Rare that affects one or two women per 1000 births, can occur as early as two days after delivery and is a psychiatric emergency. Manifestations include confusion, agitation, bizarre behavior, sleeplessness, hallucinations, and delusions, may have depression,

Tone: uterine atony is the inability of the uterus to contract and may lead to continuous bleeding. Retained placental tissue and infection may contribute to uterine atony.

Trauma: trauma from the delivery may tear tissue and vessels leading to significant postpartum bleeding.

Tissue: retention of tissue from the placenta or fetus may lead to bleeding.

Thrombin: a bleeding disorder occurs when there a failure of clotting, such as with diseases known as coagulopathies.

Medication

Intravenous oxytocin is the drug of choice for postpartum hemorrhage

Beta-adrenergic agents

  Ritodrine, Terbutaline

    Stops preterm labor

    Relaxes smooth muscles

    Increases blood sugars

  Side Effects

    Rapid heart rate

    Fluid back up into lungs, monitor for pulmonary edema

    Tachycardia, SOB, Chest pain, Hypokalemia

Magnesium sulfate

  Relaxes smooth muscles

  Calcium blocker

  Antidote: Calcium Gluconate

  Side Effects

    Resp or cardiac depression

    Reduce FHR

    Warm feeling, diminished reflexes and malaise

  Indomethacin

  Avoid after 32wks gestation, risk of premature closure to ductus arteriosus

  Stimulates uterine contractions

  Side Effects

    Epigastric pain, Nausea

Cervical Ripening

  Prostaglandins (PGE2)

    Cervidil, gel impregnated tape wrapped around cevix

    Prepidil, gel inserted into cervical os

  Misoprostol

    Cytotec, ¼ pill inserted into posterior fornix

Oxytocin/Pitocin

    Concentration 20-30 units/1000ml, IVPB

    Dose in miliunits/minute, start at low dose

    Risks

      Water retention: water intoxication

      Uterine hyperstimulation: fetal stress

labor analgesia, anesthesia, agonists, antagonists

Opioid Analgesics

  Pure agonists

    Morphine

    Demerol, respiratory depressant with infants

    Fentanyl

  Narcotic Antagonist

    Pain will return

  Mixed agonists/antagonists

    Nubain

    Stadol

Neonatal Complications

Birth injury r/t Macrosomia

Risk for:

  Hypoglycemia r/t Hyperinsulinemia

  Respiratory distress r/t Lack of surfactant

  Hyperbilirubinemia r/t Polycythemia

  Hypocalcemia r/t Blunted parathyroid hormone response, may be due to

    Hypomagnesemia

develops in an unborn infant when the mother and baby have different blood types. The mother produces antibodies that attack the developing baby's red blood cells.

The most common form of erythroblastosis fetalis is ABO incompatibility, which can vary in severity.

The less common form is called Rh incompatibility, which can cause very severe anemia in the baby.

Erythroblastosis fetalis Symptoms

• Anemia

• Edema (swelling under the surface of the skin)

• Enlarged liver or spleen

• Hydrops (fluid throughout the body's tissues, including in the spaces containing the lungs, heart, and abdominal organs)

• Newborn jaundice

HYPERBILIRUBINEMIA

Pathologic cause

Increased load of circulation bilirubin

  Polycythemia, echymosis, hematoma and hemolysis

Impaired hepatic functioning

Perinatal complications

Delayed excretion of meconium

pathologic vs physiologic Jaundice

Physiologic

  Immature functioning of newborn

  Commonly seen in term infants days 2-3

  Commonly seen in preterm infants days 3-9

  Increased first appears after 24hrs

  Peaks day 3-4 (5-6 preterm)

    Indirect values don’t exceed 12mg/dl

    Daily increases don’t exceed 5mg/dl

Disappears by day 7 (9-10 preterm)

Pathologic

  Appears within first 24hrs of life, persists longer and levels may increase more

NEONATAL RESUSCITATION

Primary Apnea

When asphyxia occurs, infant responds with increased RR

If asphyxia continues, infant becomes apneic, HR drops and BP increases

Stimulation and oxygen will restore spontaneous respirations

Secondary Apnea (Requires resuscitation)

If asphyxia continues beyond primary apnea level, infant responds with gasping respirations, further decrease in HR and Decrease in BP

