Day 2 Emergency Pediatric Department

Patient 1- Mastoiditis
Cause: Nasal flora spread to mastoid region
Clinical: Increased ESR, fever
Treat: Peperacillin -4th generation broad spectrum penicillin against pseudomonas. Ear drainage and suction out pus.

Note: first comes the increased ESR and fever and later comes the abscess...so diagnosis may sometimes have to wait until the abscess is formed.

Patient 2: girl with sever headache and hyperactive knee reflex.
action: give CT scan because of the reflexes. If nothing on CT, do LP

Patient 3: Transient synovitis
DD: infectious cellulitis, septic arthritis
Clinical: limp, increased ESR,CRP,
Test: puncture the hip to extract synovial fluid, test for bacterial growth (serious if in hip). puncture location-2 fingers distal to artery and ligament at a 45 degree angle.
fluid not cloudy or runny- no indication of bacteria-post viral is possible.

Patient 4- 2 wks old VSD,ASD, AV Canal.
Clinical:enlarged heart x-ray, increased vascularity, hepatomegaly, dyspnea.
Diagnosed with echo
Treat with Digoxin until 6 kilo gained and operate