Housestaff Manual
1
Foreword
2
Rapid Reference
2.1
Calling for Help
2.2
PALS
2.2.1
Shock
2.2.2
Respiratory Emergencies
2.3
Infectious Disease
2.3.1
Sepsis Huddle
2.3.2
CSF Analysis
2.4
Respiratory
2.4.1
Status Asthmaticus
2.4.2
ABGs & VBGs
2.4.3
Respiratory Support for Spontaneously Breathing Patients
2.4.4
Trach Troubleshooting
2.5
Status Epilepticus (SE)
2.5.1
PowerPlans & Order Sets
2.5.2
Definition
2.5.3
Presentation
2.5.4
Differential
2.5.5
Management
2.6
Psychiatric
2.6.1
Anxiety, Agitation & Delirium
2.6.2
Overnight Behavioral Plan
3
Adolescent Medicine
3.1
BCH Wards Tips
3.2
Adolescent Clinic Tips
3.2.1
Overview
3.2.2
BCH Adolescent Clinic Specifics
3.2.3
BMC Adolescent Clinic Specifics
3.3
HEEADSSS Assessment
3.3.1
Home
3.3.2
Education and/or Employment
3.3.3
Eating
3.3.4
Activities
3.3.5
Drugs
3.3.6
Sexuality
3.3.7
Suicide & Depression/Mood
3.3.8
Safety
3.4
Adolescent Screening Tools
3.5
Contraception
3.5.1
Emergency Contraception (EC)
3.5.2
Shared Decision Making (SDM)
3.5.3
Applying SDM Principles to Contraceptive Counseling Visits
3.6
Tanner Staging
3.7
Vaginal Discharge and Infections
3.8
HIV
3.8.1
Signs & Symptoms
3.8.2
Diagnosis
3.8.3
PEP vs. PrEP
3.9
Genital Ulcers and Warts
3.10
Pelvic Inflammatory Disease (PID)
3.10.1
PowerPlans / Order Sets / EBGs
3.10.2
Pathophysiology
3.10.3
Etiology
3.10.4
Clinical Manifestations
3.10.5
Physical Exam
3.10.6
Evaluation
3.10.7
Management
3.11
Heavy or Irregular Menstrual Bleeding
3.11.1
PowerPlans / Order Sets / EBGs
3.11.2
Definition
3.11.3
Differential Diagnosis
3.11.4
Clinical Manifestations
3.11.5
Evaluation
3.11.6
Management
3.12
Amenorrhea
3.12.1
Definition
3.12.2
Pathophysiology
3.12.3
Clinical Manifestations
3.12.4
Physical Exam
3.12.5
Evaluation
3.12.6
Management
3.13
Gender Affirming Care
3.13.1
Why
3.13.2
How
3.13.3
Gender Affirming Care Clinics
3.13.4
The Genderbread Person
3.14
Eating Disorders (ED)
3.14.1
Anorexia Nervosa (AN)
3.14.2
Bulimia Nervosa (BN)
3.14.3
Acute Refusal of Food Intake Disorder (ARFID)
3.15
References
4
Allergy and Immunology
4.1
Adverse Drug Reactions
4.1.1
Type A
4.1.2
Type B
4.1.3
Organ-specific ADRs
4.1.4
Multiorgan ADRs
4.2
Anaphylaxis
4.2.1
Allergens
4.2.2
Clinical
4.2.3
Severe Reaction
4.2.4
Management
Emergent
4.2.5
Med Dosing
4.2.6
ED Discharge Criteria
4.2.7
Post-discharge Treatment
4.3
Primary Immunodeficiencies
4.3.1
Pathophysiology
4.3.2
Epidemiology
4.3.3
Physical Exam
4.3.4
Diagnosis
4.3.5
Treatment
4.4
Indications for a Primary Immunodeficiency Evaluation
4.5
Diagnostic Approach to Primary Immunodeficiencies
4.5.1
Initial Labs (most cases)
4.5.2
Next Step
4.5.3
Advanced (Depending on specific history)
4.6
Classification of Primary Immunodeficiencies
4.6.1
B-cell (Humoral): decreased B-cell numbers and/or impaired antibody production
4.6.2
T-cell Defects
4.6.3
Combined B/T Cell Defect
4.6.4
Phagocytic Defects
4.6.5
Complement Defects
4.7
Selected Primary Immunodeficiencies
4.8
Selected Immunodeficiencies
4.9
Specific Antibody Deficiencies
4.10
Characteristics of Selected SCID disorders
4.10.1
T-, B+, SCID
4.10.2
T-, B-, SCID
4.11
General Approach to the Immunodeficient Patient
5
Cardiology
5.1
Cardiology Rotation Tips
5.2
Disaster Planning
5.3
EKG Approach
5.3.1
Ventricular Rate
5.3.2
Rhythm
5.3.3
QRS Axis
5.3.4
Intervals & Segments
5.3.5
Chamber Size
5.3.6
Normal EKG values by age
5.4
Other Cardiac Work-Up
5.4.1
Chest X-Ray (CXR)
5.4.2
What to do next…
5.4.3
When to start prostaglandins
5.5
Common Cardiology Concerns
5.5.1
Hyperlipidemia (HLD)
5.5.2
Hypertension (HTN)
5.5.3
Evaluating Murmurs (including in a newborn)
5.6
Arrhythmias & Pacemakers
5.6.1
Causes of Palpitations
5.6.2
Premature Ventricular Contractions (PVCs)
5.6.3
Premature Atrial Contractions (PACs)
5.6.4
Sinus Bradycardia
5.6.5
AV Block
5.6.6
Supraventricular Tachycardia (SVT)
5.6.7
Wolff-Parkinson-White Syndrome
5.6.8
Ventricular Tachycardia (VT/VTach) and Ventricular Fibrillation (VF/VFib)
5.6.9
Long QT Syndrome
5.6.10
Pacemakers
5.7
Acyanotic Congenital Heart Disease (CHD)
