Paediatrics

Orbital Cellulitis

EMKF
  • Periorbital and Orbital Cellulitis can be difficult to distinguish from initially. Know that both have a good chance of improving with IV antibiotics.
  • Not every child with preseptal/periorbital cellulitis requires a CT in the ED to rule-out orbital involvement.
    • If there is no proptosis and normal eye movement, IV antibiotics may be sufficient.
    • Hospitalization for close reassessments and eye exam can help determine if CT is eventually required.
  • Not every child with CT proven orbital cellulitis requires surgery! So don’t be mad when the ENT doctor recommends that the child is admitted for IV antibiotics to the Pediatric Service.
  • Bilateral is Bad! Think Cavernous Sinus Thrombosis!

Surviving Sepsis Guidelines 2021: Recommendations and Best Practice Statements

EMKF
  • The recommendation for an initial fluid bolus of 30 mL/kg was downgraded from a strong recommendation to a weak recommendation, based on the low quality of evidence. However, resuscitation should start immediately.
  • Balanced crystalloid solution (e.g., lactated Ringer’s solution) should be used (rather than normal saline) for resuscitation.
  • Administration of vasopressors should be initiated via peripheral access, as opposed to waiting for placement of central venous access.
  • Patients with ongoing vasopressor requirements should receive intravenous corticosteroids (this recommendation was strengthened); however, administration of intravenous vitamin C is explicitly not recommended.

Neonatal Resuscitation

EMKF

Most infants transition from intrauterine to extrauterine life without any assistance. The term-infant with good tone, color, and respiratory effort requires no assistance and should be handed off to the mother after birth. However, approximately 10% of infants require some resuscitation and about 1% require extensive resuscitation.  The main priority in neonatal resuscitation is establishment of effective ventilation and oxygenation.

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