Gershel, Jeffrey C.; Rauch, Daniel A.'s Caring for the hospitalized child : a handbook of inpatient PDF

By Gershel, Jeffrey C.; Rauch, Daniel A.

ISBN-10: 1461948010

ISBN-13: 9781461948018

ISBN-10: 1581108109

ISBN-13: 9781581108101

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Pathologic murmurs (associated with structural heart disease): See Table 5-2. 3. Chest pain/ischemia a. Since 96% of all cases of pediatric cases of chest pain are noncardiac, most ECGs will be normal. Clinical manifestations that should be more concerning for underlying cardiac chest pain include chest pain with exertion; diaphoresis; pallor; anxiety; shortness of breath; nausea/­ vomiting; radiation of pain to arm, jaw, neck, or back; and syncope. Table 5-2. ECG Findings in Structural Heart Disease Heart Condition ECG Findings Aortic regurgitation Normal to LVH, LAH Aortic valve stenosis Normal to LVH; strain pattern Atrial septal defect RAD, RVH, RBBB Coarctation of the aorta LVH; infants may have RBBB or RVH Endocardial cushion defect Superior QRS axis, LVH or BVH Hypertrophic obstructive cardiomyopathy LVH, deep Q waves in VS and V6 Patent ductus arteriosus Normal to LVH or BVH Pulmonary stenosis Normal to RAD, RVH, (RAH in severe cases) Tetralogy of Fallot RAD, RVH or BVH, possibly RAH Ventricular septal defect Normal to LVH or BVH Abbreviations: BVH, biventricular hypertrophy; ECG, electrocardiogram; LAH, left atrial hypertrophy; LVH, left ventricular hypertrophy; RAH, right atrial hypertrophy; RAD, right axis deviation; RBBB, right bundle branch block; RVH, right ventricular hypertrophy.

However, a positive D-dimer does not confirm the diagnosis of DVT. False-positive levels occur with malignancies, trauma, recent surgery, infections, pregnancy, and acute bleeding. The differential diagnosis (Table 4-2) of suspected DVT includes a variety of disorders that present in a similar fashion. It is essential to make the diagnosis because an untreated DVT may have serious sequelae. Chapter 4: Deep Venous Thrombosis Radiology 28 Caring for the Hospitalized Child Chapter 4: Deep Venous Thrombosis Table 4-2.

An infant may have nonspecific signs and symptoms, such as tachypnea, diaphoresis and/or cyanosis with feeds, irritability, and inconsolability. An older patient may complain of chest pain, nausea, palpitations, syncope/near syncope, or shortness of breath. Any age patient can present with cardiovascular collapse. Have the patient or family describe the episode and whether there were any previous similar episodes. Assess for other symptoms, including chest pain, lightheadedness, dyspnea, palpitations, fatigue, irritability, and altered mental status.

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Caring for the hospitalized child : a handbook of inpatient pediatrics by Gershel, Jeffrey C.; Rauch, Daniel A.


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