5.7.1
Atrial Septal Defect (ASD)
5.7.2
Ventricular Septal Defect (VSD)
5.7.3
Patent Ductus Arteriosis (PDA)
5.7.4
AV Canal Defects (AVCD)
5.7.5
Congenital Corrected TGA
5.7.6
Valvar Pulmonary Stenosis
5.7.7
Valvar Aortic Stenosis
5.7.8
Coarctation of the Aorta
5.8
Cyanotic Congenital Heart Disease (CHD)
5.8.1
Tetralogy of Fallot (ToF)
5.8.2
Transposition of the Great Arteries (TGA)
5.8.3
Total Anomalous Pulmonary Venous Return (TAPVR)
5.8.4
Tricuspid Atresia
5.8.5
Ebstein’s Anomaly
5.8.6
Hypoplastic Left Heart Syndrome (HLHS)
5.8.7
Double Outlet Right Ventricle (DORV)
5.8.8
Truncus arteriosus
5.8.9
Pulmonary atresia with IVS
5.9
Surgical Repair of CHD
5.9.1
Stage 1 Operation (aka Norwood Operation)
5.9.2
Bidirectional Glenn
5.9.3
Fontan
5.9.4
Arterial Switch Operation
5.10
Catheterization & Caring for the Post-Cath Child
5.11
Cardiomyopathy
5.11.1
Hypertrophic Cardiomyopathy (HCM)
5.11.2
Dilated Cardiomyopathy
5.11.3
Arrhythmogenic Cardiomyopathy
5.11.4
Restrictive Cardiomyopathy
5.11.5
Left Ventricular Non-Compaction Cardiomyopathy (LVNC)
5.12
Congestive Heart Failure (CHF)
5.13
Coronary Artery Anomalies
5.13.1
Anomalous Left Coronary Artery off the Pulmonary Artery (ALCAPA)
5.13.2
Anomalous Aortic Origin of a Coronary Artery (AAOCA)
5.14
Pulmonary Hypertension (pHTN)
5.15
Cardiac Infections
5.15.1
Myocarditis
5.15.2
Endocarditis
5.15.3
Pericarditis
5.16
References
6
Cellular Therapy
6.1
Introduction
6.2
Hematopoietic Cell Transplantation (HCT)
6.2.1
Graft
6.2.2
Donor Types
6.2.3
Conditioning Regimens
6.2.4
Timeline
6.2.5
Complications
6.3
Cytotoxic T Lymphocytes (CTLs)
6.3.1
Concept
6.4
Chimeric Antigen Receptor (CAR) T-cells
6.4.1
Concept
6.4.2
Complications
6.5
Emerging Cellular Therapies
6.5.1
Currently in Clinical Trials
7
Critical Care & ICP
7.1
Vasopressors & Inotropes
7.2
Shock
7.2.1
Types of Shock
7.2.2
Septic Shock Treatment Algorithm
7.3
Analgesia, Sedation & Paralysis
7.3.1
Analgesics
7.3.2
Sedatives
7.3.3
Paralytics
7.4
Rapid Sequence Intubation (RSI)
7.4.1
Pre-Med (“Appetizer” 🥗)
7.4.2
Induction (“Main Course” 🍔)
7.4.3
Paralysis (“Dessert” 🍰)
7.5
Respiratory Support: Ventilation & Oxygenation
7.5.1
High-Flow Nasal Cannula (HFNC)
7.5.2
Non-Invasive Positive Pressure Ventilaion (NIPPV)
7.5.3
Mechanical Ventilation (MV)
7.6
Extracorporeal Membrane Oxygenation (ECMO)
7.7
Acute Respiratory Distress Syndrome (ARDS)
7.8
Hypertensive Crisis
7.9
Diabetic Ketoacidosis (DKA)
7.10
References
8
Dermatology
8.1
Key Questions for Taking a Dermatologic HIstory
8.2
Describing Dermatologic Lesions
8.2.1
Primary Lesion
8.2.2
Secondary Changes
8.2.3
Color Descriptor
8.2.4
Lesion Shapes
8.2.5
Distribution
8.3
Newborn Derm
8.3.1
Neonatal Rashes
8.3.2
Neonatal Birthmarks
8.3.3
Diaper Dermatitis
8.4
Dermatologic Emergencies
8.4.1
Stevens Johnson Syndrome (SJS)
8.4.2
Toxic Epidermal Necrolysis (TEN)
8.4.3
Drug Reaction with Eosinophilis and Systemic Symptoms (DRESS)
8.4.4
Staph Scalded Skin Syndrome (SSSS)
8.5
Common Dermatologic Conditions
8.5.1
Acne
8.5.2
Atopic Dermatitis (Eczema)
8.5.3
Erythema Multiforme
8.5.4
Impetigo
8.5.5
Erysipelas
8.5.6
Molluscum Contagiosum
8.5.7
Pityriasis Rosea
8.5.8
Scabies
8.5.9
Lice
8.5.10
Tinea Corporis
8.5.11
Tinea Capitis
8.6
Cutaneous Signs of Systemic Disease
8.7
Drug Eruptions
8.8
Principles of Dermatologic Therapy
8.8.1
Quantities of Topicals to Prescribe
8.9
Topical Steroids
8.9.1
Classes of Topical Steroids
8.9.2
Side Effects of Topical Steroids
8.10
Sun Protection
8.10.1
Types of Sunscreen
8.10.2
Choosing Sunscreen
8.11
References
8.11.1
Additional Dermatology Resources
9
Emergency Medicine
9.1
Acute Abdominal Pain
9.1.1
Differential
9.1.2
Workup
9.2
Altered Mental Status
9.3
Blunt Abdominal Trauma
9.3.1
Treatment
9.4
Appendicitis
9.4.1
Definition
9.4.2
Pathophysiology
9.4.3
Clinical
9.4.4
Physical Exam
9.4.5
Studies
9.4.6
Treatment
9.5
Acute Chest Pain
9.5.1
Differential
9.5.2
History
9.5.3
Physical Exam
9.5.4
Studies
9.6
Acute Scrotal Pain
9.6.1
History
9.6.2
Physical Exam
