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🏥 HIGH-YIELD PEDIATRICS — END ROTATION EXAM OVERVIEW

Harish | 4th Year Clerkship Review | April 2026

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📋 TABLE OF CONTENTS

1. Pediatric Resuscitation & Emergency
2. Neonatology / NICU
3. Cardiology
4. Pulmonology / Respiratory
5. Gastroenterology / Nutrition
6. Nephrology
7. Hematology / Oncology
8. Infectious Disease
9. Neurology
10. Endocrinology
11. Development & Growth
12. PICU Essentials
13. Key Numbers to Memorize

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1. PEDIATRIC RESUSCITATION & EMERGENCY

Pediatric CPR (C-A-B)

⚠️ Pediatric arrest is asphyxial (airway first!) vs adult (cardiac). Ventilation is fundamental.

• Infants: 1 fingerbreadth below intermammary line (2-thumb encircling preferred)
• Children: Lower half of sternum
• Adolescents: Lower half of sternum

Shock Recognition

• Bradycardia <60 bpm with poor perfusion → Start CPR immediately
• Tachycardia >220 bpm → Pathologic tachyarrhythmia
• BP: Hypotension is a late sign in children
• Cap refill >2s = delayed | <1s = "flash" (warm shock)
• Pallor, mottling, cyanosis = poor perfusion

Shockable vs Non-Shockable Rhythms

Epinephrine

• Dose: 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000) every 3–5 minutes
• Endotracheal route: 0.1 mg/kg (10× the IV dose)

Anaphylaxis

• Epinephrine IM (anterolateral thigh): 0.01 mg/kg of 1:1000, max 0.5 mg
• Adjuncts: Diphenhydramine, H2 blocker, steroids — but epinephrine is first-line

Hypoglycemia (Pediatric Emergency)

• Neonate: glucose <40–45 mg/dL
• D10W 2 mL/kg IV bolus (neonates) | D25W 2–4 mL/kg (children) | D50W (adolescents)

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2. NEONATOLOGY / NICU

Gestational Age Classification

Neonatal Resuscitation (NRP) — SBAR

1. Stimulate (dry, warm, reposition airway)
2. Oxygen (free-flow if SpO2 low)
3. PPV (if HR <100 or apnea) — rate 40–60/min
4. Chest compressions if HR <60 despite 30s effective PPV — 3:1 ratio (compressions:breaths)
5. Epinephrine 0.01–0.03 mg/kg IV if HR <60 despite above

• 7–10 = Normal | 4–6 = Moderate depression | 0–3 = Severe depression

Respiratory Distress Syndrome (RDS) / Hyaline Membrane Disease

• Cause: Surfactant deficiency — premature infants
• Surfactant produced by Type II pneumocytes from ~24 weeks (mature by 35 weeks)
• CXR: Ground-glass appearance, air bronchograms, low lung volumes
• Rx: Antenatal steroids (betamethasone 2 doses IM), postnatal surfactant (poractant alfa/beractant), oxygen support/CPAP/ventilation
• L/S ratio >2 = lung maturity

Transient Tachypnea of Newborn (TTN)

• Retained fetal lung fluid — term/near-term, C-section births
• Self-limiting, resolves within 12–72 hrs
• CXR: Perihilar streaking, fluid in fissures

Meconium Aspiration Syndrome (MAS)

• Post-term infants; meconium in amniotic fluid
• Causes: Airway obstruction + surfactant inactivation + chemical pneumonitis
• CXR: Hyperinflation, patchy infiltrates, air leak
• Rx: Suctioning, O2, surfactant, ECMO if severe

Neonatal Jaundice (Hyperbilirubinemia)

• Phototherapy: Converts unconjugated bili to water-soluble isomers
• Exchange transfusion: Severe hyperbilirubinemia / Hydrops

Hypoxic-Ischemic Encephalopathy (HIE)

• 3 grades (Sarnat): Mild (irritability) → Moderate (seizures, abnormal tone) → Severe (coma)
• Therapeutic hypothermia (cooling to 33.5°C for 72h) — for ≥36 weeks GA, within 6 hours of birth
• Monitors: aEEG, EEG; treat seizures with phenobarbital

