acute 314
clinical presentation 315
etiology 314
pathophysiology 315
Diazepam 47, 178, 559
Diazoxide 559
DIC See Disseminated intravascular coagulation
Dicyclomine 559
Digoxin 145, 559
Dimercaprol 556
Dimercaptosuccinic acid 300
Dimorphic fungus 367
Dinitrophenylhydrazine 262
Diphenhydramine 47, 56, 559
Direct Coombs test 400
Discharge protocol 520
Disseminated intravascular coagulation 402, 413, 415, 501, 512
clinical presentation 403
common causes of 402
investigations 404
pathogenesis 403
treatment 404
Diuretics 286
Dizziness 161
DKA See Diabetic ketoacidosis
DNS See Dextrose normal saline
Dobutamine 47, 133, 145, 559
administration, early 268
Domperidone 559
Dopamine 47, 133, 145, 287, 559
infusion 459
Down syndrome 217
Downe's score 97t
Doxapram 509
Doxycycline 360, 465, 559
D-penicillamine 565
Drowning 423
Drowsiness 182
Drugs
first-line 178
rashes 346
second-line 178
third-line 179
Dry cold, exposure to 441
Dural sinus thrombosis 167
DW See Dextrose water
Dyselectrolytemia 244, 272, 275, 413, 425
Dysentery 314
Dyspnea 161
E
Ear-nose-throat 434
ECG See Electrocardiograph
Echocardiography 143
ECMO See Extracorporeal membrane oxygenation
Edema 161, 287, 288
Edrophonium test 199
EEG See Electroencephalography
Electrocardiography 143, 158, 234
Electrocution and lightning 429
Electroencephalography 170
Electrolyte
disorders 391
management 288
metabolism, disorders of 244
Emergency department 423
care at 428
Emergency room 47, 56
assessment in 67
primary assessment 67
secondary assessment 69
tertiary assessment 69
Empirical antibiotic therapy 118, 347
in neonatal sepsis 507t
Empyema 116, 119
chest skiagram 117
drainage of 118
etiology 116
investigations 117
prognosis 119
signs 117
symptoms 117
treatment 118
Enalapril 164, 559
Enalaprilat 164
Encephalitic syndrome, acute 171
Encephalitis 167, 182, 205, 239, 358
differential diagnosis 183
pathophysiology 183
specific therapy 184
Encephalomyelitis
acute disseminated 183, 194
differential diagnosis 195
etiopathogenesis 194
Encephalopathy 161, 461
severity of 307
Enclosure systems 60
End-expiratory pressure, positive 485
Endocrine emergencies 225
Endotracheal tube 42, 51, 62, 83, 222, 480
placement 45
Entamoeba histolytica 315
Enteroviral infection 308
diarrhea in 182
Envenomation 421
Enzyme-linked immunosorbent assay 361
Epiglottitis, acute 95, 96
Epileptic syndrome 494
Epinephrine 37, 133, 559
Episodic viral wheeze 144
Epistaxis 411
Equipment 6
diagnostic 6
miscellaneous 7
monitoring 6
procedural 6
Erythema palms 377
Erythrocyte sedimentation rate 381
Erythromycin 154, 559
Escherichia coli 298, 315, 399
pathogen 299
Esmolol 164
Ethambutol 559
Ethylene glycol 449
Etomidate 43, 48
ETT See Endotracheal tube
Euglycemia, maintain 214
Extracorporeal membrane oxygenation 150, 152
Extubation, procedure for 92
Eye
opening 172
response 172
F
Fanconi syndrome 258
Fatal disease 188
FB See Foreign body
Febrile neutropenia 414
Febrile seizures 298
Femoral vein 534
Fenoldopam 164
Fentanyl 43, 48, 432, 559
Fever 182
high 269
FFP See Fresh frozen plasma
Flaccid paralysis, acute 191–193
causes of 192
Flow-inflating bags 62
Fluconazole 368, 559
Fludrocortisone acetate 559
Fluid
and electrolyte balance 459
composition 280
loss 286
maintenance 56, 489
management 48
resuscitation, start 316
therapy 316t
type of 229
Flu-like illness 358
Flumazenil 559
Fluoxetine 218
Focal neurologic
deficits 182
stage of 189
signs, stage of 188
Folic acid 275, 317, 560
Foreign body 99
aspiration 93, 95, 96
obstruction 94, 144
of airway 93
Fosphenytoin 47, 426, 560
Fractional inspired oxygen 84
Fresh frozen plasma 343, 387, 427, 480
Fresh whole blood transfusion 343
Fulminant hepatic failure 305
common causes 306
differential diagnosis 306
pathophysiology 306
signs 306
symptoms 306
Fulminant meningococcemia 346
clinical presentation 346
differential diagnosis 346
prevention 348
subsequent management 347
Furosemide 328, 560
FWBT See Fresh whole blood transfusion
G
Gabapentin 218, 560
Galactosemia 262
Ganglioside-disialic acid 193
Gastric lavage 443
Gastroesophageal reflux 159
Gastrointestinal absorption, prevent 443
Gastrointestinal bleeding 321
common causes of 321
lower 321, 324
clinical presentation 325
common causes of 325
diagnostic workup 326
patient approach 325
physical examination 326
subsequent management 326
upper 321
clinical presentation 322
patient approach 322
Gastrointestinal system 52, 303
Gastrointestinal tract 378
GCS See Glasgow coma scale
Genetic disease 265
Genitourinary system 378
Gentamicin 111, 118, 560
Gestational age, small for 501
Giardia lamblia 315
Gitelman and Bartter syndromes 256
Glasgow coma scale 168, 170, 172b, 210, 424
Glomerular diseases 296
Glomerulonephritis 285
Glucagon 560
Glucose administration 229
Glycopyrrolate 560
Graft-versus-host disease 391, 413, 415
Gram stain 203, 544
Gram-negative bacteria 370
Grand mal seizures, early 182
Granulocyte 387
transfusion 389
dose 389
indications 389
Granulomatous disease 253
Guillain-Barre syndrome 162, 191, 192, 198, 395, 396, 529
clinical features 191
differential diagnosis 192
investigations 193
pathogenesis 192
treatment 193
H
Haemophilus influenzae B 96, 116, 158, 185, 406
infection 201
Haloperidol 218, 560
Hand-foot-mouth disease 182
Handwashing
prevention 469
steps for effective 469
steps in 470f
Hanging 434
complete 434
detailed evaluation 436
incomplete 434
investigations 436
management 435
pathophysiology 435
Head injury 167, 212
goals of therapy 213
types of 212, 213
Headache 161, 205, 464
Healthcare providers, guidelines for 23
Hearing
impaired 523
impairment, high-risk newborns for 523
Heart
block, complete 141, 142f
disease, congenital 273, 475
failure 152
rate 478
Heartbeats, irregular 138
Heat stroke 268
clinical presentation 268
complications 270
differential diagnosis 269
exertional 268
investigations 270
monitoring 270
nonexertional 269
prevention 271
subsequent management 270
Hemarthrosis 411
Hematologic system 52
Hematology
oncology 385
tests 73
Hematuria 161, 295
assess degree of 295
causes of 295
common causes of gross 295
Hemodialysis, intermittent 289
Hemoglobin 236, 405, 501
Hemolytic anemia 352
Hemolytic reactions 391
management 391
Hemolytic uremic syndrome 210, 359, 389, 399
clinical presentation 400
diarrhea-associated 401
etiology 399
prognosis 401
subsequent management 401
Hemophilia 210, 409
A 390
and B, treatment of 411t