9.6.3
Studies
9.7
Atraumatic Limp
9.7.1
Differential Diagnoses
9.7.2
Workup
9.7.3
Management
9.7.4
Discharge Criteria
9.8
Animal Bites
9.8.1
Bacteria
9.8.2
Clinical Presentation
9.8.3
Workup
9.8.4
Management and Treatment
9.9
Brief Resolved Unexplained Event (BRUE)
9.9.1
Presentation
9.9.2
Workup
9.9.3
Management and Treatment
9.10
Burns
9.10.1
Classification: 1st degree
9.10.2
Classification: 2nd degree
9.10.3
Classification: 3rd Degree
9.10.4
Pathogenesis
9.10.5
Estimating Burn Size
9.10.6
Workup
9.10.7
Treatment
9.11
Deep Space Neck Infections
9.11.1
Peritonsillar Abscess
9.11.2
Parapharyngeal Abscess
9.11.3
Retropharyngeal Abscess
9.12
Dehydration
9.12.1
Definition
9.12.2
Presentation
9.12.3
Physical Findings of Volume Depletion
9.12.4
Differential
9.12.5
Workup
9.12.6
Treatment
9.13
Dental Emergencies
9.13.1
Avulsion
9.13.2
Fracture
9.13.3
Luxation Injuries
9.13.4
Workup
9.13.5
Treatment
9.14
Epistaxis
9.14.1
Pathogenesis
9.14.2
Etiology
9.14.3
Clinical Presentation
9.14.4
Workup
9.14.5
Treatment
9.15
Febrile Infant
9.15.1
Definition
9.15.2
Etiology
9.15.3
Pathogenesis
9.15.4
Most Common Pathogens by Age
9.15.5
Clinical Presentation
9.15.6
Workup
9.15.7
Treatment
9.16
Foreign Body Aspiration
9.16.1
Presentation
9.16.2
Workup
9.16.3
Management
9.17
Foreign Body Ingestion
9.17.1
Pathogenesis
9.17.2
Presentation
9.17.3
Workup
9.17.4
Treatment
9.18
Suspected Child Abuse
9.18.1
Presentation
9.18.2
Workup
9.19
Sexual Assault
9.19.1
Workup (<12yo)
9.19.2
Treatment (<12yo)
9.19.3
Workup (>12yo)
9.19.4
Treatment (>12yo)
9.19.5
Discharge planning (>12yo)
9.20
Syncope
9.20.1
Differential
9.20.2
Workup
9.21
Trauma
9.21.1
ATLS
9.22
Mild Traumatic Brain Injury (Contusion and Concussion)
9.22.1
Definition
9.22.2
Pathogenesis
9.22.3
Presentation
9.22.4
Workup
9.22.5
Treatment
9.23
Cervical Spine Injury
9.23.1
Workup & Treatment
9.24
Laceration Repair
9.24.1
Equipment
9.24.2
General Technique
10
Endocrinology
10.1
Adrenal Insufficiency
10.1.1
PowerPlan/Order sets
10.1.2
Definition
10.1.3
Presentation
10.1.4
Diagnostic Studies
10.1.5
Acute Treatment
10.1.6
Maintenance Therapy
10.2
Diabetic Ketoacidosis
10.2.1
PowerPlan/Order sets
10.2.2
Definition
10.2.3
Pathophysiology
10.2.4
Presentation
10.2.5
Diagnostic Studies
10.2.6
Treatment
10.2.7
Subcutaneous Insulin Regimen
10.3
Hypoglycemia
10.3.1
PowerPlan/Order sets
10.3.2
Definition
10.3.3
Etiology
10.3.4
Presentation
10.3.5
Diagnostic Approach
10.3.6
Diagnostic Studies
10.3.7
Treatment
10.4
Diabetes Insipidus
10.4.1
PowerPlan/Order sets
10.4.2
Definition
10.4.3
Etiology
10.4.4
Presentation
10.4.5
Diagnostic Studies
10.4.6
Treatment
10.5
Syndrome of Inappropriate ADH (SIADH)
10.5.1
Definition
10.5.2
Etiology
10.5.3
Pathophysiology
10.5.4
Presentation
10.5.5
Diagnostic Studies
10.5.6
Treatment
10.6
Calcium Homeostasis
10.7
Hypocalcemia
10.7.1
Definition
10.7.2
Etiology
10.7.3
Clinical Manifestations
10.7.4
Diagnostic Studies
10.7.5
Treatment
10.8
Hypercalcemia
10.8.1
Definition
10.8.2
Etiology
10.8.3
Clinical Manifestations
10.8.4
Diagnostic Algorithm
10.8.5
Treatment
11
Gastroenterology, Hepatology & Nutrition
11.1
Constipation
11.1.1
Bristol Stool Chart
11.1.2
PowerPlans, Order Sets & Clinical Pathways
11.1.3
Presentation
11.1.4
Differential
11.1.5
Red Flags
11.1.6
Work-up
11.1.7
Management
11.2
Diarrhea
11.2.1
PowerPlans, Order Sets & Clinical Pathways
11.2.2
Differential
11.2.3
Work-up
11.2.4
Interpretation
11.2.5
Acute Management
11.3
Acute Gastroenteritis
11.3.1
PowerPlans, Order Sets & Clinical Pathways
11.3.2
Presentation
11.3.3
Pathophysiology
11.3.4
Management
11.3.5
Anticipatory Guidance
11.4
Clostridium Difficile (C. diff)
11.4.1
PowerPlans, Order Sets & Clinical Pathways
11.4.2
Presentation
11.4.3
Pathophysiology
11.4.4
Work-up
11.4.5
Management
11.5
Inflammatory Bowel Disease (IBD)
11.5.1
PowerPlans, Order Sets & Clinical Pathways
11.5.2
Crohn’s Disease (CD)
11.5.3
Ulcerative Colitis (UC)
11.6
Malabsorption
11.6.1
Carbohydrates
11.6.2
Fat
11.6.3
Protein
11.7
Celiac Disease