Neonatal Sepsis

Necrotizing Enterocolitis (NEC)

• Preterm infants (most common GI emergency in preterm)
• Triad: Feeding intolerance + abdominal distension + bloody stools
• CXR: Pneumatosis intestinalis (pathognomonic) → Portal venous gas → Free air (perforation)
• Bell Staging: I (suspect), II (confirmed), III (advanced — surgery)
• Rx: NPO, NGT, IV antibiotics, surgery if perforation

Patent Ductus Arteriosus (PDA)

• Failure of ductus arteriosus to close after birth
• L→R shunt → pulmonary overcirculation
• Signs: Bounding pulses, wide pulse pressure, continuous "machine-like" murmur
• Rx (preterm): Indomethacin or Ibuprofen (COX inhibitors); surgical ligation if medical fails
• Spontaneous closure common in term infants

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3. CARDIOLOGY

Congenital Heart Disease (CHD)

PGE1 (Prostaglandin E1): Keep ductus open for ductal-dependent lesions (HLHS, TGA, severe pulm stenosis, coarctation)

Tet Spells (Hypercyanotic Episodes)

• Precipitants: Crying, feeding, fever
• Management: Knee-to-chest/squatting position, O2, morphine, IV fluids, phenylephrine, propranolol
• Mechanism: Infundibular spasm → ↑R→L shunt

Kawasaki Disease

1. Conjunctivitis (bilateral, non-purulent)
2. Rash (polymorphous)
3. Adenopathy (cervical, unilateral, >1.5 cm)
4. Strawberry tongue / oral changes
5. Hands/feet (erythema, desquamation in subacute phase)

• Most feared complication: Coronary artery aneurysm (25% untreated)
• Rx: IVIG (2g/kg single dose) + high-dose Aspirin → once afebrile, low-dose aspirin
• Echocardiogram at diagnosis, 2 weeks, 6–8 weeks

Rheumatic Fever (Jones Criteria)

• Carditis (pancarditis — most serious, mitral regurg most common valve)
• Polyarthritis (migratory, large joints — most common)
• Chorea (Sydenham's — involuntary movements)
• Erythema marginatum
• Subcutaneous nodules

• Rx: Penicillin (treat strep) + Aspirin (arthritis/carditis) + Steroids if severe carditis
• Secondary prophylaxis: Penicillin G benzathine monthly IM (duration depends on carditis presence)

MIS-C (Multisystem Inflammatory Syndrome in Children)

• Post-COVID-19 inflammatory syndrome
• Cardiac dysfunction in 35–100% — monitor BNP, troponin, ECG, echocardiogram
• 1st-degree AV block in ~20%
• Rx: IVIG, steroids, aspirin; follow Kawasaki-like protocols for coronary involvement

Hypertension in Children

• Definition: BP ≥95th percentile for age, sex, height on ≥3 occasions
• Stage 1: ≥95th–99th percentile + 5 mmHg
• Stage 2: >99th percentile + 5 mmHg
• Most common cause in children: Renovascular (secondary)

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4. PULMONOLOGY / RESPIRATORY

Asthma

1. SABA (salbutamol/albuterol) — first-line
2. Ipratropium bromide (add in moderate-severe)
3. Systemic corticosteroids (IV methylprednisolone or oral prednisolone)
4. Magnesium sulfate IV (severe, refractory)
5. Heliox, IV terbutaline, intubation (life-threatening)

Bronchiolitis

• Most common: RSV (also parainfluenza, rhinovirus, hMPV)
• Age: Typically <2 years (peak 2–6 months)
• Signs: Wheezing, tachypnea, subcostal retractions, crackles
• Rx: Supportive only — O2, IV/NG fluids; NO bronchodilators (not recommended routinely), NO steroids
• Prevention: Palivizumab (anti-RSV monoclonal Ab) for high-risk preterm (<29wk) and CHD

