Practice Based Learning: VTE Prophylaxis in Pediatric Covid-19 infection and in MIS-C patients

Saleem   Presented by Nabil Saleem, MD (PGY-1)

Hospital / ED Course

  • In ED, noted to have increased WOB, CXR showing PNA, placed on 2L O2, Ampicillin started, workup: Covid PCR, CBC/diff, CMP, CRP, ESR, blood cx, troponin, BNP, DIC screen, Ferritin, U/A, EKG
    • Covid returned positive, CBC once on floor notable for PLT 143, anemia to 12.5, leukopenia of 2.72
    • ESR 17, CRP 9.0
    • DIC panel notable for DDIMER 322 (normal = 220 ng/mL), Fibrinogen 469 (normal = 200-400 mg/dL), normal PT and APTT
    • CMP on floor notable for albumin 2.8, ALT 37,
    • Ferritin 215
    • Normal cardiac enzymes, U/A, EKG

MIS-C Inclusion Criteria

MIS-C inclusion criteria

Clinical Question:

Would you give this patient VTE Prophylaxis, what kind, and why? Continue reading

Urticaria Multiforme

Kara N Shah, Paul J Honig, Albert C Yan. “Urticaria multiforme”: a case series and review of acute annular urticarial hypersensitivity syndromes in childrenPediatrics. 2007 May;119(5):e1177-83. doi: 10.1542/peds.2006-1553. PMID: 17470565

“The diagnosis is typically made on clinical grounds and should not require skin biopsy. The individual lesions of urticaria multiforme, like typical lesions of urticaria, are evanescent, initially appearing as small urticarial macules, papules, or plaques, but they expand
rapidly to form annular, arcuate, and polycyclic wheals that subsequently fade within hours. Centrally, lesions may display either central clearing or a dusky, ecchymotic, hemorrhagic hue, which has been reported to occur more commonly in infants with acute urticaria (up
to 49% of infants aged 1–36 months).4–6 This dusky hemorrhagic hue resembles ecchymosis or purpura but rapidly resolves with antihistamine or systemic corticosteroid therapy. Associated angioedema of the face, hands, and feet represents subcutaneous vascular leak with resultant dermal edema and has been reported to occur in 37% to 60% of patients with acute urticaria. This angioedema is self-limiting and has not been associated with laryngoedema.4–6 In our series, the presence of facial and/or acral edema was common and was documented in more than two thirds (72%) of the patients. Pruritus is also commonly seen in urticaria, with a reported prevalence of 60% to 89%, although excoriations are uncommon.4,5 Pruritus was an almost universal finding associated with urticaria multiforme that was seen in 94% of the patients in this study. Fever was much less
common and was seen in only 44% of the patients in this study.” Continue reading

Practice Based Learning: Accuracy of Pulse Oximetry

Zach West   Presented by Zachary West, MD (PGY-1)

Clinical Question:

How accurate are pulse oximeters in children?

  • Increasingly more kids with lower oxygen levels
  • Especially in kids with cyanotic congenital heart disease

Continue reading

Zach West   Presented by Zachary West, MD (PGY-1)

Clinical Question:

How accurate are pulse oximeters in children?

  • Increasingly more kids with lower oxygen levels
  • Especially in kids with cyanotic congenital heart disease

Continue reading