11.7.1
PowerPlans, Order Sets & Clinical Pathways
11.7.2
Presentation
11.7.3
Pathophysiology
11.7.4
Work-up
11.7.5
Management
11.8
Gastrointestinal Bleeding
11.8.1
PowerPlans, Order Sets & Clinical Pathways
11.8.2
Presentation
11.8.3
Anatomy
11.8.4
Work-up
11.8.5
Differential Diagnosis
11.8.6
Management
11.9
Gastroesophageal Reflux Disease (GER/GERD)
11.9.1
PowerPlans, Order Sets & Clinical Pathways
11.9.2
Definitions
11.9.3
Presentation
11.9.4
Management
11.10
Pancreatitis
11.10.1
PowerPlans, Order Sets & Clinical Pathways
11.10.2
Presentation
11.10.3
Pathophysiology
11.10.4
Diagnostic Criteria
11.10.5
Work-up
11.10.6
Management
11.10.7
Complications
11.11
Functional Gastrointestinal Disorders (FGID)
11.11.1
Pathophysiology
11.11.2
Alarm Symptoms
11.11.3
Management
11.11.4
Irritable Bowel Syndrome (IBS)
11.11.5
Functional Dyspepsia (FD)
11.11.6
Abdominal Migraine
11.11.7
Functional Abdominal Pain (FAP)
11.11.8
Cyclic Vomiting Syndrome
11.11.9
Functional Nausea
11.11.10
Functional Vomiting
11.11.11
Rumination Syndrome
11.12
Newborn GI
11.12.1
Pyloric Stenosis
11.12.2
Malrotation/Volvulus
11.12.3
Biliary Atresia (BA)
11.13
GI Imaging
11.13.1
Abdominal XR (KUB)
11.13.2
Modified Barium Swallow (MBS)
11.13.3
Upper GI (UGI) Series
11.13.4
Abdominal CT
11.13.5
Contrast Enema
11.14
G-Tubes & J-Tubes
11.14.1
PowerPlans, Order Sets & Clinical Pathways
11.14.2
Indications
11.14.3
Tube Troubleshooting
11.14.4
Devices
11.15
Infant Formulas
11.15.1
Helpful Math
11.15.2
Types of Formula
11.15.3
Caloric Supplements
11.16
Total Parenteral Nutrition (TPN)
11.16.1
PowerPlans, Order Sets & Clinical Pathways
11.16.2
Indications
11.16.3
Access
11.16.4
Monitoring
11.17
Liver Enzymes
11.18
Infectious Hepatitis
11.18.1
Hep B Serologies
11.19
Autoimmune Hepatitis
11.19.1
Presentation
11.19.2
Pathophysiology
11.19.3
Work-up
11.19.4
Management
11.20
Non-Alcoholic Fatty Liver Disease (NAFLD)
11.20.1
Presentation
11.20.2
Pathophysiology
11.20.3
Work-up
11.20.4
Management
11.21
References
12
Hematology
12.1
Anemia
12.1.1
Definition
12.1.2
Approach to Anemia (by MCV & Retics)
12.1.3
Microcytic Anemias
12.1.4
Sickle Cell Anemia
12.1.5
Hemolytic Anemias
12.1.6
Other Normocytic Anemias
12.1.7
Macrocytic Anemias
12.1.8
Pediatric-Specific Anemias
12.2
Sickle Cell Anemia
12.2.1
Vaso-Occlusive Episode (VOE)
12.2.2
Acute Chest Syndrome (ACS)
12.2.3
Fever
12.2.4
Blood Transfusions in SCD
12.3
Transfusion Medicine
12.3.1
Consenting a Patient for Blood Products
12.3.2
Acute Transfusion Reactions
12.3.3
Transfusion Products
12.4
Pancytopenia
12.4.1
Marrow
12.4.2
Systemic
12.4.3
Meds
12.4.4
Infectious
12.5
Thrombocytopenia
12.5.1
Causes
12.6
Hematologic Disorders of the Newborn/Child
12.6.1
Anemia of Prematurity
12.6.2
Transient Erythroblastopenia of Childhood
12.6.3
Neonatal Polycythemia
12.7
Coagulation Disorders
12.8
Antiplatelet / Anticoagulant Medications
12.9
References
13
Infectious Diseases
13.1
Antibiogram+
13.2
Antibiotic Susceptibilities
for Common Pathogens
13.2.1
Gram Negative Susceptibilities
13.2.2
Gram Positive Susceptibilities
13.2.3
Anaerobe Susceptibilities
13.3
Antibiotic Recommendations
(Dosing, Duration) for Common Infections
13.3.1
Bone & Joint
13.3.2
Head & Neck
13.3.3
Gastrointestinal
13.3.4
Genitourinary
13.3.5
Respiratory
13.3.6
Skin & Soft Tissue
13.4
Cellulitis & Abscess
13.4.1
PowerPlans, Order Sets & Clinical Pathways
13.4.2
Etiology
13.4.3
Differential
13.4.4
Work-up
13.4.5
Managament
13.5
Osteomyelitis
13.5.1
PowerPlans, Order Sets & Clinical Pathways
13.5.2
Etiology
13.5.3
Presentation
13.5.4
Differential
13.5.5
Work-up
13.5.6
Treatment
13.6
Septic Arthritis
13.6.1
PowerPlans, Order Sets & Clinical Pathways
13.6.2
Etiology
13.6.3
Presentation
13.6.4
Differential
13.6.5
Work-up
13.6.6
Treatment
13.7
Infectious Mononucleosis
13.7.1
Etiology
13.7.2
Presentation
13.7.3
Differential
13.7.4
Work-up
13.7.5
Treatment
13.8
Acute Otitis Media (AOM)
13.8.1
PowerPlans, Order Sets & Clinical Pathways
13.8.2
Etiology
13.8.3
Differential
13.8.4
Work-up