Croup (Laryngotracheobronchitis)

• Parainfluenza virus (type 1 most common)
• Age: 6 months–3 years; Fall/winter
• Signs: Barking cough, stridor (inspiratory), hoarseness, "steeple sign" on AP neck CXR
• Rx: Oral/IM dexamethasone (single dose); nebulized racemic epinephrine for moderate-severe

Epiglottitis

• Classic: H. influenzae type b (Hib); now rare with vaccination; also Staph aureus
• Age: 2–7 years
• Signs: High fever, "toxic" appearance, drooling, tripod position, muffled "hot potato" voice, "thumb sign" on lateral neck CXR
• ⚠️ DO NOT examine throat → risk of laryngospasm
• Rx: Airway management first (intubation in OR); IV ceftriaxone/cefuroxime

Cystic Fibrosis

• CFTR gene (chromosome 7q) — most common mutation: ΔF508
• Autosomal recessive
• Newborn screen: Immunoreactive trypsinogen (IRT); confirm with sweat chloride >60 mEq/L
• Features: Recurrent pulmonary infections (Pseudomonas, Staph aureus, Burkholderia cepacia), bronchiectasis, pancreatic exocrine insufficiency, meconium ileus at birth, male infertility (bilateral absent vas deferens)
• Rx: Chest physiotherapy, DNase (dornase alfa), CFTR modulators (ivacaftor, elexacaftor/tezacaftor/ivacaftor — Trikafta)

Foreign Body Aspiration

• Peak age: 1–3 years
• Right main bronchus more common (more vertical)
• Vegetable matter (peanuts) most common
• CXR: Expiratory film — air trapping/hyperinflation on affected side
• Rx: Rigid bronchoscopy

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5. GASTROENTEROLOGY / NUTRITION

Pyloric Stenosis

• Age: 2–8 weeks; males > females (4:1); first-born males
• Signs: Projectile non-bilious vomiting after feeds, olive-shaped mass (RUQ), hypochloremic hypokalemic metabolic alkalosis
• Diagnosis: Ultrasound (pyloric wall thickness >4mm, channel length >16mm)
• Rx: Correct electrolytes FIRST, then Ramstedt pyloromyotomy

Intussusception

• Age: 3 months–3 years (peak 6–12 months); males > females
• Most common site: Ileocolic
• Classic triad: Colicky pain + currant jelly stools + sausage-shaped mass (RUQ)
• Diagnosis: US (target sign); contrast enema (diagnostic + therapeutic)
• Rx: Air/contrast enema (1st line); surgery if failed/peritonitis/perforation
• Lead point in children >2 yrs: Meckel's, polyp, lymphoma

Malrotation & Volvulus

• Age: Usually presents in 1st month of life
• Signs: Bilious vomiting in neonate = surgical emergency until proven otherwise
• UGI contrast: Malposition of DJ junction ("corkscrew" appearance)
• Rx: Emergency surgery (Ladd's procedure)

Hirschsprung Disease (Congenital Aganglionic Megacolon)

• Absent ganglion cells in rectum (extends proximally)
• Presents as: Failure to pass meconium within 48h, abdominal distension, bilious vomiting
• Dx: Rectal suction biopsy (absent ganglion cells, hypertrophied nerve bundles) — gold standard
• Barium enema: Transition zone (narrow aganglionic segment → dilated proximal)
• Rx: Surgical pull-through

GERD in Infants

• Physiologic regurgitation vs pathologic GERD
• Pathologic: Poor weight gain, arching, irritability, esophagitis, apnea
• Rx: Positioning, thickened feeds, trial of H2 blocker/PPI for severe cases

Celiac Disease

• Gluten-sensitive enteropathy (wheat, rye, barley)
• Screening: Anti-tissue transglutaminase IgA (anti-tTG IgA) — most sensitive
• Confirm: Duodenal biopsy (villous atrophy, crypt hyperplasia, ↑intraepithelial lymphocytes)
• HLA: HLA-DQ2 (90%) or HLA-DQ8
• Rx: Strict gluten-free diet

