Practical Pediatric Viral Rash Algorithm Child presenting with rash and current/ recent symptoms of viral illness but is well with fever less than five days and no signs/ symptoms of sepsis or meningitis — What is the likely diagnosis? Dr. Edward Snelson @sailordoctor #Rash #Viral #Algorithm #Pediatrics #Peds #Diagnosis

“Step by Step” – the new kid on the block – aims to risk stratify this group to both reduce the number of unnecessary investigations and treatments in this group as well as predict those patients at risk of serious bacterial infections (SBI). There are clear parameters for each of the components of the algorithm. To be considered “low risk” an infant with fever without source must be: - Well appearing - Aged >21 days - No leukocytes in urine - Procalcitonin <0.5 ng/mL - Absolute Neutrophil Count <10,000/mm3 - CRP < 20 mg/L #Diagnosis #Management #Pediatrics #Peds #Febrile #Infant #StepByStep #Algorithm #LP #Antibiotics #Risk #Stratification #Fever

Assessment of diabetic control: - Any episodes of hypoglycaemia, diabetic ketoacidosis, hospital admission? - Is there still awareness of hypoglycaemia? - Absence from school? School supportive of diabetes care? - Interference with normal life? - HbA1c results — 58 mmol/mol (7.5%) or less? - Diary of blood glucose results — if monitoring, is he reacting to results? - Insulin regimen — appropriate? Correction bolus doses given? - Lipohypertrophy or lipoatrophy (Fig. 25.6a and b) at injection sites? - Diet — healthy diet, manipulating food intake and insulin to maintain good control? General overview (periodic): - Normal growth and pubertal development, avoiding obesity — measure each visit - Blood pressure check for hypertension yearly (age-specific centiles) - Renal disease — screening for microalbuminuria yearly from 12 years - Eyes — photography for retinopathy or cataracts, yearly from 12 years - Feet — maintaining good care — yearly - Screening for coeliac and thyroid disease at diagnosis, thyroid screening yearly, coeliac again after 3 years or if weight gain poor. - Annual reminder to have flu vaccination #diabetes #primarycare #DM1 #Peds #Pediatrics #Assessment

PocketPEM - Pediatric Fever Workup #Diagnosis #Peds #EM #Fever #Pediatric #Fever #Workup #PocketCard #PocketPEM

Pediatric UTI Algorithm (2-24 months of age) Risk stratify with UTI Calc: - Age months - Maximum temperature 239 - Not self described race as black - Female or uncircumcised male - No other fever source identified Emergency Medicine Cases @EMCases #Pediatric #UTI #Algorithm #Diagnosis #Management #UrinaryTractInfection #Peds #Risk #Stratification

COPD Management Algorithm - GOLD 2019 guidelines Categorize into COPD GOLD A-D -> Initiate first-line therapy -> Follow-up based on further DYSPNEA or EXACERBATIONS COPD GOLD 2019 guidelines were published in November and a few changes were included. When managing the pharmacotherapy of COPD, the first step is to categorize patients into GOLD Group A-D based on their dyspnea level and history of exacerbations. Which group they are in will tell you what to initiate as a first-line agent. See one of my previous posts about how to categorize and what to initiate (this is unchanged from GOLD 2018). What did change is the follow-up step. Instead of simply stepping up therapy from single to dual to triple, GOLD 2019 recommendations take into account whether the patient is having worsening dyspnea or exacerbations on current regimens. If dyspnea is present, recommendation is to step to dual bronchodilators or change devices (there are only 3 dual bronchodilator combo inhalers available in the US). If patient has exacerbations, you can consider initiating triple therapy which includes ICS if patients have high levels of eosinophils. ICS use should only be used in patients who have high eosinophils. Unnecessary ICS use actually increases risk of pneumonia and patients with COPD naturally have a higher risk of pneumonia, so careful consideration of inhalers is needed. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #COPD #GOLD #GOLD2019 #Guidelines #Management #Pulmonary #Algorithm #pharmacology

Azithromycin - since there has been a lot of noise around chloroquine/hydroxychloroquine, thought we can take a quick review of azithromycin since it is being used in combination with hydroxychloroquine as one of the investigational treatments for COVID-19… - Note azithromycin has a long half-life of about 68 hrs (or more) and is an inhibitor of P-glycoprotein/ABCB1 so watch for potential DIs with colchicine, dabigatran, edoxaban, ranolazine, etc. Also, don't forget about increased QT prolongation risk when used in combo with chloroquine or hydroxychloroquine‼️ For Educational Purposes Only #Azithromycin #COVID19 #Pandemic #Treatment #Coronavirus #InfectionDiseases