The infant takes a last gasp and enters into a second period of apnea

Infant will not respond to stimulation and death will occur unless immediate resuscitation initiated

RDS is the major cause of respiratory distress in the newborn and prematurity is the single most important risk factor

Etiology

Immature lungs and inadequate surfactant production

  Surfactant composed of Lecithin and Sphingomyelin (L/S)

  Lecithin levels increase gradually starting around 27 wks with sharp increase around

    35 wks gestation

  Sphingomyelin remains constant

  L/S ratio of greater than 2:1 indicates mature lungs

Decreased muscle mass in respiratory muscles

Immature respiratory center

Decreased chest wall compliance

 is a recessive X-linked form of muscular dystrophy, which results in muscle degeneration, difficulty walking, breathing, and death.

Early signs may include pseudohypertrophy (enlargement of calf and deltoid muscles), low endurance, and difficulties in standing unaided or inability to ascend staircases. As the condition progresses, muscle tissue experiences wasting and is eventually replaced by fat and fibrotic tissue (fibrosis).

 is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein^[1] (proteinuria at least 3.5 grams per day per 1.73m² body surface area)^[2] from the blood into the urine.

it is characterized by proteinuria (>3.5g/day), hypoalbuminemia, hyperlipidemia and edema which is generalized & also known as anasarca or dropsy. Common among 2–6 years old boys. The edema begins in the face.

Babies born with severe CP often have an irregular posture; their bodies may be either very floppy or very stiff. Birth defects, such as spinal curvature, a small jawbone, or a small head sometimes occur along with CP. 

 CP becomes evident when the baby reaches the developmental stage at six and a half to 9 months and is starting to mobilise, where preferential use of limbs, asymmetry or gross motor developmental delay is seen

caring for children with Duchenne & respiratory infection

Patients should visit a physician specializing in pediatric

respiratory care twice yearly after confinement to a wheelchair, fall in vital capacity below 80% predicted, and/or age 12 years.

• Children should have at least one visit with a physician specializing in pediatric respiratory care early in the course of the disease (between 4 and 6 years of age) and before confinement to a wheelchair to obtain baseline pulmonary function testing, for anticipatory medical guidance regarding the potential respiratory complications of the disease, and to assess the need for intensified therapy.

• Individuals who require mechanically assisted airway clearance therapy or mechanically assisted ventilation should see a pulmonologist every 3 to 6 months or as indicated for routine follow-up.

treatment of osteomyelitis

Hip dysplasia, developmental dysplasia of the hip (DDH)^[1] or congenital dysplasia of the hip (CDH)^[2] is a congenital or acquired deformation or misalignment of the hip joint.

Treatment: harness, cast, traction, surgery

Skin traction is generally less desirable due to the fact that skin can be injured when pressure is applied for extend periods of time. Skin traction called Buck's traction is commonly used in patients who have a hip fracture.

Skeletal traction does have the disadvantage of complications associated with pin insertion, and infections can come from the sites of pin insertion.

 is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). While a number of disorders may result in hyperthyroidism, Graves' disease is the most common cause

Radioactive iodine therapy
With this therapy, you take radioactive iodine, or radioiodine, by mouth. Because the thyroid needs iodine to produce hormones, it takes up the radioiodine, which destroys the overactive thyroid cells over time. This causes your thyroid gland to shrink, and problems lessen gradually, usually over several weeks to several months.

Anti-thyroid medications interfere with the thyroid's use of iodine to produce hormones. These prescription medications include propylthiouracil and methimazole (Tapazole).

Beta blockers
These medications don't inhibit the production of thyroid hormones, but they do block the effect of hormones on the body. They may provide fairly rapid relief of irregular heartbeats, tremors, anxiety or irritability, heat intolerance, sweating, diarrhea and muscle weakness.

mite that burrows under the skin

Clothes, bedding, and towels used by the infested person should be washed in hot water two days before treating scabies. Lotions used to treat the infection include sulfur, permethrin, and lindane. In people with HIV (or those with Norwegian scabies), an oral medication known as ivermectin is typically used. It is possible to get a scabies infection again despite successful treatment.

Tegretol or Carbatrol (carbamazepine)

• First choice for partial, generalized tonic-clonic and mixed seizures.