Dehydration Management

• Mild-moderate: ORS 50–100 mL/kg over 3–4h
• Severe: IV normal saline 20 mL/kg bolus

Nutrition

• Breast milk: Best for all infants; contains secretory IgA, lactoferrin, lysozyme
• WHO recommends exclusive breastfeeding ×6 months
• Vitamin D supplementation: All breastfed infants (400 IU/day from birth)
• Iron supplementation: Preterm infants from 1 month (2 mg/kg/day)
• Introduction of solids: ~6 months

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6. NEPHROLOGY

Urinary Tract Infection (UTI)

• Most common organism: E. coli
• Infants: Non-specific symptoms (fever, poor feeding, irritability)
• Older children: Dysuria, frequency, urgency, flank pain (pyelonephritis)
• Diagnosis: Urine culture from catheterized specimen (gold standard)
• Rx: Age/severity-dependent — TMP-SMX or amoxicillin-clavulanate; IV ceftriaxone for sepsis
• Imaging: VCUG for recurrent UTI (vesicoureteral reflux grading I–V)

Nephrotic Syndrome

• 4th feature: Hyperlipidemia + lipiduria
• Rx: Prednisolone (2 mg/kg/day); complications — infection (encapsulated bacteria — pneumococcus), thrombosis, hyperlipidemia

Nephritic Syndrome

Acute Kidney Injury (AKI)

• Pre-renal: BUN/Cr >20, FeNa <1%, responds to fluids
• Intrinsic renal: FeNa >2%, muddy brown casts (ATN)
• Post-renal: Hydronephrosis on US

Hemolytic Uremic Syndrome (HUS)

• Triad: Microangiopathic hemolytic anemia + Thrombocytopenia + AKI
• Classic cause: E. coli O157:H7 (STEC) — bloody diarrhea → HUS
• Rx: Supportive; NO antibiotics (↑toxin release); dialysis if needed

Vesicoureteral Reflux (VUR)

• Grading I–V (I: into ureter only → V: gross reflux with calyceal dilation)
• Rx: Low-grade (I–II) = prophylactic antibiotics; high-grade (IV–V) = surgical correction

Chronic Kidney Disease (CKD) in Children

• <5 years: Congenital anomalies of kidney and urinary tract (CAKUT) most common
• Older children: Acquired glomerular diseases
• Complications: Anemia (↓EPO) → ESA; Mineral bone disease → phosphate binders, vitamin D
• Dialysis indications: Intractable acidosis, K+ >6.5, volume overload, uremia (BUN >150), dialyzable toxins

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7. HEMATOLOGY / ONCOLOGY

Anemia

Sickle Cell Disease — High Yield

• Vasoocclusive crisis: Most common presentation; bone pain; precipitated by cold, dehydration, infection
• Acute chest syndrome: Fever + pulmonary infiltrate + chest pain; Rx: O2, exchange transfusion, IV fluids, antibiotics
• Splenic sequestration: Sudden splenomegaly + drop in Hb + hypovolemia (young child, 1st crisis)
• Aplastic crisis: Parvovirus B19 → sudden drop in Hb, no reticulocytes
• Stroke: Transcranial Doppler (TCD) screening annually; chronic transfusion program prevents recurrence
• Functional asplenia: Vaccinate against encapsulated organisms (Pneumococcus, Hib, Meningococcus); penicillin prophylaxis from 2 months until 5 years
• Hydroxyurea: Increases HbF, reduces crises

ITP (Immune Thrombocytopenia)

• Healthy child, sudden bruising/petechiae after viral illness or vaccination
• Platelet count <100,000/μL; large platelets on smear; normal WBC and RBC
• Dx: Clinical (exclude other causes); bone marrow only if systemic symptoms/other cytopenias
• Rx:
  • Mild (>30k, no significant bleeding): Observe
  • Moderate-severe: IVIG (1g/kg × 1–2 days) or IV anti-D (Rho+ patients) or steroids (prednisolone 2 mg/kg/day × 4 weeks)
  • Severe/life-threatening bleeding: IVIG + IV methylprednisolone + platelet transfusion
• Chronic ITP: Persists >12 months → rituximab, thrombopoietin receptor agonists