subsequent management 412
types of 409
Hemorrhage 552
epidural 209f
Hemorrhagic disease 512
Hemorrhagic fevers 295, 296, 346, 352
Henoch-Schönlein vasculitis 346
Heparin 560
flushing 417
Hepatic encephalopathy 260, 305
clinical staging of 308t
Hepatic failure 270, 360
chronic 389
Hepatic sickle cell crisis 407
Hepatitis 358
A 372
B virus chronic infection 308
Hepatomegaly 260
Herald severe disease 329
Herpes infections 494
Herpes simplex 194
virus infection 308
Hirschsprung disease 325
Histoplasma capsulatum 367
Histoplasmosis 364, 367
clinical presentation 368
diagnosis 368
treatment 368
HMD See Hyaline membrane disease
Homatropine hydrobromide 560
Hormone therapy, avoid 237
Hospital-acquired infections 370
clinical presentation 372
organisms 371
predisposing factors 370
environmental factors 371
host factors 370
prevention 373
source of 371
types of 371
Hospital-acquired pneumonias 115
Hudson mask 59, 60f
Human immunodeficiency virus 273, 366
Hungry bone syndrome 258
Hurst disease 195
Hyaline membrane disease 510
Hydralazine 164, 560
Hydrocarbons 444
Hydrochlorothiazide 560
Hydrocortisone 47, 56, 560
Hydroxymethyl 74
Hydroxyzine 560
Hyoscyamine hydrobromide 560
Hyperammonemia 260, 264
causes 260
clinical presentation 261
diagnosis 262
differential diagnosis 262
laboratory evaluation 261
laboratory interpretation in 262t
pathophysiology 261
treatment 263
of unconjugated 502
Hypercalcemia 253
causes 253
clinical presentation 253
investigations 254
treatment 254
Hypercalciuria nephrocalcinosis 256
Hypercarbia 74
Hypercatabolic disease 273
Hypercyanotic attacks 147
differential diagnosis 147
etiopathogenesis 147
investigations 148
treatment 148
Hypercyanotic spells, algorithm for management of 148fc
Hyperglycemia 205, 240, 425, 426
Hyperkalemia 233, 249
causes 249
clinical presentation 249
correction of 250
ECG changes in 250t
management of 251fc
true 249
Hyperleukocytosis 413, 415
Hypermagnesemia 255
causes 255
clinical presentation 255
diagnosis 256
investigations 256
pathophysiology 255
treatment 256
Hypernatremia 244
causes 244
clinical presentation 244
complications 245
management of 246fc
pathophysiology 245
Hyperornithinemia-hyperammonemia-homocitrullinuria syndrome 260
Hyperphosphatemia 257
causes 257
chronic 258
clinical features 257
laboratory evaluation 258
treatment 258
Hypertension 161, 168, 205, 216, 288
cause for 163
Hypertensive crisis 161, 164
classification 161
diagnosis 162
drug therapy in 164t
etiology 162
primary 162
secondary 162
Hypertensive urgency, drugs for 164t
Hyperthermia 268
Hypertriglyceridemia 328
Hyperuricemia 413
Hyperventilation 215
Hypervolemia 287
Hypoaldosteronism 291
Hypocalcemia 254, 494
causes 254
clinical presentation 254
symptomatic 255
Hypoglycemia 233, 272, 274, 494
asymptomatic 496
correction of 147
Hypokalemia 192, 251, 275
causes 251
clinical presentation 252
correction of 229, 253, 294
diagnostic approach to 252fc
suspect 252
treatment 252
Hypomagnesemia 256, 275
causes 256
clinical presentation 256
investigations 257
severe 257
treatment 257
Hyponatremia 233, 246
asymptomatic 248
chronic 248
clinical presentation 247
etiology 246
hypervolemic 248
mild 247
monitoring 248
pathophysiology 247
severe 247
Hypophosphatemia 192, 258
causes 258
clinical features 258
diagnosis 259
investigations 259
treatment 259
Hypotension 223, 546
Hypothermia 215, 223, 272, 274, 439, 475, 477
correct 519
differential diagnosis 439
investigations 440
mild 169, 439
and moderate 476
moderate 439
monitoring 440
oxygen, severe 475
profound 439
severe 476
Hypotonia 191
Hypovolemia 286, 288
Hypoxemia 216
Hypoxia 223
hypercarbia 213
I
Ibuprofen 218, 560
ICP See Intracranial pressure
Idiopathic thrombocytopenic purpura 454
Iliopsoas hemorrhage 411
Illness observation scale, acute 70
Immune
deficiency disorders
primary 396
secondary 396
modulation 396
thrombocytopenia 346
thrombocytopenic purpura 210, 395, 396
Immunoglobulin IV 561
Indomethacin 561
Infant 27
chest thrusts in 28f
Infection 205, 272, 275, 289, 295, 402, 552
severe 402
source of 371
types of 371
Infectious diseases 337
Infectious laryngitis, acute 95, 96
Infective endocarditis 155
Inflammatory bowel disease 325, 326
Inflammatory disease 106
chronic 100
Influenza 194
A virus 95
Infusion, rate of 279
Inhaler, metered dose 100
Initiate breastfeeding 472
Innocent cardiac murmurs 155
Insulin 561
infusion 229
preparation of 229
Intensive bronchodilator therapy 103
Intensive care
concept of 1
unit 210, 373
Intermittent mandatory ventilation, ventilator controls in 485
Intra-arterial blood pressure 536
Intra-arterial injection 432t
inadvertent 431
Intracranial hemorrhage 167, 208, 211
classification 208
clinical presentation 210
etiology 210
outside brain 208
pathophysiology 210
within brain 208
Intracranial pressure 43, 170
increased 261
management of raised 170fc
raised 167, 415
signs of 173b
Intraosseous access 539, 540f
complications 540
infusion sites 539
procedure 540
requirements 539
Intrauterine infections 522
Intravenous 74
ampicillin 299
calcium gluconate 255
cefotaxime 299
ceftriaxone 299
dexamethasone 169
edrophonium chloride 199
furosemide 169
mannitol 169
methylprednisolone 102
quinine combination therapy 355
Intravenous fluid 48, 102, 342
therapy 278
complications of 281
components of 279
indications 278
maintenance 279
replacement 280
routes of administration 279
Intravenous immunoglobulin 146, 152, 191, 194, 349, 395
administration of 377
therapy 395
indications 396
mode of action 395
Intubation equipment 480
Invasive aspergillosis 366
clinical presentation 366
diagnosis 367
treatment 367
Invasive fungal infections 364, 369
Ipratropium 102
bromide 561
Iron 275, 561
elemental 561
salts 449
Irritability 182
Isoniazid 188, 328, 449, 561
Itchy rash 392
ITP See Idiopathic thrombocytopenic purpura
Ivermectin 561
IVIG See Intravenous immunoglobulin
J
Jatropha curcas 449
Jaundice 260, 298
severity of 500
Jerky movements, short-lived 494
Jitteriness 496
Jugular vein
external 534
internal 533
Juvenile idiopathic arthritis 155, 395
K
Kadallavanakku 449
Kawasaki disease 155, 186, 377, 395, 397, 416
atypical 378, 380
clinical presentation 377
complicated 380
IVIg-resistant 379
treatment 379
uncomplicated 379, 380
Kernicterus 494
Kerosene 444
lethal dose of 444
Ketamine 43, 48, 432
Ketoacid correction 229
Ketone body 261
Kidney injury
acute 285, 290, 358
common causes 286