13.8.5
Treatment
13.9
Influenza
13.9.1
PowerPlans, Order Sets & Clinical Pathways
13.9.2
Etiology
13.9.3
Presentation
13.9.4
Work-up
13.9.5
Treatment
13.9.6
Prophylaxis
13.9.7
Complications
13.10
Fever of Unknown Origin (FUO)
13.10.1
PowerPlans, Order Sets & Clinical Pathways
13.10.2
Definition
13.10.3
Differential
13.10.4
Work-up
13.10.5
Treatment
13.11
Urinary Tract Infection (UTI), First Febrile
13.11.1
PowerPlans, Order Sets & Clinical Pathways
13.11.2
Etiology
13.11.3
Work-up
13.11.4
Treatment
13.12
Bacterial Meningitis
13.12.1
PowerPlans, Order Sets & Clinical Pathways
13.12.2
Presentation
13.12.3
Differential
13.12.4
Work-up
13.12.5
Etiology/Management
13.12.6
Complications
13.13
COVID-19
13.13.1
PowerPlans, Order Sets & Clinical Pathways
14
Metabolism
14.1
I think this might be metabolic…
14.2
Management of Metabolic Crises
14.2.1
General Principles
14.2.2
Acute Metabolic Encephalopathy
14.2.3
Hyperammonemia
14.2.4
Metabolic Acidosis d/t suspected IEM
14.2.5
Seizures d/t suspected IEM
14.2.6
Ketotic Hypoglycemia
14.2.7
Access in a metabolic crisis
14.3
Differential Diagnosis by Clinical Manifestations
14.3.1
Presenting in
Neonatal period
or
early infancy
14.3.2
Later onset
14.4
Aminoacidopathies
14.5
Carbohydrate Metabolism Defects
14.6
Fatty Acid Oxidation Disorders
14.7
Lysosomal Diseases
14.8
Mitochondrial Disorders / Primary Lactic Acidemias
14.9
Organic Acidemias
14.10
Peroxisomal Disorders
14.11
Urea Cycle Defects
14.12
Glossary
14.13
Resources
15
Nephrology
15.1
Formulas
15.1.1
Modified Bedside Schwartz
15.1.2
Insensible Fluid Loss
15.1.3
Total Body Water
15.1.4
Free Water Deficit
15.1.5
Fractional Excretion Sodium
15.1.6
Fractional Excretion of Urea
15.1.7
Urine Protein/Cr Ratio
15.1.8
Transtubular Potassium Gradient
15.1.9
Tubular Reabsorption of Phosphate
15.1.10
Urine Calcium/Cr Ratio
15.1.11
Corrected Calcium
15.1.12
Calculated Serum Osmolality
15.1.13
Osmolar Gap
15.2
Fluid Management
15.2.1
Dehydration
15.2.2
Maintenance Fluid Therapy
15.2.3
Holliday-Segar Method
15.3
Acid/Base
15.3.1
Simple Acid/Base Disorders
15.3.2
Metabolic Acidosis
15.3.3
Metabolic Alkalosis
15.3.4
Respiratory Acidosis
15.3.5
Respiratory Alkalosis
15.4
Hyponatremia
15.5
Hypernatremia
15.6
Hypokalemia
15.7
Hyperkalemia
15.8
Proteinuria
15.9
Hematuria
15.10
Nephrotic Syndrome
15.11
Nephritic Syndrome
15.12
Acute Kidney Injury
15.13
Chronic Kidney Disease
15.14
Hemolytic-Uremic Syndrome
15.15
Hypertension
15.16
Urinary Tract Infections
15.17
Nephrolithiasis
15.18
References
16
Neurology
16.1
Neurologic Emergencies
16.1.1
Status Epilepticus
16.1.2
Increased Intracranial Pressure (ICP)
16.1.3
Stroke
16.2
Weakness
16.2.1
Guillain-Barré Syndorme (GBS)
16.2.2
Miller-Fisher variant of Guillain-Barré
16.2.3
Myasthenia Gravis
16.2.4
Bell’s Palsy
16.2.5
Acute Flaccid Myelitis (AFM)
16.3
Hypotonia
16.3.1
Approach to Neonatal Hypotonia
16.3.2
Infantile Botulism
16.4
Neuroimmunology
16.4.1
Multiple Sclerosis (MS)
16.4.2
Acute Disseminated Encephalomyelitis (ADEM)
16.4.3
Transverse Myelitis
16.4.4
Autoimmune Encephalitis (NMDA Receptor Antibody Encephalopathy)
16.5
Neuropsychiatric
16.5.1
Functional Neurologic Disorder
16.6
Headache
16.6.1
Migraine
16.6.2
Tension Headache
16.6.3
Concussion
16.6.4
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
16.7
Seizures
16.7.1
Febrile Seizure
16.7.2
First-time Unprovoked Seizure
16.7.3
Breakthrough Seizure (in a patient w/ epilepsy)
16.7.4
Infantile Spasms
16.8
Meningitis
16.8.1
Bacterial Meningitis
16.8.2
Viral Meningitis & Encephalitis
16.9
References
17
Newborn Nursery
17.1
Rotation Specific Entities
17.2
Gestational Age
17.3
Normal Infant Feeding
17.3.1
Breastfeeding
17.3.2
Formula Feeding
17.3.3
Tongue Ties
17.4
Newborn Behavior
17.5
Anticipatory Guidance / Discharge Teaching
17.5.1
Feeding
17.5.2
Normal Voiding / Stooling
17.5.3
Cord Care
17.5.4
Circumcision Care
17.5.5
Safe Sleep
17.5.6
Tummy Time
17.5.7
Consoling
17.5.8
Illness
17.6
Hyperbilirubinemia
17.6.1
Definition
17.6.2
Pathophysiology
