Beef with the Chiefs

Systemic infections – Dr Robin Lund

• Rocky mountain spotted fever
  • Highest mortality in children, males, most common in Midwest
  • Treatment – doxycycline
• Kawasaki Disease
  • CRASH symptoms
  • Kawasaki Disease Shock Syndrome
  • Treatment – IVIG, ASA
  • KD vs MISC
    • MISC more GI symptoms, usually older kids, higher inflammatory markers
• Meningits
  • Most likely in neonates – GBS
  • Most likely in other peds – Strep pneumo
  • Classic signs/symptoms
    • HA, fever, AMS, paradoxical irritability
  • Cannot exclude meningitis based on labs, CSF
  • Treatment – Abx, steroids
• Osteoarticular infections
  • Septic arthritis
    • More common in males, < 20 yo
    • Typically hematogenous spread
    • Erythema, edema, tenderness
  • Acute hematogenous osteomyelitis
    • More commonly in metaphysis
  • Typical pathogens – Staph, GABHS, S pneumo
  • Workup – Joint tap, blood cultures
  • Treatment – Abx

Acetaminophen Toxicity – Justin Arnold

• Acetaminophen in multiple combination drugs
• Adult dosing
  • Immediate release 325mg
  • Extra strength 500mg
  • Arthritis 650mg
  • Max 4g/day, 2.5g/day in liver failure patients
• MOA: don’t really know
  • Inhibition of COX, PGs
  • Reduction in pain signaling
• Single toxic dose – in a 24 hour period
  • Adults: 7.5g
  • Pediatrics: 150mg/kg
• 4 stages of toxicity
  • Stage 1 – Asx/mild symptoms (day 1)
  • Stage 2 – Liver toxicity (day 2,3)
  • Stage 3 – Liver failure (day 3,4)
  • Stage 4 – Recovery (day 4-10)
• Treatment – NAC
  • Goal to administer within 8 hours of ingestion
  • Possible anaphylactoid reactions
    • Most likely during 1 hour load
    • Treat as you would with anaphylaxis
    • Start again at half the rate
• Diagnosis
  • Need a tylenol level on every ingestion patient
  • Rumack-Matthew Nomogram
  • King’s College Criteria for prognosis/transplant need