complications 289
diagnostic criteria 285
fluid management 288
investigations 287
management 287
network 285
cause of acute 399
staging of acute 286t
Klebsiella 298, 371, 505
L
Labetalol 164, 561
Lactate dehydrogenase 400
Lactic dehydrogenase 287
Lactulose 561
Lamotrigine 561
Lansoprazole 561
L-asparaginase 328
Lay rescuers, guidelines for 23
L-carnitine 561
Lead 450
Leptospira antibody 307
Leptospirosis 352, 358
anicteric 358
clinical presentation 358
differential diagnosis 359
icteric 359
pathogenesis 358
specific therapy 360
subsequent management 360
supportive therapy 360
suspect 359
Lethal illness 265
Leukemia 158, 205, 239
Leukopenia 506
Levamisole 562
Levetiracetam 328
Levosimendan 134
Levothyroxine 562
LFT See Liver function test
LGIB See Lower gastrointestinal bleeding
Liddle syndrome 253
Lidocaine 43, 48, 562
cream 219
infiltration 219
Life support, withholding and withdrawing 19
Life-threatening reaction 393
Linezolid 372, 562
Lipid amphotericin B formulations 556
Listeria monocytogenes 185
Liver biopsy 549, 552
complications 552
contraindications 549
equipment needed 550
indications for 549
menghini 1 second 550
precautions 550
procedure 550
site 551f
ultrasonography-guided 550
Liver cell
failure, acute 305
necrosis 305
Liver disease 255, 260, 269, 549
acute 310
chronic 236, 305
suspected 549
Liver failure 268
acute 260, 305, 313
chronic 260
Liver function test 126, 132, 168, 206, 211, 238, 299, 307, 323, 400
Local tissue damage 441
Loratadine 562
Lorazepam 47, 178, 562
Lower gastrointestinal bleeding 323
diagnostic workup of 323b
Low-molecular-weight heparin 416, 417
Lumbar cerebrospinal fluid 215
Lumbar puncture 202, 230, 529, 530f
complications 531
contraindications 529
indications 529
procedure 530
Lung
crackles 287, 444
disease, chronic 273
parenchyma, inflammation of 111
Lymphoma 158, 205, 239
M
Macrolides 109
Macrophage activation syndrome 381
clinical presentation 381
diagnostic criteria 382
differential diagnosis 382
subsequent management 382
Magnesium
hydroxide 562
sulfate 562
Malabsorption syndrome 273
Malaria 352, 359, 565
clinical presentation 352
differential diagnosis 352
late treatment failure 357
monitoring 356
peripheral smear for 132
response to therapy 356
severe complicated 352, 355
subsequent management 353
supportive therapy in severe 355
Malarial parasite 173
Mallory-Weiss tears 321
Malnutrition
severe 332
severe acute 272
causes 272
clinical presentation 273
differential diagnosis 273
investigations 273
Mannitol 240, 562
MAO See Monoamine oxidase
MAP See Mean arterial pressure
Maple syrup urine disease 267
MAS See Meconium aspiration syndrome
Massive hematemesis 323
Mastoiditis 206
Mean airway pressure 85
Mean arterial pressure 135, 167
Mebendazole 562
Mechanical ventilation 83, 103, 109, 208
controlled 85f
expiratory phase characteristics 87
extubation 91
indications for 84
inspiratory phase characteristics 87
laboratory investigations 89
normal versus 83
phases of 85
preparation and monitoring 88
radiological 89
starting of 88
termination of inspiration 87
terminologies used 84
ventilator assessment 89
weaning 91
Meckel's diverticulum 325
Meconium aspiration syndrome 486
Mediastinal disease, severe 368
Mediastinal tumors 159
Mefloquine 563
Megavitamin therapy 260
Menghini needle biopsy 550
Meningeal irritation
signs of 182
stage of 188
Meningitis 167, 183, 205, 206, 239, 352, 359, 494
Meningococcal vaccine 401
Meningococcemia 352
Mental status 434
Meropenem 347, 562
Metabolic abnormalities 413
Metabolic acidosis 77, 78, 233, 294
Metabolic alkalosis 77, 78
causes 78
clinical features 79
treatment 79
Metabolic complications, management of 268
Metabolic emergencies 225
Metabolic problems 52
Metabolism 509
inborn errors of 205, 260, 265
Metabolites, deficient 267
Methadone 562
Methanol 449
Methicillin-resistant Staphylococcus aureus 370
Methotrexate 563
Methylene blue 563
Methylphenidate 563
Methylprednisolone 47, 56, 104, 194, 382, 563
Metolazone 562
Metoprolol 562
Metronidazole 328, 563
Micronutrient deficiency 272, 275
Microorganisms causing pneumonia 112t
Midazolam 43, 47, 83, 178, 432, 563
Migraine 205
Miller-Fisher syndrome 192
Milrinone 134
Mitral valve prolapse 155
Monoamine oxidase 43
Montelukast 563
Morphine 83, 432
sulfate 563
Mortality, pediatric risk of 71
Multidrug-resistant Plasmodium falciparum 354
Multiorgan
dysfunction syndrome 131, 461
failure 452
Multisystem disease, acute 349
Myalgia 464
in influenza 182
Myasthenia gravis 192
Myasthenia, mild 199
Myasthenic crisis 200
Myasthenic paralysis 197, 200, 452
confirmatory tests 199
differential diagnosis 198
investigations 198
pathogenesis 197
treatment 199
Mycobacterium tuberculosis 158
Mycoplasma pneumoniae 106, 194
Myocardial hypoxia 423
Myocarditis 150
causes of 151
N
N-acetyl cysteine 308, 555
Nalidixic acid 563
Naloxone 48, 563
Naphthalene 450
Naproxen 218, 563
Nasal cannula, high flow 108
Nasal prongs 59, 59f
Nasogastric aspiration 323
Nebulization 104, 106
Nebulized adrenaline 57
Nebulized ipratropium 102
Nebulized salbutamol 57, 102
NEC See Necrotizing enterocolitis
Neck stiffness 161
Necrotizing enterocolitis 510, 513
Needle thoracocentesis 541
complications 542
contraindications 541
indications 541
Neisseria meningitides 185, 406
Neomycin sulfate 563
Neonatal anemia, diagnostic approach to 516fc
Neonatal convulsions 493
causes 493
clinical presentation 493
investigations 494
Neonatal hypocalcemia 498
causes 498
clinical presentation 499
investigations 499
management of 499fc
Neonatal hypoglycemia 496
clinical presentation 496
management of 497fc
risk factors 496
Neonatal hypothermia 475
clinical presentation 476
differential diagnosis 476
grading 475
management 476
pathophysiology 475
prevention 477
supportive measures 477
Neonatal intensive care unit 491
admission to 491
Neonatal jaundice 500
diagnostic approach to 501fc
physical examination 500
Neonatal resuscitation 478
algorithm 479fc
equipment checklist 479
Neonatal seizures, anticonvulsant therapy in 495fc
Neonatal sepsis 395, 505
approach to 507fc
clinical features 506
differential diagnosis 506
etiology 506
risk factors for 505
Neonatal transport 518
Neonatal ventilation 482
mechanical 485
normal 485
Neonate
audiology screening in 522
bleeding 512
Neonatology 467
Neostigmine methylsulfate 563
Neostigmine test 199
Nephrogenic diabetes insipidus 240