17.6.3
Evaluation
17.6.4
Management
17.7
Infant of a Diabetic Mother (IDM)
17.7.1
Increased risks
17.7.2
Congenital anomalies
17.7.3
Management
17.7.4
Hypoglycemia
17.8
Neonatal Abstinence Syndrome (NAS)
17.8.1
Pathophysiology
17.8.2
Presentation
17.8.3
Management
17.9
Newborn ID
17.9.1
Early Onset Sepsis
17.9.2
Hepatitis B
17.9.3
HIV
17.9.4
HSV
18
Neonatology (NICU)
18.1
APGAR Scoring
18.2
Neonatal Respiratory Disorders & Delivery Room Pathology
18.2.1
Choanal Atresia
18.2.2
Pharyngeal Airway Malformation
18.2.3
Congenital Diaphragmatic Hernia (CDH)
18.2.4
Pleural Effusion
18.2.5
Pneumothorax
18.2.6
Meconium Aspiration
18.2.7
Persistent Pulmonay Hypertension (PPHN)
18.2.8
Respiratory Distress Syndrome (RDS)
18.2.9
Transient Tachypnea of the Newborn (TTN)
18.3
Neonatal Cardiology
18.3.1
Blood Pressure for Premature Infants
18.3.2
Patent Ductus Arteriosus (PDA)
18.4
Neonatal Hematology
18.4.1
Anemia
18.4.2
Polycythemia
18.4.3
Thrombocytopenia
18.5
Neonatal Neurology
18.5.1
Interventricular Hemorrhage (IVH)
18.5.2
Therapeutic Cooling
18.6
Neonatal Infectious Disease
18.6.1
Sepsis
18.6.2
TORCH infections
18.6.3
Vertical Transmission
18.7
Neonatal Endocrinology
18.7.1
Hypoglycemia
18.8
Neonatal Gastroenterology
18.8.1
Emesis in an Infant
18.8.2
Acute Abdomen in the Neonate
18.8.3
Indirect Hyperbilirubinemia
18.8.4
Neonatal Entercolitis (NEC)
18.8.5
Malrotation (+/- Mid Gut Volvulus)
18.8.6
Duodenal Atresia
18.8.7
Jujonoileal Atresia
18.8.8
Meconium ileus
19
Oncology
19.1
Order Sets & PowerPlans
19.2
Common Pediatric Cancers
19.2.1
Hematologic Cancers
19.2.2
Musculoskeletal Tumors
19.2.3
Nervous System Tumors, managed by Neuro-Oncologists
19.2.4
Nervous System Tumors, managed by Non-Neuro Oncologists
19.2.5
Kidney Tumors
19.2.6
Liver Tumors
19.2.7
Germ Cell Tumors
19.3
Common Chemotherapies
19.4
Common Targeted Therapies
19.5
Oncologic Emergencies
19.5.1
Tumor Lysis Syndrome (TLS)
19.5.2
Fever and Neutropenia
19.5.3
Anterior Mediastinal Mass & Superior Vena Cava Syndrome
19.5.4
Spinal Cord Compression
19.5.5
Hyperleukocytosis & Leukostasis
19.5.6
Increased ICP
20
Pain
20.1
Chronic Pain
20.1.1
Complex Regional Pain Syndrome (CRPS)
20.1.2
Sickle Cell Disease
20.1.3
Adjunct Pain Medications Often Used in Chronic Pain
20.2
Acute Pain
20.2.1
Post-Surgical Pain
20.2.2
Acute Infectious Pain
20.2.3
Acute Sickle Cell Pain
20.3
Cancer Pain Management
20.3.1
Patient-Controlled Analgesia (PCA)
20.3.2
Neuraxial Catheters with Pump
21
Pediatric Advanced Care Team (PACT) “CODE CARD”
21.1
Pediatric Palliative Care (PPC)
21.2
Specialty PPC at BCH
21.2.1
PACT Teams
21.2.2
Requesting a PACT Consult
21.2.3
Introducing PACT to Families: Sample Language
21.3
Primary PPC: Skills for All Clinicians
21.3.1
Promoting Child Wellbeing
21.3.2
COMMUNICATING EFFECTIVELY
21.3.3
CARING FOR A CHILD FACING END OF LIFE
22
Primary Care
22.1
Developmental Milestones
22.2
Red Flags
22.3
Newborn Visit
22.3.1
HPI
22.3.2
Exam
22.3.3
A/P
22.4
2 Month WCC
22.4.1
HPI
22.4.2
Exam
22.4.3
A/P
22.5
4 Month WCC
22.5.1
HPI
22.5.2
Exam
22.5.3
A/P
22.6
6 Month WCC
22.6.1
HPI
22.6.2
Exam
22.6.3
A/P
22.7
9 Month WCC
22.7.1
HPI
22.7.2
Exam
22.7.3
A/P
22.8
12 Month WCC
22.8.1
HPI
22.8.2
Exam
22.8.3
A/P
22.9
15 Month WCC
22.9.1
HPI
22.9.2
Exam
22.9.3
A/P
22.10
18 Month WCC
22.10.1
HPI
22.10.2
Exam
22.10.3
A/P
22.11
2 Year Old WCC
22.11.1
HPI
22.11.2
Exam
22.11.3
A/P
22.12
3 Year Old WCC
22.12.1
HPI
22.12.2
Exam
22.12.3
A/P
22.13
4 Year Old WCC
22.13.1
HPI
22.13.2
Exam
22.13.3
A/P
22.14
School Age (~5-10)
22.14.1
HPI
22.14.2
Exam
22.14.3
A/P
22.15
Middle School (~11-13)
22.15.1
HPI
22.15.2
Exam
22.15.3
A/P
22.16
Adolescence (~13-18)
22.16.1
HPI
22.16.2
Exam
22.16.3
A/P
22.17
Vaccine Schedule (Birth to 18 years)
22.18
CHPCC Vaccine Schedule
22.19
CHPCC Screening Schedule
22.20
BMC Clinic Screening Questionnaire Schedule
22.21
Autism Management in Primary Care Clinic (**CHOP EBG)
22.21.1
Who to Screen
22.21.2
How to Screen
22.21.3
Developmental Red Flags
22.21.4
Positive screening - what now?
