Cases in Pediatric Acute Care

Strengthening Clinical Decision Making

Andrea Kline-Tilford, Catherine Haut, Andrea Kline-Tilford, Catherine Haut

• Publisher: Wiley-Blackwell
• Year: 2020
• ISBN:
  9781119568216
• Edition: 1
• Topic: Medizin
• Subtopic: Pedriatische Krankenpflege

Cases in Pediatric Acute Care presents over 100 real-world pediatric acute care cases, each including a brief patient history, a detailed history of present illness, presenting signs and symptoms, vital signs, and physical examination findings. Ideal for developing a systematic approach to diagnosis, evaluation, and treatment, this resource provides students and advanced practitioners with the tools required to deliver comprehensive care to acute, chronic and critically ill children. The cases encompass a wide range of body systems, medical scenarios, professional issues and general pediatric concerns, and feature laboratory data, radiographic images and information on case study progression and resolution.

• Develops the essential skills necessary to provide the best possible pediatric acute care
• Discusses the most appropriate differential diagnoses, diagnostic evaluation, and management plans for each case
• Presents cases related to pulmonary, cardiac, neurologic, endocrine, metabolic, musculoskeletal, and other body systems
• Highlights key points in each case to quickly identify critical information

Cases in Pediatric Acute Care is an excellent resource for advanced practice provider students and pediatric healthcare providers managing acutely ill children.

1
Complication of Pneumonia

Ji‐Yeon Kim

Children’s Hospital of Michigan, Detroit, MI, USA

A 2‐year‐old previously healthy female is admitted to the pediatric intensive care unit (PICU) with tachypnea, grunting, and nasal flaring. She is hypoxic despite receiving supplemental oxygen with a high‐flow nasal cannula (HFNC) at 12 L/min and FiO₂ 0.7.

History of Present Illness

This is a 2‐year‐old female with no significant past medical history who presented with 2 days of fever, cough, and difficulty breathing. Her mother reports that for the past 2 weeks the patient has had intermittent low‐grade fever with cough. Difficulty breathing started 2 days ago with fever of 40°C (104°F). She has been eating and drinking less and having decreased wet diapers. She has been in close contact with her older brother who has also had symptoms of cough, rhinorrhea, and congestion. Her parents decided to bring her to the emergency department (ED) when her fever did not defervesce with acetaminophen and she continued to have difficulty breathing.

Past Medical History

The patient was born at 39 weeks gestational age. Family denies history of hospitalizations or outpatient visits for illness. Immunizations are up‐to‐date for age, but she has not received the influenza vaccine this year.

Past Surgical History

Family denies any previous surgical procedures.

Family History

Parents are healthy. There is a 6‐year‐old sibling who had a cold and fever about a week ago. Grandparents are alive and well. Paternal grandmother has a history of breast cancer. Denies family history of asthma or allergies.

Current Status

On arrival in the ED, the patient is noted to have difficulty breathing, with grunting and nasal flaring. She is tachycardic, with heart rate of 160 bpm, and tachypneic, with respiratory rate of 56 breaths per minute. On examination the patient has diminished breath sounds over the left lung field. The patient is placed on 50% oxygen using HFNC at 8 L/min but remains hypoxic with pulse oximeter reading of 90% saturation. A basic metabolic panel and complete blood count are obtained with values as noted in Tables 1.1 and 1.2. The chest X‐ray is shown in Figure 1.1.

Questions

Answer the following questions using the details provided.

1. What are the pathologic findings on the X‐ray?
2. What are the most common pathogens causing pneumonia in infants and children?
3. What are the recommended anti...