Nephrotic syndrome 130, 205, 273, 332, 334, 389, 390, 461, 463
Nephrotoxic drug 285
Nervous system 51, 165
examination 174
Neuritis 461
Neurologic vital signs 71
Neurological function 493
Neurometabolic screening 261, 262
Neuroprotective therapy 206
Neutral head position 26f, 214
Neutropenia 413
Newborn
care of normal 471
danger signs in 474
fluid therapy in 488
visual screening in 524
indications 524
with anemia, transfusion protocol for 516t
with bloody stools, approach to 513fc
with generalized bleeding, approach to 512fc
Niacin 275
Nicardipine 164
Niclosamide 563
Nifedipine 164, 563
Nitrofurantoin 563
Nitroglycerine 134
Nitroprusside 134
sodium 564
NMS See Neurometabolic screening
Nonconvulsive seizures, treatment for 169
Nonhemolytic reactions 392, 393
febrile reaction 392
Non-rebreathing masks 60
Nonshockable rhythm 36, 37fc
Nonsteroidal anti-inflammatory drugs 158
Norepinephrine 133
bitartrate 564
Normal newborn, care of 471
basic principles 471
care of cord 472
examine 472
eye care 472
postnatal care 472
prevention of infection 473
skin care 472
Normothermia 214
Normovolemia 169
Nortriptyline 218
Nutrition 289
O
Obstructive airway disease 510
OCS See Oral corticosteroids
Odollam 450
Ofloxacin 564
Oleander
white 450
yellow 450
Oliguria 161
Ondansetron 564
OPA See Oropharyngeal airway
Opioids 450
Oral contraceptive pills, combined 235
Oral corticosteroids 104
Oral itraconazole 368
Oral medroxyprogesterone acetate 237
Oral rehydration solution 246
Organ donation 223
Organic acidemias 262
Organization and staffing 7
ancillary staff 8
doctor-in-charge 7
medical staff 8
nursing staff 8
Organochlorines 450
Organophosphate poisoning 192, 198, 328, 445
management of 445, 445fc
specific therapy 446
symptoms 445
Organophosphorus poisoning 197
Oropharyngeal airway 31, 33f
advancing 33f
method of insertion of 32, 33f
position 33f
rotating 33f
ORS See Oral rehydration solution
Oseltamivir therapy 109
Osmotherapy 169
Otoacoustic emission 522
Oxcarbazepine 564
Oxygen 56
delivery systems 59
high-flow 60
low-flow 59
therapy 58
adverse effects of 63
indications 58
monitoring of 63
P
Packed cell volume 132
Pain management
and sedation 216
drug therapy for 217t
Pancreatin 564
Pancreatitis 332
Pancreatitis, acute 327, 331
classification 327
clinical presentation 328
differential diagnosis 329
etiology 328
mild 327
pathogenesis 328
severe 328
subsequent management 330
Pancuronium 48, 432
Papilledema 161, 205, 260
Paracetamol 306, 456, 564
for fever 214
Paralysis 44, 161, 244
Paralytic agents 43
Paralytic poliomyelitis 191, 192
Parenteral fluid therapy 488
Parenteral therapy 488
Patent ductus arteriosus 143
PBS See Peripheral blood smear
PEA See Pulseless electrical activity
Peak inspiratory pressure 84, 89, 486, 487
Pediatric bradycardia 37
algorithm 38fc
drug dosages 37
Pediatric chain of survival 25f
Pediatric Drug Formulary 553
Pediatric intensive care unit 3, 9, 54, 83, 147, 148, 150, 154, 167, 192, 199, 206, 233, 234, 243, 245, 425, 438
admission
indications for 333
notes 13
care 342
levels of 8
communication in 16
critically ill children in 18
daily routine in 9
discharge summary 15
documentation in 11
equipment, essential 6b
ethics in 18, 19
autonomy 18
beneficence 18
justice 18
nonmaleficence 18
general guidelines 13
prescriptions 14
procedure notes 14
progress notes 13
rounds 11
systematic approach for examination 12
transfer notes 14
Pediatric pain 216
Pediatric tachycardia 38
algorithm 39fc
drug dosages 38
Pediatrician's responsibilities in brain death 222
PEEP See Positive end-expiratory pressure
PEM See Protein-energy malnutrition
Penicillin
G 360, 465, 564
benzathine 564
procaine 564
V 154, 564
Pentagon, assessment 68f
Pentazocine 564
Pentobarbital infusion 169, 215
Pericardial cyst 159
Pericardial effusion 158, 160f
common causes 158
differential diagnosis 159
pathophysiology 159
Pericardiocentesis 543
complications 544
equipment 543
indications 543
preambles 543
procedure 544
Peripheral arterial cannulation 536
arteries used 536
complications 538
contraindications 536
equipment 537
indications 536
procedure 537
Peripheral blood smear 238, 323, 379, 506
Peritoneal dialysis 289
Permanent pacemaker 141
Permethrin 564
Persistent diarrhea 314, 318
Persistent pulmonary hypertension of newborn 146
Pethidine 564
Peutz-Jeghers syndrome 326
Phenazopyridine 564
Pheniramine 56
Phenobarb 426
Phenobarbitone 47
Phenol 450
Phenothiazines 450
Phenoxybenzamine 565
Phenylephrine 564
Phenytoin 432, 451
Phototherapy 502
unit, quality assessment of 503
Phytonadione 564
PICU See Pediatric intensive care unit
Pinworm infestation 300
PIP See Peak inspiratory pressure
Piperacillin 372, 565
Piperacillin-tazobactum 565
Plasma
ammonia 173, 260, 307
phosphorus 257
transfusion 389
dose and administration 390
indications 389
Plasmodium falciparum 352
Platelet 387
count 132, 339
transfusion 388
indications 388
type of 389
Pleural effusion 340f
Pleural fluid
needle aspiration of 542
study 118
Pleurodynia 159
Pneumocystis jiroveci 414
Pneumomediastinum 120, 122
clinical features 122
common causes 122
diagnosis 123
pathogenesis 122
treatment 123
with pneumopericardium, chest X-ray 123f
Pneumonia 111, 358, 399
adjuncts to treatment 118
clinical presentation 112
complications of 115
etiology 111
management 112
Pneumothorax 120, 121f, 544
aspiration pneumonia 51
clinical presentation 121
investigations 121
pathogenesis 120
physical examination 121
treatment 122
Poison
and drugs, clues for 442
promote excretion of 443
Poisoning 171, 421, 447
common 444
in children 442
management 447
symptomatology 447
to hydrocarbons, management of 444fc
Polydipsia, primary 240
Polymorphonuclear cell 203
Polymorphonuclear leukocytosis 186
Polyuria 280, 286
Poor urine stream 286
Portal hypertension 332
Positive airway pressure 132
Positive end-expiratory pressure 59, 84, 89, 487
Positive pressure ventilation 478, 479
intermittent 106, 110
Postdiphtheritic paralysis 192
Post-intubation care 45
Post-resuscitation care 50
approach 50
system-wise approach 51
Postresuscitation management 480fc
Poststreptococcal glomerulonephnitis 295
Post-transfusion care 504
Potassium chloride 48
PPHN See Persistent pulmonary hypertension of newborn
PPV See Positive pressure ventilation
Pralidoxime 564
Prazosin 564
Prednisolone 102, 564
Pre-existing disease, chronic 269
Prematurity
recurrent apnea of 511
retinopathy of 524
Primaquine 565
Promethazine 565
