Pediatrics on call by Charles A Pohl

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By Charles A Pohl

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Motion and improper oximeter probe placement may lead to falsely low readings. If pulse tracing is strong and corresponds to the heart rate, and the reading remains low, provide oxygen and examine patient. B. What is patient’s ventilation and hemoglobin saturation state? Pulse oximeters reflect only oxygenation and do not measure ventilation. Altered hemoglobin saturation states (eg, methemoglobin and carboxyhemoglobin) may lead to false oximeter readings. C. How severe and prolonged has hypoxia been?

May result from primary or secondary brainstem lesions. d. Ataxic breathing. May result from primary disruption of medullary respiratory centers. 4. Toxidromes (see Table I–4). 5. Neurologic findings. Perform a thorough neurologic exam. 6. Smell of patient’s breath. May reveal alcohol intoxication or diabetic ketoacidosis. 7. Signs of trauma. Boggy scalp swelling, Battle sign, raccoon eyes, retinal hemorrhages, hemotympanum, bruises, hematomas. 8. Abdomen. Tenderness and palpable sausage-shaped mass are consistent with intussusception.

The best imaging study for gynecologic causes of abdominal pain (eg, ovarian torsion, ovarian cysts, PID with tuboovarian abscess). May identify inflamed appendix when diagnosis is unclear. 3. CT scan. Provides excellent anatomic detail of entire abdomen. Considered 95% accurate in diagnosing appendicitis. Typhlitis may be diagnosed and followed to identify necrosis and perforation. Because significant radiation exposure is involved, use only when necessary. 4. GI contrast x-rays. Immediately obtain an upper GI series for bilious vomiting if midgut volvulus is suspected.

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