Important knowledge

⚡️when you hear rhonchi by stethoscope give nebulizer for patient (with exceptions مو كل مريض يفيدة ) ▪︎rhonchi (wheezing ) = give nebulizer

⚡️Golden standard from dr.wasnah --------------------- Give 1CC Kcl for each 100cc fluid [ 5cc for pint ] (100cc fluid = add 1cc kcl ) ملاحظة مهمة جدن (بالنون) Except in DKA give 2cc for each 100cc fluid [10cc for pint] (100cc fluid =add 2cc kcl ) ▪︎cc = ml

⚡️we not give the full maintenance dose of fluid in this cases ▪︎chest infection ▪︎CNS infection ▪︎nephrotic syndrome We give 1/2 or 2/3 of the dose only

⚡️normal saline is used only for rehydration (as shoot)

⚡️بحالات ال S.O.B اذا ال Respiratory rate اعلى من الطبيعي (tachypnic ) نوقف ال feeding ونعلك fluid للطفل لانه ال rapid breathing ممكن يدخلنا ب aspiration pneumonia

⚡️Treatment of pertussis is 5 days azithromycin : ▪︎ either 10mg/kg first day then 5mg/kg for 4 days ▪︎ or 5mg/kg for 5 days 🔸️We should give prophylaxis[ azithromycin or Erythromycin ] to mother's and other children in the house

⚡️S.O.B + cynosis/apnia + absolute lymphocytosis think about pertussis

⚡️اهل ال CP يكون عدهم poor swallowing لذلك يصير عدهم feeding deficulty ويصير عدهم recurrent aspiration

⚡️Important vaccines in case of S.O.B is : ▪︎streptococcal pneumonia ▪︎hemophilus influenza ▪︎influenza vaccine ▪︎DTaP ▪︎Meningococcal vaccine (not all patients)

⚡️Signs of severity in S.O.B د.وسناء --------------------------- 1) Cynosis 2) disturbed level of conscious 3) lethargy (poor activity) 4) poor feeding 5) poor sleep

Gasping breathing *Important

⚡️Liver span of liver in paediatric age group is 6-8cm while in neonate >5cm is considered enlarged

⚡️spleen in neonate is descending inferiorly ( not diagonaly as adult)

⚡️If you found supraclavicular with epicondyler lymphadenopathy you should exclude malignancy

⚡️when you palpate pulsatile anterior fontanel put your stethoscope on A. Fontanel for bruit to exclude AV malformation.

⚡️Signs of dyspnia according to severity (from up to down) : -------------------------- ▪︎nasal flaring ▪︎subcostal retraction ▪︎intercostal retraction ▪︎suprasternal retraction ▪︎supraclavicular retraction ▪︎grunting (expiratory sound due to expiration against partially closed epiglottis ) ▪︎cynosis

⚡️ ال growth chart ميصير نطبقة لطفل ال GA مالته اقل من 35w ( لان الباراميترز مالته كلها راح تطلع قليلة )

⚡️شلون نحسب fluid لمريض ال hypo glycemia? ▪︎Symptomatic = 4ml/Kg bolus ▪︎ Asymptomatic= 2ml/kg bolus ----------------------------------- 🔸️maintenance = 6-8 mg /kg /min.

⚡️hypoglycemia in neonate is <45mg/dl (45 or more is not hypoglycemia) except first day <30