Prophylactic anticoagulant therapy 416
Propofol 43, 48, 432
Propoxyphene 565
Propranolol 565
Prostaglandin E1 134, 565
Protein-energy malnutrition 252
Proteus groups 298
Prothrombin time 236
Proton pump inhibitor 513
Pseudohyperkalemia 249
Pseudomonas 371
aeruginosa 185
Pseudotumor cerebri 167
Puberty menorrhagia 235
etiology 235
Pulmonary aspergillosis 367
Pulmonary blood flow 147
Pulmonary disease, moderate 387
Pulmonary edema 459
Pulmonary histoplasmosis
acute 368
chronic 368
Pulmonary score 100, 102
Pulseless
cardiac arrest, management of 35, 35fc
electrical activity 36f, 37, 37fc
ventricular tachycardia 36, 37fc
Pyelonephritis, acute 298
subsequent management 300
Pyogenic meningitis, complication of 201
Pyrazinamide 188
Pyridostigmine 565
Pyridoxine 178, 565
Q
Q fever 361
QT syndrome, long 140, 141f
Quetiapine 218
Quinine 355
sulfate 565
Quinupristin 565
R
Radial artery 537
puncture, stabilizing wrist for 537f
Ranitidine 48, 565
Rapid digitalization, digoxin for 145t
Rapid sequence intubation 41, 42, 46, 180, 206, 213
algorithm 46fc
contraindications for 42
indications for 41
medications in 43t
preparation 42t
procedure 42
sedatives for 44t
Rat-bite fever 464
differential diagnosis 465
pathophysiology 464
treatment 465
RBC See Red blood cell
RBS See Random blood sugar
RDS See Respiratory distress syndrome
Rebreathing mask, partial 59
Red blood cell 235, 323, 387, 404, 405
transfusion 387, 409
indications 387
precautions 388
types of 388
Refeeding syndrome 258
Refractory status epilepticus 179, 180
Rehabilitation, subsequent 277
Renal angle tenderness 298
Renal disease 245, 255, 269, 333
Renal failure 161, 268, 270, 397
acute 285
chronic 273
intrinsic 288
Renal function
normal 258
test 126, 132, 168, 206, 211, 234, 238, 245, 299, 307, 323, 339, 392, 400
Renal replacement therapy, continuous 289
Renal system 52, 283
Renal tubular acidosis 252, 273, 291, 294
clinical presentation 293
clinical types 292
differential diagnosis 293
hyperkalemic 292
pathophysiology 292
proximal 292
subsequent management 294
type of 293
Replacement therapy 396
Respiration 172
Respiratory acidosis 77, 78
causes 78
clinical features 78
treatment 78
Respiratory alkalosis 77, 79
bag for 74
causes 79
clinical features 79
treatment 79
Respiratory depression 178
Respiratory distress 287, 491
Respiratory distress syndrome 483, 486
causes of acute 124t
Respiratory infection, upper 106
Respiratory rate 106, 491
Respiratory sound, abnormal 95
Respiratory syncytial virus 106
infection 109
Respiratory system 51, 81
Restlessness 243
Resuscitation 21
equipment and drugs 47
Retinopathy 161
of prematurity 524
clinical manifestations 525
diagnosis 525
pathogenesis 524
screening 525fc
treatment 525
Retropharyngeal abscess 95, 96, 99
Revised National Tuberculosis Control Program 188
Reye syndrome 217, 261, 266, 306, 311, 313
clinical features 312
clinical staging of 312t
differential diagnosis 312
etiology 311
investigations 312
pathogenesis 311
subsequent management 313
treatment 313
RFT See Renal function test
Rheumatic carditis 154, 157
antibiotic therapy 156
anti-inflammatory therapy 156
differential diagnosis 155
rest in 156t
subsequent management 156
supportive therapy 156
Rheumatic fever 157t
Rheumatoid disease 219
Rheumatological disorders 195
Ribavirin 109
Riboflavin 267, 275
Rickets, development of 291
Rickettsia conorii 361
Rickettsia tsutsugamushi 361
Rickettsial disease 186
Rickettsial fever 347
Rickettsial infections 361, 363
clinical presentation 361
differential diagnosis 362
management 362
pathogenesis 361
specific therapy 363
subsequent management 362
supportive therapy 363
Rifampicin 187, 188, 348, 361, 565
Ringer's lactate 435
Risperidone 218, 565
Rocuronium 43, 48, 432
Rotavirus 314
RPA See Retropharyngeal abscess
RSE See Refractory status epilepticus
RSI See Rapid sequence intubation
RTA See Renal tubular acidosis
Rubella 494
Rule of palm 428
S
SABA See Short-acting beta agonists
Salbutamol 101, 106, 565
nebulization 48, 102
Salicylates 451
Saline, normal 148, 278, 339
Salmonella 185, 315, 371, 372, 406
Sarcoid-like disease 368
SBP See Systolic blood pressure
SBR See Serum bilirubin
SCH See Succinylcholine
Sclerosis, multiple 195
Scorpion envenomation 457, 460
clinical presentation 458
differential diagnosis 458
management 459
monitoring 460
pathophysiology 457
poor prognostic indicators 460
systemic symptoms 458
Scrub typhus 361
Seizure 147, 205, 244, 260, 270, 288, 493, 496
continuing 179
control 268
Self-inflating bags 61
Sellick maneuver 44
Sensorium 260, 452
altered 177
Sensory stimulation 277
Sensory symptoms, mild 191
Sepsis 206
prevention 469
syndrome 347
Septic arthritis 346
Septic shock 352
Serum 400
ascites albumin gradient, interpretation of 334t
bilirubin 501
electrolytes 126, 132, 143, 206, 211, 296, 299, 307, 339, 392, 400, 425
glutamic oxaloacetic transaminase 311
glutamic pyruvic transaminase 311
osmolality 240
sickness 461
Severe dengue
with compensated shock, fluid therapy in 343fc
with hypotensive shock, fluid therapy in 343fc
with organ failure, fluid therapy in 343fc
Sexual maturity rating 236
Shigella 315
dysentery 399
Shock 129, 137, 150, 213, 270, 356, 426, 552
additional therapies 135
cardiogenic 130
catecholamine-resistant 133
cold 131
distributive 130
fluid refractory 133
hemodynamic management of 135fc
hypovolemic 130
management 131
monitoring 135
obstructive 130
patient approach 131
poor prognostic factors 136
refractory 135
septic 131
severe dehydration with 274
signs of recovery from 133b
therapy 132
vasoactive drugs in 134t
warm 131
Shockable rhythm 23, 36
Short-acting beta agonists 100, 104
Sick child 240
ethical issues in treating 18
Sick neonates, transporting 518
Sickle cell
anemia 205, 207
crisis 405
diagnosis 407
infectious 405
management 407
noninfectious 406
nonspecific fever 405
disease 296, 405
Simple oxygen mask 59
Snake envenomation 197, 198, 452, 454, 454fc
complications 455
in hospital, management of 455fc
pathophysiology 453
prehospital management 454
supportive therapy 455
with complications, management of 456fc
Sodium
bicarbonate 48, 294
nitroprusside 164, 459
polystyrene sulfonate 565
thiosulfate 566
valproate 47
Soft-tissue neck radiographs 436
Solitary rectal ulcer syndrome 325
Spasmodic croup 95, 96
Spinal cord compression 415
Spine, arthritis of 155
Spirillum minus 464
infection 465
Spironolactone 566
