By Charles Pohl, Kathleen Bradford, Clara Callahan, J. Carlton Gartner
I. On-Call Problems
II. Laboratory Tests
III. Bedside Procedures
IV. Fluids and Electrolytes
V. dietary administration of the Pediatric Patient
VI. Blood part Therapy
VII. Ventilator Management
VIII. administration of Perioperative Complications
IX. known Medications
Appendix
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Extra resources for PEDIATRICS ON CALL
Sample text
E. Has patient had this pain before? Functional abdominal pain is most likely to be recurrent. However, volvulus and even appendicitis may be self-limited on several occasions and then recur with full-blown manifestations. 2. ABDOMINAL PAIN 7 F. Are there associated GI symptoms? Individuals with significant intra-abdominal pathology are rarely hungry. Nausea, vomiting, and a change in bowel habits often accompany GI conditions such as gastroenteritis, appendicitis, and intestinal obstruction. Bilious vomiting is indicative of obstruction and possibly volvulus.
Glucose is elevated in diabetic patients whose abdominal pain is associated with ketoacidosis. 3. Bilirubin, AST, ALT, alkaline phosphatase. Elevated in hepatobiliary disease. 4. Amylase, lipase. Elevated in pancreatitis (lipase is more specific). 2. ABDOMINAL PAIN 11 5. Urinalysis and culture. UTIs are associated with WBCs in urine and a positive culture; calculi produce hematuria. ) Urine sediment is often abnormal in Henoch-Schönlein purpura. 6. -HCG. Exclude ectopic pregnancy in postpubertal girls with lower abdominal pain.
AG may not reflect an underlying acidosis in a 3. 5). In these circumstances, albumin is more negatively charged, which increases unmeasured anions. III. Differential Diagnosis. In acutely ill patients, metabolic and respiratory acidosis commonly coexist. A. Respiratory Acidosis. There are many possible causes of respiratory acidosis, including airway obstruction (foreign bodies, tongue displacement, laryngospasm, congenital malformations or airway malacia, severe bronchospasm), respiratory center depression (general anesthesia, sedatives, narcotics, CNS injury or ischemia, drugs or toxins, and electrolyte disorders), increased CO2 production (sepsis, seizures, malignant hyperthermia, shivering, hypermetabolic states, overfeeding with TPN), neuromuscular diseases (spinal cord injuries, Guillain-Barré syndrome, myasthenia gravis, polymyositis, spinal muscular atrophy, muscular dystrophy, infantile botulism), intrinsic pulmonary disease (obstructive and restrictive conditions such as in chondrodystrophies, acute lung injury, acute respiratory distress syndrome [ARDS], pulmonary edema), extrinsic pulmonary disease (hemothorax, pneumothorax, flail chest, pleural effusions, obesity), and issues related to mechanical ventilation (obstructed endotracheal tube, inadequate ventilatory support, permissive hypercapnia).