Pediagogy

Key points: -Bronchiolitis is seen in kids under the age of 2 and caused by RSV -Treatment is supportive including fluids, oxygen, and suction -Learn about palivizumab and other new preventive therapies against bronchiolitis Supplemental Information: AAP 2014 guidelines: https://pediatrics.aappublications.org/content/134/5/e1474 Day of Illness and Outcomes in Bronchiolitis Hospitalizations: https://publications.aap.org/pediatrics/article/146/5/e20201537/75296/Day-of-Illness-and-Outcomes-in-Bronchiolitis

Key points: -Brief, resolved, unexplained events in patients

Key points: -DKA presents with hyperglycemia, ketosis, and anion gap metabolic acidosis, which if severe can cause cerebral edema and CNS dysfunction -Initial management includes fluid resuscitation and IV insulin -Learn about the 2 bag system for DKA -There is a rule to correct for hyponatremia in hyperglycemia -Learn about how to manage potassium, bicarbonate, and phosphorus in DKA Supplemental information: Pediatrics in Review 2019 DKA: https://publications.aap.org/pediatricsinreview/article-abstract/40/8/412/35321/Diabetic-Ketoacidosis?redirectedFrom=fulltext

Key points: -Remember the 4-2-1 rule for calculating maintenance fluids in children -Use of hypotonic fluids is based on historical data in healthy children -Data now supports use of isotonic fluids like NS or LR to reduce risk of hyponatremia and SIADH -Newer data may support LR over NS Supplemental information AAP 2018 Maintenance Fluid Guidelines: https://publications.aap.org/pediatrics/article/142/6/e20183083/37529/Clinical-Practice-Guideline-Maintenance

Key points: -There are specific clinical criteria for diabetes -There are some differences to help distinguish between type 1 versus type 2 diabetes -Learn about how to manage diabetes on the inpatient floor, including how to calculate total daily insulin dose, correction factors, and carbohydrate ratios. Supplemental information: Pediatrics in Review 2013: https://publications.aap.org/pediatricsinreview/article-abstract/34/5/203/34790/Type-1-Diabetes-Mellitus?redirectedFrom=fulltext American Diabetes Association 2018 Position Statement: https://diabetesjournals.org/care/article/41/9/2026/40739/Type-1-Diabetes-in-Children-and-Adolescents-A

Key points: -First line management is insulin when in DKA -First line management is lifestyle modification and metformin when not in DKA -Consider adding insulin and GLP-1 agonists if still in poor control Supplemental Information AAP guidelines 2013: https://publications.aap.org/pediatrics/article/131/2/364/31847/Management-of-Newly-Diagnosed-Type-2-Diabetes AAFP guidelines 2018: https://www.aafp.org/afp/2018/1101/p590.html ISPAD guidelines 2018: https://www.ispad.org/page/ISPADGuidelines2018

Key points: -New strategies for management of febrile infants depending on age (1-3 weeks, 3-4 weeks, or 4-8 weeks) -Inflammatory markers like CRP and procalcitonin help to determine if LP is needed in older patients. -Learn about common bugs that cause infection in infants and the antibiotics we use to treat them -Observation of febrile infants is now reduced from 48 hours to 24-36 hours Supplemental information: AAP guidelines 2020: https://pediatrics.aappublications.org/content/148/2/e2021052228 Yale Observation Scale Score in febrile infants 60 days and younger: https://publications.aap.org/pediatrics/article/140/1/e20170695/37958/The-Yale-Observation-Scale-Score-and-the-Risk-of

Key points: -Ask about common triggers for asthma like smoke or allergens as well as medication adherence -Asthma is a clinical diagnosis but ancillary tests like PFTs may help -Symptom frequency and severity can help you classify the asthma as intermittent versus persistent -Learn about controller/maintenance therapy, including the new SMART therapy -Learn about steroid use for acute exacerbations as well as next line medications like magnesium, ipratropium, and epinephrine Supplemental information: NIH 2020 guideline updates: https://pediatrics.aappublications.org/content/147/6/e2021050286 Peds in review 2019: https://pedsinreview.aappublications.org/content/40/11/549 Asthma control test: https://www.greenhillspeds.com/wp-content/uploads/2015/12/Asthma-Control-Test-4-to-11-years.pdf GINA 2020 Pocket Guide: https://ginasthma.org/wp-content/uploads/2020/04/Main-pocket-guide_2020_04_03-final-wms.pdf NIH Guidelines 2007: https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma JAMA 2021 guideline update summary: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2780356