Leukemia (ALL — Most Common Pediatric Malignancy)

• Peak age: 2–5 years
• Signs: Pallor, petechiae/purpura, lymphadenopathy, hepatosplenomegaly, bone pain
• WBC: Variable (may be high, normal, or low); blasts on smear
• Dx: Bone marrow biopsy (>25% blasts)
• Favorable prognosis: Age 1–10, WBC <50k, hyperdiploidy, TEL-AML1 translocation
• Poor prognosis: <1y or >10y, WBC >100k, T-cell ALL, Philadelphia chromosome (t(9;22))
• Rx: Induction (vincristine, prednisone, asparaginase, daunorubicin) → consolidation → maintenance (6-MP, methotrexate)
• CNS prophylaxis: Intrathecal chemotherapy

Hemophilia

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8. INFECTIOUS DISEASE

Fever Without Source (FWS)

Bacterial Meningitis

• Neonates: GBS, E. coli, Listeria → Ampicillin + Gentamicin (or cefotaxime)
• 1–3 months: GBS + N. meningitidis + S. pneumoniae → Ampicillin + Cefotaxime/Ceftriaxone

• 3 months: N. meningitidis, S. pneumoniae → Ceftriaxone + Dexamethasone (↓hearing loss)

• CSF: ↑WBC (PMNs), ↑protein, ↓glucose, positive gram stain/culture

Meningococcemia

• N. meningitidis; non-blanching petechiae → purpura fulminans
• Emergency: IV Penicillin G / Ceftriaxone immediately
• Prophylaxis contacts: Rifampicin (2 days) or ciprofloxacin (single dose)

Common Pediatric Exanthems

Otitis Media (AOM)

• Most common: S. pneumoniae, NTHi, M. catarrhalis
• Signs: Ear pain, fever, red bulging tympanic membrane, ↓mobility
• Rx: Amoxicillin (first line) 80–90 mg/kg/day × 10 days (or 5 days if >2yr, mild)
• Penicillin allergy: Azithromycin
• Failed treatment: Amoxicillin-clavulanate

Pertussis (Whooping Cough)

• Bordetella pertussis
• 3 phases: Catarrhal (contagious) → Paroxysmal (inspiratory whoop, post-tussive vomiting) → Convalescent
• Infants: Apnea instead of whoop; most dangerous in <6 months
• Dx: PCR nasopharyngeal swab; lymphocytosis on CBC
• Rx: Azithromycin (macrolide); prophylaxis contacts

TB in Children

• Primary TB often asymptomatic; can progress to miliary TB/meningitis in infants/immunocompromised
• TST (Mantoux): Read at 48–72h; positive ≥10mm (most children), ≥5mm (immunocompromised/contact)
• IGRA (QuantiFERON): Not affected by BCG; preferred in older children
• Rx: Latent TB — Isoniazid × 9 months; Active TB — HRZE × 2 months → HR × 4 months

Parasites

• Giardia: Frothy foul-smelling stool, flatulence; Rx: Metronidazole
• Ascaris: Roundworm; most common helminth; Rx: Albendazole/mebendazole
• Pinworm (Enterobius): Perianal itching at night; Scotch tape test; Rx: Mebendazole × 2 doses (2 weeks apart)

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9. NEUROLOGY

Seizures

• Age 6 months–6 years; fever ≥38°C; no CNS infection
• Lumbar puncture: Required if <12 months, meningeal signs, or complex seizure

• Seizure >5 min OR ≥2 seizures without full recovery
• Rx algorithm:
  1. 0–5 min: ABC, IV access, glucose check
  2. 5–20 min: Lorazepam 0.1 mg/kg IV (or diazepam 0.5 mg/kg PR, midazolam 0.2 mg/kg IM)
  3. 20–40 min: Phenytoin 20 mg/kg IV (or fosphenytoin) OR levetiracetam OR valproate
  4. >40 min (refractory): Phenobarbital, propofol, thiopental (ICU + intubation)