Splenic sequestration, acute 406
Spontaneous mode 86
Spotted fever 361
Stabilize airway 162
Staphylococcus 406
aureus 96, 116, 185, 349, 371, 505
pneumonia 111, 117
chest X-ray in 117f
Starvation 286
Status epilepticus 171, 176
algorithm for management of 180t
clinical presentation 177
common causes 176
mechanism of 177
prevention of complications 179
prognostic factors in 177t
treatment 179
Steroid 328
therapy 187
Streptobacillus moniliformis 464
Streptococcus
pneumoniae 96, 116, 185, 406
pyogenes 96
Streptokinase 566
Streptomycin 188, 566
Stridor 95
child with acute 99fc
Stridor, acute 95
common causes 95
investigations 98
monitoring 98
prognosis 98
salient features 95
Stroke in children, acute 204
classification 204
clinical presentation 205
differential diagnosis 205
management of 204
patient approach 206
Subclavian vein access 534
Subdural empyema 201
clinical features 201
diagnostic investigations 201
differential diagnosis 202
procedure 202
treatment 202
Subdural fluid tap 202
Subdural hemorrhage 209f
Submersion duration 426
Submersion injuries 423
Succinylcholine 43, 48, 432
dose of 44
Sucralfate 566
Sulphonyl ureas 451
Superior vena cava syndrome 415
Suprapubic aspiration 548f
Suprapubic urine aspiration 547
complications 548
equipment 547
materials 547
procedure 547
Supraventricular tachycardia 138
algorithm for treatment of 139fc
ECG in 139f
Sweating 496
erythema and pain 428
Synchronized cardioversion 38
Synchronized intermittent mandatory ventilation 86, 86f
Syndrome of inappropriate antidiuretic hormone 248
Systemic analgesia 219
Systemic diseases 236
chronic 273
Systemic infections 317
Systemic reactions 462
Systolic blood pressure 343
T
Tachyarrhythmias 138
Tachycardia 216, 243, 296, 496
Tachypnea 216, 269, 405, 444, 491, 496
Tardieu spots 436
Temperature homeostasis 52
Tension pneumothorax, needle decompression for 541
Terbutaline sulfate 566
Terfenadine 566
Tet spells 147
Tetanus
antitoxin 566
immunoglobulin 566
toxoid 459
TFT See Thyroid function test
Theophylline 509, 566
Therapeutic food 276
ready to use 276
Thiamine 267, 275, 566
Thiopental 43, 432
sodium 566
Thrombocytopenia 383, 413, 414
Thromboembolic diseases 416
Thrombolytic therapy 416, 418
Thromboplastin time, partial 409
Thrombotic disorders 205
Thyroid
crisis 242
differential diagnosis 243
management 243
pathogenesis 242
function test 238
hormones 242
stimulating hormone, low 242
storm 242
Thyroxine 242
Tiagabine 566
Tibia, upper end of 540f
Tick
paralysis 197, 198
typhus 361
Tidal volume 84, 486
Tincture iodine 451
Tissue injury 403
Topiramate 566
Toxic liver damage 305
Toxic reactions 462
Toxic shock syndrome 349
clinical presentation 349
diagnostic criteria 350
etiology 349
exclusion criteria 350
treatment 351
Toxins 403
Toxoplasmosis 494
Tracheal compression 415
Transfusion
exchange 503
indications 503
requirements 503
reactions 391
Transverse myelitis, acute 192
Traumatic acute cord compression 192
Traumatic brain injury 208, 210, 212
causes of 212
Tricuspid atresia 143
Tricyclic antidepressants 451
Triiodothyronine 242
Tropicamide 566
Tuberculin skin test 189
Tuberculosis disease 188
Tuberculous meningitis 183, 188–190, 195
radiology 189
specific treatment 190
Tumor lysis syndrome 249, 254, 257, 413
Typhoid 359
fever 352
Tyrosine kinase, muscle-specific 198
U
Umbilical vein 488
Unfractionated heparin 417
Unit design 3
central station 4
clean and dirty utility rooms 5
communication area 5
crash cart 4
entry doors 4
ICU beds 4
power supply and temperature control 4
resuscitation trolley 4
room layout and bed area 3
storage 5
waste disposal 5
United Nations International Children's Emergency Fund 272
Upper airway obstruction 97t
Urea cycle disorder 262
Urinary tract hematuria, lower 295
Urine output, normal 489
Urokinase 566
Urolithiasis 295, 296
Ursodeoxycholic acid 566
Uterine bleeding
abnormal 235
algorithm of management of abnormal 238fc
dysfunctional 235
Uterine problems 236
Utero-ovarian mass 235
V
VAD See Ventricular assist devices
Valproic acid 328, 567
Valvular heart disease, chronic 154
Vancomycin 187, 370, 372
Varicella 194
Vasculitis 195, 461
syndrome 205
Vaso-occlusive
complications 405
incidents, acute 407
Vasopressin 567
deficiency 241
Vecuronium 43, 48, 567
Veins 533
Venomous snakes of Kerala 452
Venoms and toxins 402
Venous blood gas 233, 307
Ventilation bags 61
Ventilator dyssynchrony 216
Ventilator parameters, disease-based 89t
Ventilator problems encountered 90
Ventilator settings, initial 486t
Ventilatory support
for hypoxia 74
types of 482
Ventricular assist devices 152
Ventricular fibrillation 23, 36f, 140
Ventricular tachycardia 36f, 140, 140f
management of 37fc
Venturi masks 60
Verbal output 172
Vessel wall defects 210
Vibrio cholerae 315
Vigabatrin 567
Vim-Silverman needle biopsy 549, 550, 552
Vincristine 192
Viral hepatitis 352, 359
Viral markers 307
Viral myocarditis 150, 155
common organisms 150
diagnosis of 151
differential diagnosis 151
investigations 151
management of 152, 152fc
Viral pericarditis 155
Visceral perforation 552
Vision, blurring of 161
Visual screening in newborns 524
Vitamin
A 275, 317
B12 267
B6 267
D 275, 291
K 275, 305, 471
antagonists 416, 418
injection 475
K1 564
Vomiting 227, 286, 464
von Willebrand disease 236, 390, 410
W
Warfarin 416, 451
Warm transport 519
WBCT See Whole blood clotting time
WBT See Whole blood transfusion
Weil syndrome 359
Wheeze 444
Whole blood transfusion 343, 387
Wilson's disease 306, 307
Wiskott-Aldrich syndrome 396
Wong-Baker faces pain 217f
World Health Organization 216, 272
X
Xylometazoline 567
Y
Yersinia 315
Z
Zinc 275, 451, 567
Zoonotic infection 358
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Handbook of Pediatric and Neonatal Emergencies
Handbook of Pediatric and Neonatal Emergencies
Editor S Sushamabai MD DCH FIMSA FIAP Professor and Head Department of Pediatrics Pushpagiri Medical College Thiruvalla, Kerala Former Professor and Head Department of Pediatrics Government Medical College Kottayam, Kerala, India Email: drsushamabai@gmail.com Foreword Professor (Dr) MKC Nair
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Handbook of Pediatric and Neonatal Emergencies
First Edition: 2020
9789352706143
Printed at
K Rajagopalan, my husband for the upstanding support
Raj Anand, my son for the help and encouragement
and all above
GOD Almighty for showing me the right path.
