Pediatric Fever without focus Management

Terrible T's: cyanoisis

 Tetrology of Falot

a congenital heart defect which is classically understood to involve four anatomical abnormalities (although only three of them are always present). It is the most common cyanotic heart defect, and the most common cause of blue baby syndrome.


Tricuspid Atresia

Tricuspid fails to form (unopened).  No blood flow from RA to RV.  Tiny RV.  Blood instead shunts across Foramen Ovale or ASD into Pulmonary Arterial system for oxygenation.

Salter Harris

SALTER mnemonic for classification

The mnemonic "SALTR" can be used to help remember the first five types.  This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.

• I - S = Same (or Straight across). Fracture of the cartilage of the physis (growth plate)
• II - A = Above. The fracture lies above the physis, METAPHYSIS. (MOST FREQUENT 75%)
• III - L = Lower. The fracture is below the physis in the epiphysis.
• IV - T = Through. The fracture is through the metaphysis, physis, and epiphysis.
• V - R = Rammed (crushed). The physis has been crushed. (May dx on mechanism alone)

Pediatric Fever

Historically, children aged 3 months to 3 years with rectal temperatures of 38.5^o C (101.3 F) or higher had a risk of 2-4% for occult bacteremia.^{[1, 2]} The leading cause of bloodstream infection was S pneumoniae, followed by H influenzae type b. With the introduction of effective vaccines for these pathogens, the incidence and epidemiology of childhood bacteremia in the immunologically normal host has changed.
The incidence of occult bacteremia in this population now ranges from 0.5-1%; moreover, 2 out of every 3 blood isolates from these children represent an artifact (contamination) and not a true pathogen.^[3]S pneumoniae and E coli are the most common pathogens, accounting for two thirds of cases. In infants with S pneumoniae, many isolates are strains not covered by the currently available heptavalent conjugate vaccine.

Who do we need to get cath urine on???

Urine Cath Specimen: (from Boston Criteria for fever without focus)

< 6 month old males circumcised
<12 month old males uncircumcised
<24 month old females

Bulging Fissure

Associated with Klebsiella Pneumonia:

Oxygen Dissociation Curve

http://en.wikipedia.org/wiki/Oxygen%E2%80%93haemoglobin_dissociation_curve

The causes of shift to right can be remembered using the mnemonic, "CADET, face Right!" for CO2, Acid, 2,3-DPG, Exercise and Temperature.^[1] Factors that move the oxygen dissociation curve to the right are those physiological states where tissues need more oxygen. For example during exercise, muscles have a higher metabolic rate, and consequently need more oxygen, produce more carbon dioxide and lactic acid, and their temperature rises.

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CADET, face Right!

• CO2  
• Acid
• 2,3-DPG(aka 2,3-BPG)
• Exercise
• Temperature

Asbestosis

Background

Pneumoconiosis is the general term for lung disease caused by inhalation and deposition of mineral dust.

Pneumoconiosis caused by asbestos inhalation is called asbestosis. The word asbestos is derived from Greek and means inextinguishable, and asbestos is a group of naturally occurring, heat-resistant fibrous silicates. Asbestos fibers are long and thin (length-to-diameter ratio >3) and may be either curved or straight. The curved fibers are called serpentine (chrysotile is the prime example), and the straight fibers are amphiboles. Several different types of amphiboles (ie, amosite, anthophyllite, tremolite, actinolite, crocidolite) have been recognized. Chrysotile is by far the most common type of asbestos fiber produced in the world and accounts for virtually all asbestos used commercially in the United States.
Production and use of asbestos increased greatly between 1877 and 1967. In the 1930s and 1940s, scientists recognized a causal link between asbestos exposure and asbestosis. In the 1950s and 1960s, researchers established asbestos as a predisposing factor for bronchogenic carcinoma and malignant mesothelioma.

Note the image below.
Asbestos pleural plaques. 

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Causes

In modern times, the risk to persons in the United States occurs mainly through the processing, manufacturing, and end-use of asbestos.
Manufacturers commonly use asbestos in the following products:

• Products containing asbestos cement - Pipes, shingles, clapboards, sheets
• Vinyl-asbestos floor tiles
• Asbestos paper in filtering and insulating products
• Material in brake linings and clutch facings
• Textile products - Yarn, felt, tape, cord, rope
• Spray products used for acoustical, thermal, and fireproofing purposes

Examples of occupations associated with asbestosis include the following:

• Insulation workers
• Boilermakers
• Pipefitters
• Plumbers
• Steamfitters
• Welders
• Janitors
   Imaging
  
  Case 1. Postero-anterior (PA) chest radiograph in a 58-year-old man with a history of occupational exposure to asbestos shows right diaphragmatic pleural plaque calcifications, linear calcification along the left pericardium, and bilateral pleural plaques along upper ribs. 
  
   Case 4. The soft-tissue window setting of this chest computed tomography (CT) scan shows the envelope-like mass along the pleural surface surrounding the lung. This was a mesothelioma.

  Pleural calcification

  On chest radiographs, the prevalence of calcification in pleural plaques is reported to be 10-15%. In profile, calcified plaques appear as opaque lines that lie parallel to the chest wall, mediastinum, pericardium, and diaphragm. Viewed en face, calcified plaques are seen as irregular, heterogeneous densities, the so-called holly leaf. The presence of bilateral, superior diaphragmatic surface calcifications with clear costophrenic angles is virtually pathognomonic for asbestos-related pleural disease. (See the image below.)
  Case 1. Postero-anterior (PA) chest radiograph in a 58-year-old man with a history of occupational exposure to asbestos shows right diaphragmatic pleural plaque calcifications, linear calcification along the left pericardium, and bilateral pleural plaques along upper ribs.