Dilantin (Phenytoin)

• Controls partial seizures and generalized tonic-clonic seizures. 

Depakene, Depakote (valproate, valproic acid)

• Used to treat partial, absence, and generalized tonic-clonic seizures.

Valium and similar tranquilizers such as Klonopin or Tranxene

• Effective in short-term treatment of all seizures. Used often in the emergency room to stop a seizure.

Encephalitis is a general term that means inflammation of the brain.

Encephalitis can occur two different ways: from direct infection of the brain, or from a previous infection that causes your immune system to attack your brain. Direct infection can be caused by many different agents, including bacteria, fungi, and viruses. This article will explore only viral causes of encephalitis. There are many encephalitis-causing viruses, so only causes, symptoms, and treatment related to the most common viruses will be discussed.

defining characteristics Legg Calve Perthes disease

Common symptoms include hip, knee, or groin pain, exacerbated by hip/leg movement. The pain feels like a tooth ache, possibly severe. There is a reduced range of motion at the hip joint and a painful or antalgic gait. There may be atrophy of thigh muscles from disuse and an inequality of leg length. In some cases, some activity can cause severe irritation or inflammation of the damaged area including standing, walking, running, kneeling, or stooping repeatedly for an extended period of time.

The first signs are complaints of soreness from the child, which are often dismissed as growing pains, and limping or other guarding of the joint, particularly when tired. The pain is usually in the hip, but can also be felt in the knee ('referred pain'). In some cases, pain is felt in the unaffected hip and leg due to the child favoring the injured side and placing the majority of their weight on the "good" leg. It is predominantly a disease of boys. Perthes is generally diagnosed between 5 and 12 years of age, although it has been diagnosed as early 18 months. Typically the disease is only seen in one hip, but bilateral Perthes is seen in about 10-20% of children diagnosed.

Onset of pain may be up to 4 hours after inactivity. Knee pain is felt in the back of the knee rather than in the front, not unlike a localized charley horse. This lasts for an hour or so and returns nightly on inactivity.

 (CP), defined as a nonprogressive disorder of posture or movement due to a lesion in the developing brain. While in certain cases there is no identifiable cause, typical causes include problems in intrauterine development (e.g. exposure to radiation, infection), asphyxia before birth, hypoxia of the brain, and birth trauma during labor and delivery, and complications in the perinatal period or during childhood. CP is also more common in multiple births.

Treatment for high blood pressure
Keeping your blood pressure under control is key to protecting your kidneys. To control your high blood pressure and slow the decline in kidney function, your doctor may prescribe one of several medications, including:

• Diuretics
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor agonists

Treatment for an underlying cause
If there's an underlying cause for your kidney inflammation, your doctor may prescribe other drugs to treat the underlying problem, in addition to treatment to control any hypertension:

• Strep or other bacterial infection.Your doctor likely will prescribe an appropriate antibiotic.
• Lupus or vasculitis.Doctors often prescribe corticosteroids and immune-suppressing drugs to control inflammation.
• IgA nephropathy.Both fish oil supplements and certain immune-suppressing drugs have been successful in some people with IgA nephropathy. Further research is being done.
• Goodpasture's syndrome. Plasmapheresis is sometimes used to treat people with Goodpasture's syndrome. Plasmapheresis is a mechanical process that removes antibodies from your blood by taking some of your plasma out of your blood and replacing it with other fluid or donated plasma.

Myelomeningocele is a birth defect in which the backbone and spinal canal do not close before birth. The condition is a type of spina bifida

newborn may have a sac sticking out of the mid to lower back. The doctor cannot see through the sac when shining a light behind it. Symptoms include:

• Loss of bladder or bowel control
• Partial or complete lack of sensation
• Partial or complete paralysis of the legs
• Weakness of the hips, legs, or feet of a newborn

Juvenile rheumatoid arthritis causes persistent joint pain, swelling and stiffness. Some children may experience symptoms for only a few months, while others have symptoms for the rest of their lives. There are several types of juvenile rheumatoid arthritis, each classified according to:

• The number of joints affected
• The signs and symptoms
• The results of blood tests

Some types of juvenile rheumatoid arthritis can cause serious complications, such as growth problems and eye inflammation. Treatment of juvenile rheumatoid arthritis focuses on controlling pain, improving function and preventing joint damage.