22.21.5
Follow up
22.22
ADHD
22.22.1
EBGs
22.22.2
ADHD Definition
22.22.3
How to Screen
22.22.4
Common Coexisting Disorders
22.22.5
Additional Evaluation PRN
22.22.6
Considerations Prior to Initiating Pharmacotherapy
22.22.7
Follow Up
22.22.8
General Prescribing Principles
22.22.9
Stimulants
22.23
Anxiety
22.23.1
Types of Anxiety Disorders
22.23.2
How to Screen
22.23.3
Positive Screening
22.23.4
Initial treatment (school aged)
22.24
Depression
22.24.1
Background
22.24.2
Neurovegetative Symptoms (SIGECAPS)
22.24.3
How to Screen
22.24.4
Therapy
22.24.5
Follow Up
22.25
Medication Management: Anxiety and Depression
22.25.1
Side Effects/Precautions with SSRI use (see chart below for medication recs)
22.25.2
Anxiety
22.25.3
Depression
22.26
BMC Primary Care Clinic Resources
22.26.1
Asthma Education
22.26.2
Reach out and Read (ROR)
22.26.3
Lactation Resources
22.26.4
Food Pantry
22.26.5
Street Cred
22.26.6
Child Witness to Violence Project
22.27
BMC Pediatrics Specialty Outpatient Clinics
22.27.1
CCP Clinic
22.27.2
GROW Clinic
22.27.3
Baby Steps Clinic
22.28
SoFAR Clinic
22.28.1
Teen and Tot Clinic
22.28.2
IEP Clinic
22.28.3
Family Planning Services
22.28.4
Pain Clinic
22.28.5
CATALYST Clinic
22.28.6
Menstrual Disorders Clinic
22.28.7
Lead Clinic
22.28.8
CATCH Clinic
22.28.9
Embedded Child Psychiatrist
22.29
BMC Indications for Social Work Consult
22.30
BMC Clinic Tips
22.31
CHPCC Co-Located “Specialty” Clinics
22.31.1
Asthma Clinic
22.31.2
Advocating Success for Kids (ASK)
22.31.3
Rainbow
22.31.4
RASH
22.31.5
Young Parents Program (YPP)
22.32
CHPCC Contacts
23
Psychiatry
23.1
Consulting Psych
23.2
A/P Template for Patients Awaiting Inpatient Psych Placement
23.3
Agitation
23.3.1
Identifying Agitation
23.3.2
Non-Pharm Management
23.3.3
Restraints
23.3.4
Pharmacologic Management
23.4
Medications That Cause Psychiatric Side Effects
23.4.1
Selected Meds
23.4.2
Psychosis
23.4.3
Agitation/Confusion/Delirium
23.4.4
Depression
23.4.5
Anxiety
23.4.6
Sedation/Poor concentration
23.5
Capacity Assessment
23.6
Depression & Anxiety
23.6.1
Diagnosis
23.6.2
Management
23.7
Suicide
23.8
Antidepressants
23.8.1
Selective Serotonin Reuptake Inhibitors (SSRIs)
23.8.2
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
23.8.3
Tricyclic Antidepressants (TCAs)
23.8.4
Monoamine Oxidase Inhibitors (MAOIs)
23.8.5
Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
23.8.6
Alpha2-Adrenergic Receptor Antagonists
23.8.7
Serotonin Receptor Antagonists and Agonists
23.8.8
Nicotinic ACh Receptor Partial Agonist
23.9
Antipsychotics
23.9.1
Typical Antipsychotics (1st Generation)
23.9.2
Atypical Antipsychotics (2nd Generation)
23.10
Mood Stabilizers
23.10.1
Lithium
23.10.2
Valproic Acid (Depakote)
23.10.3
Carbamazepine (Tegretol)
23.10.4
Buspirone (BuSpar)
23.10.5
Benzodiazepines
23.10.6
Barbiturates
23.10.7
Non-Benzodiazepine Hypnotics
23.11
Other Psychotropic Medications
23.11.1
Stimulants
23.11.2
Acetylcholinesterase Inhibitors
23.11.3
NMDA (Glutamate) Receptor Antagonist
23.12
Electroconvulsive Therapy (ECT)
23.12.1
Definition
23.12.2
Indications
23.12.3
Safety
23.12.4
Side Effects
23.13
Psychotherapy
24
Pulmonology
24.1
Asthma – ED/Inpatient: EBG
24.1.1
History to Elicit
24.1.2
Exam
24.1.3
Etiology
24.1.4
Work-up
24.1.5
Order Sets
24.1.6
Treatment
24.1.7
Discharge Criteria
24.2
Asthma – Outpatient:
24.2.1
History to Elicit
24.2.2
Presentation
24.2.3
Etiology
24.2.4
Workup
24.2.5
Severity Classification
24.2.6
Stepwise Approach to Asthma Treatment
24.3
Bronchiolitis: EBG
24.3.1
Presentation
24.3.2
Differential
24.3.3
Workup
24.3.4
Treatment
24.3.5
Prevention
24.4
Approach to Cough
24.4.1
Definition
24.4.2
History to Elicit
24.4.3
Exam
24.4.4
Differential Diagnosis
24.5
Cystic Fibrosis: EBG
24.5.1
Clinical Manifestations
24.5.2
Diagnosis
24.5.3
Pulmonary Exacerbations
24.5.4
Chronic Pulmonary Treatment
24.5.5
Treatment CF Exacerbations
24.5.6
Admission Labs
24.5.7
Lab monitoring:
24.5.8
Antibiotics:
24.5.9
Pulmonary Clearance:
24.5.10
Bowel Regimen
24.6
Hemoptysis (CF)
24.6.1
Definition
24.6.2
Management
24.6.3
Clinically stable patient with hemoptysis
24.7
Pneumothorax
24.7.1
Types
24.7.2
Presentation
24.7.3
Workup
24.7.4
Management
24.8
Pneumonia: EBG
24.8.1
Presentation
24.8.2
Etiology
24.8.3
Differential
24.8.4
Workup
24.8.5
When to Hospitalize
24.8.6
Treatment
24.9
Pleural Effusions
24.9.1
Presentation
24.9.2
Differential
24.9.3
Workup
24.9.4
Treatment
24.10
Obstructive Sleep Apnea
24.10.1
Presentation
24.10.2
Differential
24.10.3
Workup
24.10.4
Treatment
24.11
Tuberculosis
24.11.1