Contributors Foreword
I am pleased to write the Foreword for Handbook of Pediatric and Neonatal Emergencies, 1st edition by S Sushamabai, because of the paucity of books solely on emergency care, especially from Kerala and also because proper management of childhood emergencies will definitely reduce the infant mortality rate. Illnesses and emergencies differ in different parts of the world as well as within a country itself, so that treatment protocols may require modification according to the situation. This book is particularly beneficial in dealing with the pediatric emergencies encountered in Asian countries.
There are 125 chapters in this book. The initial five chapters deal with the setting up of a Pediatric Intensive Care Unit and its functioning, which is helpful for the beginners in pediatrics to step into emergency care. Procedures and drug dosages are also included and the topics are presented in simple language, point projected and with systematic approach. Tables, diagrams and flowcharts are included in most chapters facilitating quick approach.
The contributors of this book are well-known faculty for their expertise, clinical acumen, astute patient care and academic excellence. S Sushamabai is one of the stalwarts in the field of pediatrics, a great academician, who has revealed a genuine interest to bring up the emergency care services for children in whichever hospitals she had worked.
I am happy to recommend this book as a bedside companion to residents in pediatrics and nurses working in pediatric emergency care department. Further, this book will be of undeniable help for the pediatricians working single-handed in peripheral health services, whether in government or private sector, since they are the group of doctors encountering the vast majority of emergencies at first.
Professor (Dr) MKC Nair
MD PhD M Med Sc MBA MA FNNF FIAP FIACAM
Founder Director, Child Development Centre, Kerala, India
National President, Indian Academy of Pediatrics (IAP: 2004)
National President, National Neonatology Forum (NNF) (2011-2012)
Vice Chancellor Kerala University of Health Sciences
www.kuhs.ac.in Phone: +91 487-2207664 Fax: +91 487 2206770 e-mail: vc@kuhs.ac.in
Preface
Emergencies denote serious and unexpected situations requiring immediate intervention. In medical situations, they herald death or disability to the affected person which can be prevented by prompt and appropriate treatment.
Unlike the situation in adults, children rapidly plunge into critically ill stage because of the immaturity of organs and systems. The clinical manifestations will be subtle in them delaying the exact diagnosis and subsequently denying the right treatment. But if revived in the golden hour, the prognosis and complete recovery are far better in children, thus reducing the infant mortality rate and improving the manpower of the country. Hence, it is mandatory that the fraternity involved in child health should be updated with advances in emergency management.
This handbook deals with the childhood emergencies, especially from Asian countries. Most childhood emergencies have a typical clinical presentation, but at times may reveal the uncommon presentation of a common illness or the common presentation of an uncommon illness. I have incorporated my long years of clinical experience from wherever I have worked, which include less privileged areas to high technology centers in diagnosis and patient approach, ultimately getting good survival rate.
I sincerely hope that this book will be beneficial to every beginner in pediatrics to bring up self-skills and confidence in managing emergencies and an added help to all pediatricians working in the peripheral hospitals shouldering great responsibility.
S Sushamabai
Acknowledgments
I acknowledge the prompt and immense help of Mr VKG Nair, the Chief Librarian of the Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India, for sorting out the large number of references for this manuscript.
This textbook reflects the meritorious work of the contributors, each one having vast experience in managing pediatric emergencies. I appreciate their hard work and dedication in providing the chapters entrusted to them in time.
Ms Annamma AV and Ms Remya Krishnan deserve special thanks for taking up the huge responsibility of the computer work for this manuscript with enthusiasm and good will, sacrificing their free time.
I am thankful to Mr Sreeraj of Alumni Association, Government Medical College, Kottayam Kerala, for helping me with the emailing of important matters at the right time for the manuscript.
My husband K Rajagopalan was the real spirit and moral support behind me for preparing this text and my son Raj Anand with his amazing computer knowledge has helped me in preparing the difficult flow charts and tables for it. My grand daughters Shivani and Vedika and my daughter-in-law Dina Raj were encouraging me in bringing out this manual.
I am indebted to the innumerable number of sick children cared by me in the emergency departments of various hospitals I have worked and to their parents, for being the real eye openers stimulating me to read extensively and bring out this text.
The pediatricians working single-handed in peripheral hospitals with constraints have inspired me for the preparation of this text, which I think will be much helpful to them.
I remember with gratitude Dr V Jose Kuruvilla, my colleague for long years, but passed away in the early stage of preparation of this manuscript, who used to remind me very often the scarcity of simple books for caring the emergencies in children.
I am extremely grateful to Professor (Dr MKC Nair), Vice Chancellor, Kerala University of Health Sciences for providing a nice and generous foreword to this manuscript, in time, amidst his heavy schedules.
This is my second textbook getting published by M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India. I am extremely grateful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy) of M/s Jaypee Brothers Medical Publishers (P) Ltd, for accepting my manuscript for publication for the second time.