• Absence epilepsy (Childhood): 4–8 years; staring episodes 5–10 sec; 3 Hz spike-wave on EEG; Rx: Ethosuximide (first choice) or valproate
• Juvenile Myoclonic Epilepsy (JME): Morning myoclonus + GTCS; 4–6 Hz EEG; Rx: Valproate
• West Syndrome: Infantile spasms (salaam attacks) + hypsarrhythmia on EEG; Rx: ACTH, vigabatrin

Meningitis vs Encephalitis

• HSV encephalitis: Temporal lobe involvement on MRI; Rx: IV Acyclovir (first-line)

Cerebral Palsy (CP)

• Static, non-progressive motor disorder from perinatal brain injury
• Types: Spastic (most common — UMN signs) | Athetoid/dyskinetic | Ataxic
• Associated: Intellectual disability, epilepsy, visual/hearing impairment
• Rx: Multidisciplinary; spasticity → baclofen, botulinum toxin

Neural Tube Defects

• Folic acid deficiency; prevented by supplementation (400 mcg/day pre-conception)
• Anencephaly: Lethal; absence of forebrain
• Spina bifida occulta: Defect in vertebral arch, covered by skin; asymptomatic
• Myelomeningocele: Spinal cord in sac; most severe; neurological deficits

Hydrocephalus

• Non-communicating (obstructive): Aqueductal stenosis (most common), Arnold-Chiari
• Communicating: Impaired CSF reabsorption; post-meningitis
• Signs: Bulging fontanelle, ↑head circumference, "sunset sign" (eyes deviated downward)
• Rx: VP shunt

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10. ENDOCRINOLOGY

Diabetes Mellitus

• Autoimmune destruction of β-cells (anti-GAD, anti-IA-2, anti-insulin antibodies)
• DKA presentation common at diagnosis in children
• Rx: Insulin (basal-bolus regimen)

• Triad: Hyperglycemia (>200) + Acidosis (pH <7.3) + Ketones (>3 mmol/L or large urinary)
• Causes in known T1DM: Missed insulin, infection
• Rx protocol:
  1. Fluid: NS 10 mL/kg over 1h (no glucose)
  2. Insulin infusion: 0.05–0.1 units/kg/hr (start AFTER 1h of fluids)
  3. K+ replacement (add to fluids before starting insulin if K+ <3.5)
  4. No bicarbonate (unless pH <6.9)
  5. Monitor for cerebral edema (most feared complication in children)
  • Cerebral edema Rx: Mannitol 0.5–1 g/kg IV or hypertonic saline

Thyroid Disorders

Growth Hormone Deficiency

• Short stature (<3rd percentile), delayed bone age, normal body proportions
• Diagnosis: Stimulation tests (insulin, arginine); low IGF-1 and IGFBP-3
• Rx: Recombinant GH injections until growth complete

Adrenal Disorders

• Most common: 21-hydroxylase deficiency (95%)
• Results in: ↓cortisol, ↓aldosterone, ↑androgens
• Classic: Salt-wasting crisis (neonatal shock, hyponatremia, hyperkalemia, acidosis) + virilization of females
• Non-classic: Premature pubarche, hirsutism
• Dx: ↑17-hydroxyprogesterone
• Rx: Hydrocortisone (replacement); fludrocortisone for salt-wasting

Puberty

• Precocious puberty: <8 years girls, <9 years boys; GnRH analog treatment (central); treat underlying cause (peripheral)
• Delayed puberty: >14 years boys, >13 years girls; most common cause = constitutional delay (benign)

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11. DEVELOPMENT & GROWTH

Developmental Milestones

Autism Spectrum Disorder (ASD)

• Red flags: No social smile by 2 months, no babbling by 12 months, no single words by 16 months, no 2-word phrases by 24 months, any regression at any age
• Dx: M-CHAT (Modified Checklist for Autism in Toddlers) at 18 and 24 months
• Rx: Early intensive behavioral therapy (ABA); no proven pharmacological cure