Symptoms
24.11.2
Workup
24.11.3
Treatment
24.12
Pulmonary Function Tests
24.12.1
Definitions
24.13
Obstructive vs. Restrictive Lung Disease
24.14
Bronchodilator/Bronchoprovocation Testing in Asthma
24.15
EVALI (E-Cigarette and Vaping Associated Lung Injury)
24.15.1
Presentation
24.15.2
Etiology/Pathophysiology
24.15.3
Differential
24.15.4
Proposed Criteria for Diagnosis
24.15.5
Workup
24.15.6
Consults
24.15.7
Treatment
25
Rheumatology
25.1
Pediatric approach to rheumatic disease
25.2
Inflammatory markers and autoantibodies
25.3
Childhood Vasculitides
25.4
Henoch-Schonlein Purpura (IgA vasculitis)
25.5
Kawasaki Disease
25.6
Polyarteritis Nodosa
25.7
Connective Tissue Disorders
25.7.1
SLE
25.7.2
Juvenile Polymyositis
25.7.3
Juvenile Dermatomyositis
25.7.4
Sjogren’s
25.7.5
Scleroderma
25.7.6
CREST
25.7.7
Mixed Connective Tissue Disease
25.8
Systemic Lupus Erythematosus
25.9
Inflammatory Myopathies
25.10
Sjogren Syndrome
25.11
Pediatric arthritides: Approach to Joint Disease
25.12
Juvenile Idiopathic Arthritis
25.13
Systemic JIA (Still’s disease)
25.14
Macrophage Activation Syndrome (MAS)
25.15
Fever of Unknown Origin
25.16
Autoinflammatory Diseases
25.16.1
Periodic Fever Syndromes
25.16.2
Autoinflammatory Disorders without Periodic Fever
25.17
Common Rheumatology Medications
26
Sports Medicine
26.1
General Approach to the MSK Exam
26.2
Fractures
26.2.1
Salter-Harris Classification for Physeal Fractures
26.3
Pre-Participation Physical
26.4
Upper Extremity: Elbow, Forearm & Wrist
26.4.1
Anatomy
26.4.2
Exam Pearls
26.4.3
Supracondylar Fracture
26.4.4
Nursemaid’s Elbow (Subluxation of Radial Head)
26.4.5
Distal Radius Fracture
26.5
Upper Extremity: Shoulder
26.5.1
Anatomy
26.5.2
Exam Pearls & Special Tests
26.5.3
Proximal Humeral Fracture
26.5.4
Dislocation
26.5.5
Rotator Cuff Injury
26.5.6
Little Leage Shoulder (Proximal Humeral Epiphysiolysis)
26.5.7
Acromioclavicular (AC) Joint Injury
26.5.8
Clavicular Fracture
26.6
Lower Extremity: Hip
26.6.1
Anatomy
26.6.2
Exam Pearls & Special Tests
26.6.3
Legg-Calve-Parthes Disease
26.6.4
Slipped Capital Femoral Epiphysis (SCFE)
26.6.5
Developmental Dysplasia of the Hip (DDH)
26.6.6
Femoroacetabular Impingement (FAI)
26.7
Lower Extremity: Knee
26.7.1
Anatomy
26.7.2
Exam Pearls & Special Tests
26.7.3
Osgood-Schlatter Disease
26.7.4
Patellofemoral Pain Syndrome (PFPS)
26.7.5
Anterior Cruciate Ligament (ACL) Injuries
26.7.6
Meniscus Injuries
26.7.7
Iliotibial (IT) Band Syndrome
26.7.8
Osteochondritis Dissecans
26.8
Lower Extremity: Ankle/Foot
26.8.1
Anatomy
26.8.2
Exam Pearls & Special Tests
26.8.3
Ankle Sprain
26.8.4
Sever’s Disease
26.8.5
Spiral/Oblique Fracture
26.8.6
Congenital Clubfoot
26.9
Spine
26.9.1
Anatomy
26.9.2
Exam Pearls & Special Tests
26.9.3
Scoliosis
26.9.4
Spondylolysis & Spondylolisthesis
26.9.5
Spondyloarthropathies
26.10
Head
26.10.1
Mild Traumatic Brain Injury (TBI) (Concussion)
27
Toxicology
27.1
Key Resources
27.2
Approach to Poisoned Patient
27.2.1
Stabilization
27.2.2
Physical Exam
27.2.3
History
27.2.4
Basic Labs
27.2.5
Tox Screens
27.2.6
Management
27.3
Toxidromes
27.4
Differential Diagnosis (non-exhaustive)
27.4.1
Temperature
27.4.2
Heart Rate
27.4.3
Blood Pressure
27.4.4
Respiratory Rate
27.4.5
Blood Glucose
27.5
Acetaminophen Overdose
27.5.1
Toxic Dose
27.5.2
Pathophysiology
27.5.3
Symptoms
27.5.4
Evaluation
27.5.5
Management
27.5.6
Rule of 150
27.6
Aspirin Overdose
27.6.1
Toxic Dose
27.6.2
Pathophysiology
27.6.3
Symptoms
27.6.4
Evaluation
27.6.5
Management
27.7
Beta-Blocker Overdose
27.7.1
Toxic Dose
27.7.2
Pathophysiology
27.7.3
Symptoms
27.7.4
Evaluation
27.7.5
Management
27.8
Calcium Channel Blocker Overdose
27.8.1
Toxic Dose
27.8.2
Pathophysiology
27.8.3
Symptoms
27.8.4
Evaluation
27.8.5
Management
27.9
Antidepressants: SSRIs and SNRIs
27.9.1
Toxicity
27.9.2
Pathophysiology
27.9.3
Symptoms
27.9.4
Evaluation
27.9.5
Management
27.10
Antidepressants: TCAs
27.10.1
Toxic Dose
27.10.2
Pathophysiology
27.10.3
Symptoms
27.10.4
Evaluation
27.10.5
Management
27.11
Antidepressants: Buproprion
27.11.1
Toxic Dose
27.11.2
Pathophysiology
27.11.3
Symptoms
27.11.4
Evaluation
27.11.5
Management
27.12
Iron
27.12.1
Toxic Dose
27.12.2
Pathophysiology
27.12.3
Symptoms
27.12.4
Evaluation
27.12.5
Management
27.13
Lead
27.13.1
Toxic Dose
27.13.2
Pathophysiology
27.13.3
Symptoms
27.13.4
Evaluation
27.13.5
Management
27.14
Drugs of Abuse
27.14.1
Ethanol
27.14.2
Marijuana
27.14.3
Stimulants (Amphetamines, Cocaine, Ecstasy/MDMA, “Bath Salts”)
27.14.4
Opioids
References
Published with bookdown
BCRP Handbook
References