List of Abbreviations µg:
Microgram
ABC:
Airway, Breathing, Circulation
ABG:
Arterial Blood Gas
ACE:
Angiotensin Converting Enzyme
ACHD:
Acyanotic Congenital Heart Disease
ACT:
Artemisinin Combination Therapy
ACTH:
Adrenocorticotropic Hormone
ADD:
Acute Diarrheal Disease
ADEM:
Acute Demyelinating Encephalomyelitis
AED:
Automated External Defibrillation
AF:
Anterior Fontanel
AFB:
Acid Fast Bacilli
AFP:
Acute Flaccid Paralysis
AHA:
American Heart Association
AKI:
Acute Kidney Injury
ALCAPA:
Anomalous Origin of Left Coronary Artery from Pulmonary Artery
ART:
Anti-Retroviral Therapy
ASO:
Antistreptolysin O
ASV:
Anti-Snake Venom
AVPU:
Alert, Verbal, Pain, Unresponsive
BERA:
Brain Stem Evoked Response Audiometry
BLS:
Basic Life Support
BMI:
Body Mass Index
BMV:
Bag and Mask Ventilation
BSA:
Body Surface Area
BU:
Blood Urea
CAH:
Congenital Adrenal Hyperplasia
CAP:
Community-acquired Pneumonia
CBC:
Complete Blood Count
CBG:
Capillary Blood Glucose
CCF:
Congestive Cardiac Failure
CCHD:
Congenital Cyanotic Heart Disease
CHB:
Complete Heart Block
CHF:
Congestive Heart Failure
CoA:
Coarctation of Aorta
CPAP:
Continuous Positive Airway Pressure
CPK:
Creatinine Phospho Kinase
CPP:
Cerebral Perfusion Pressure
CRFT:
Capillary Refill Time
CRP:
C-reactive Protein
CSF:
Cerebro-spinal Fluid
CVP:
Central Venous Pressure
CxR:
Chest X-ray
DCT:
Direct Coombs Test
DIC:
Disseminated Intravascular Coagulation
DKA:
Diabetic Ketoacidosis
DLC:
Differential Leukocyte Count
DNS:
Dextrose Normal Saline
DRL:
Dextrose Ringer Lactate
EBM:
Expressed Breast Milk
ECG:
Electrocardiograph
ECMO:
Extra Corporeal Membrane Oxygenation
EEG:
Electroencephalo Graph
ESR:
Erythrocyte Sedimentation Rate
ET/TE:
Expiratory Time
ETT:
Endotracheal Tube
FiO2:
Fraction of Inspired Oxygen
FB:
Foreign Body
FDP:
Fibrin Degradation Product
Fe Na:
Fractional Excretion of Sodium
FFP:
Fresh Frozen Plasma
FHF:
Fulminant Hepatic Failure
FOUR SCORE:
Full Outline of Un Responsiveness Score
FTT:
Failure To Thrive
GAS:
Group A Streptococcus
GBS:
Group B Streptococcus
GCS:
Glasgow Coma Scale
GERD:
Gastroesophageal Reflux Disease
HCT:
Hematocrit
HDN:
Hemorrhagic Disease of the Newborn
HIE:
Hypoxic Ischemic Encephalopathy
HIV:
Human Immunodeficiency Virus
HMD:
Hyaline Membrane Disease
HR:
Heart Rate
hr:
Hourly
Hrs:
Hours
HSV:
Herpes Simplex Virus
HUS:
Hemolytic Uremic Syndrome
I:E:
Inspiration : Expiration
ICD:
Intercostal Drainage
ICH:
Intracranial Hemorrhage
ICP:
Intracranial Pressure
ICS:
Inhaled Corticosteroid
ICSOL:
Intracranial Space Occupying Lesion
ICU:
Intensive Care Unit
IEM:
Inborn Errors of Metabolism
Ig:
Immunoglobulin
IM:
Intramuscular
INR:
International Normalized Ratio
IO:
Intraosseous
IT:
Intratracheal
ITP:
Immune Thrombocytopenic Purpura
IV:
Intravenous
IVH:
Intraventricular Hemorrhage
JVP:
Jugular Venous Pressure
KD:
Kawasaki Disease
LBW:
Low Birth Weight
LFT:
Liver Function Test
LGA:
Large for Gestational Age
LP:
Lumbar Puncture
M:
Month/Months
M.TB:
Mycobacterium Tuberculosis
MAP:
Mean Arterial Pressure
MAS:
Meconium Aspiration Syndrome
MCU:
Micturating Cystourethrogram
min:
Minutes
MODS:
Multiorgan Dysfunction Syndrome
MP:
Malarial Parasite
MRI:
Magnetic Resonance Imaging
MRSA:
Methicillin Resistant Staphylococcus Aureus
MUAC:
Mid Upper Arm Circumference
Mx test:
Mantoux test
Neb:
Nebulization
NEC:
Necrotising Enterocolitis
NG Tube:
Nasogastric Tube
NIBP:
Noninvasive Blood Pressure
NS:
Normal Saline
O2:
Oxygen
OAE:
Oto Acoustic Emission
OPA:
Oropharyngeal Airway
ORS:
Oral Rehydration Solution
ORT:
Oral Rehydration Therapy
PAH:
Pulmonary Arterial Hypertension
PALS:
Pediatric Advanced Life Support
PCO2:
Partial Pressure of Carbondioxide
PCP:
Pneumocystis Carinii Pneumonia
PCR:
Polymerase Chain Reaction
PCV:
Packed Cell Volume
PDA:
Patent Ductus Arteriosus
PEEP:
Positive End Expiratory Pressure
PEFR:
Peak Expiratory Flow Rate
PEM:
Protein Energy Malnutrition
PFO:
Patent Foramen Ovale
PICU:
Pediatric Intensive Care Unit
PIP:
Peak Inspiratory Pressure
PLEDS:
Periodic Lateralized Epileptiform Discharges
PO:
Per Oral
PPE:
Personal Protective Equipment
PPHN:
Persistent Pulmonary Hypertension of Newborn
PPV:
Positive Pressure Ventilation
PR:
Per Rectal
PRBC:
Packed Red Blood Cells
PRP:
Platelet Rich Plasma
PT:
Prothrombin Time
PTH:
Parathyroid Hormone
PTT:
Partial Thromboplastin Time
PVH:
Pulmonary Venous Hypertension
RBS:
Random Blood Sugar
RDA:
Recommended Daily Allowance
RDS:
Respiratory Distress Syndrome
RDT:
Rapid Diagnostic Test
RFT:
Renal Function Test
RHD:
Rheumatic Heart Disease
RL:
Ringer Lactate
RNTCP:
Revised National Tuberculosis Control Program
Rpt:
Repeat
RR:
Respiratory Rate
RSI:
Rapid Sequence Intubation
RTA:
Renal Tubular Acidosis
SABA:
Short Acting Beta Agonist
SAM:
Severe Acute Malnutrition
SBP:
Systolic Blood Pressure
SC:
Sub cutaneous
Sch:
Succinylcholine
SE:
Serum Electrolytes
SGA:
Small for Gestational Age
SIADH:
Syndrome of Inappropriate ADH Secretion
SL:
Sublingual
SLP:
Serum Lipid Profile
SND:
Sinus Node Dysfunction
SpO2:
Peripheral Capillary Oxygen Saturation
Sq Ft:
Square Foot
SR:
Sustained Release
SRUS:
Solitary Rectal Ulcer Syndrome
SVO2:
Superior Venacaval Oxygen
SVT:
Supraventricular Tachycardia
TA:
Tricuspid Atresia
TBW:
Total Body Water
TFT:
Thyroid Function Test
TGA:
Transposition of Great Arteries
Ti:
Inspiratory Time
TOF:
Tetralogy of Fallot
TPN:
Total Parenteral Nutrition
TTN:
Transient Tachypnea of Newborn
TTP:
Thrombotic Thrombocytopenic Purpura
U:
Unit
URT:
Upper Respiratory Tract
USG:
Ultra SonoGram
VAD:
Ventricular Assist Device
VBG:
Venous Blood Gas
VF:
Ventricular Fibrillation
VLBW:
Very Low Birth Weight
VSD:
Ventricular Septal Defect
VT:
Ventricular Tachycardia
VUR:
Vesicoureteric Reflux
VZIG:
Varicella Zoster Immuneglobulin
WBCT:
Whole Blood Clotting Time
WBT:
Whole Blood Transfusion
WHO:
World Health Organization
WK:
Week/Weeks
WOB:
Work of Breathing
WPW:
Wolf Parkinson White
Yr:
Year