ADHD

• Inattention and/or hyperactivity-impulsivity >6 months in ≥2 settings, before age 12
• Rx: Behavioral therapy (ages <6); methylphenidate/amphetamines (≥6 years) + behavioral therapy

Growth

• Birth weight doubles by 4–5 months, triples by 12 months
• Birth length increases by 50% at 12 months
• Head circumference: 35 cm at birth → 47 cm at 12 months → 52 cm at 3 years
• Anterior fontanelle closes: 12–18 months
• Posterior fontanelle closes: 6–8 weeks

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12. PICU ESSENTIALS

Pediatric Sepsis (Surviving Sepsis Campaign)

• Sepsis: SIRS + suspected/confirmed infection
• Septic shock: Sepsis + cardiovascular dysfunction (need vasoactive after fluid resuscitation)
• 1-hour bundle:
  1. Obtain blood cultures
  2. Broad-spectrum antibiotics within 1 hour
  3. IV fluid bolus: 20 mL/kg isotonic saline (reassess after each bolus — max 40–60 mL/kg)
  4. Vasopressor if persistent shock after fluids: Norepinephrine (1st line)
  5. Measure lactate
• Dopamine: Still used in pediatric septic shock (less so now); Epinephrine for cold shock

Respiratory Failure

• Type I (hypoxemic): PaO2 <60 mmHg on air; P/F ratio <300
• Type II (hypercapnic): PaCO2 >50 mmHg
• PARDS (Pediatric ARDS): P/F ratio <300 (<200 moderate, <100 severe); lung-protective ventilation (low Vt 6 mL/kg, PEEP titration, FiO2 <60%)

Common PICU Medications

Fluid & Electrolytes

• Maintenance fluids (Holliday-Segar rule):
  • 0–10 kg: 100 mL/kg/day
  • 10–20 kg: 1000 mL + 50 mL/kg/day for each kg >10

  • 20 kg: 1500 mL + 20 mL/kg/day for each kg >20

• Fluid of choice: Normal saline or LR (NOT hypotonic in PICU/postop)
• Hypernatremia: Correct slowly <0.5 mEq/L/hr (risk cerebral edema if too fast)
• Hyponatremia: Symptomatic → 3% NaCl; correct slowly (risk osmotic demyelination)

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13. KEY NUMBERS TO MEMORIZE

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🎯 EXAM DAY HIGH-YIELD PEARLS

1. Bilious vomiting in neonate = surgical emergency (malrotation/volvulus until proven otherwise)
2. Petechiae + fever = meningococcemia → IV antibiotics STAT
3. Stridor + drooling + toxic-looking child = epiglottitis → DO NOT examine throat, secure airway in OR
4. Barking cough + stridor = croup → Dexamethasone ± nebulized epinephrine
5. Never give antibiotics for STEC-HUS (↑toxin release, worsen prognosis)
6. Pyloric stenosis → hypochloremic hypokalemic metabolic alkalosis; fix lytes BEFORE surgery
7. ITP → isolated thrombocytopenia, large platelets, recent illness; no BM biopsy unless needed
8. Tet spells → knee-to-chest position first
9. HIE treatment → therapeutic hypothermia within 6 hours
10. Kawasaki → IVIG + aspirin; echo to screen coronary aneurysms
11. Jones criteria → 2 major OR 1 major + 2 minor + evidence of prior GAS
12. Post-strep GN → ↓C3, normal C4; Cola urine; 2–3 weeks post-throat infection
13. CF → ΔF508 mutation; sweat chloride >60; Pseudomonas infections in lungs
14. DKA cerebral edema → mannitol/hypertonic saline; most feared complication
15. ALL → peak 2–5 years; blasts on smear; bone marrow biopsy confirms

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• CRASH = Kawasaki criteria
• C-P-C-E-S = Jones major criteria
• PROVe = Tetralogy of Fallot components
• 3 C's of measles = Cough, Coryza, Conjunctivitis