#flu v rsv

[reportwire]

COVID, flu, RSV: The benefits of advocating for boosters in the workplace–and how to go about it

COVID, flu, RSV: The benefits of advocating for boosters in the workplace–and how to go about it

With a triple pandemic of COVID, flu, and Respiratory syncytial virus (RSV) hitting the U.S. hard this winter and resulting in an explosion of cases, business executives need to take the lead on promoting the newly updated, Omicron-specific boosters. Doing so will help reduce the number of sick days taken by their workers, minimize COVID outbreaks and superspreader events in their companies,…

[breesays]

Des Does CHLA

It’s been an interesting nearly two weeks. First, my phone died, upsetting my life in a multitude of ways including but not limited to: navigation, baby monitors, music, COMMUNICATION. But I’m not gonna bury the lede, which is: Desmond was in the hospital for three days.

Let me start from the beginning. Or the beginning of THIS particular strain, which was also the failing of my own immune system. Oh, and Tim’s. It was a Tuesday, I had no voice and no phone and when I picked Desmond up from daycare he had a fever.  Wednesday we both got worse. I tried to make an appointment with the pediatrician but they were full and referring to urgent care. I felt like such garbage I asked Tim to come home from work and help us. We went to urgent care and they said Des’s oxygen was a bit low. They gave him a breathing treatment and said to try baby Motrin, and to follow up with the pediatrician the next day.

I should stop to say—not only was Des coughing, secreting green junk out his eyes, barely eating and running a fever—he also just wasn’t HIMSELF. All he wanted to do was lay on me and moan. He would NOT let me put him down. He didn’t want to play and was super lethargic. We were giving him Tylenol but it was only lowering his fever a bit.

So Thursday afternoon we get an appointment with the pediatrician, who also says his oxygen is low, but not, apparently, terrible. He tests negative for the flu. The doc send us home but tells us what to watch for: Belly breathing, oxygen below 90, unresponsiveness, not eating in 6 hours, not making a wet diaper in 8 hours. 

We’re all so sick at this point. We all go to bed early. 

At 10:30PM, the Owlet starts going off. It’s saying it can’t get a reading but I see in the background the Des’s oxygen is reading 91. He’s burning up. We unzip his pajamas and he’s belly breathing. He won’t wake up. We are going to the ER.

I throw on a bra and a shirt and keep my pajama pants on, slip on some shoes. Tim throws his rain shell over Des’s carseat because of course it is raining. Bless that CHLA is only 4 minutes away.   

The waiting room is FULL and he’s just flopped over my shoulder while I’m giving info. The nurse comes out to take his temp and test his oxygen and it’s something insane like 77 we don’t have to wait at all, we are taken straight back and the nurse is like “a lot of doctors are going to descend upon him in a minute, don’t be alarmed.” I was grateful for the heads up. Within seconds he is swarmed, getting tests, getting hooked up to oxygen. Within minutes they’ve found pneumonia. He’s also dehydrated. Fluids, meds.   

The swarm leaves. They turn off the lights so we can “rest.” Desmond is laying on Tim on a stretcher. A doctor comes in to say they’ve put in a bed request for us upstairs. Adrenaline is just coursing through me. 

When we left for the ER I thought, oh, we’re going to be there several hours. We probably have to wait, and then he’ll have a breathing treatment or something. A doctor comes in around 1AM to say its RSV and pneumonia and we will likely be there 2-3 DAYS. I am suddenly both very wound up AND inexplicably exhausted. But at 5AM Friday, we get moved upstairs. We have a room with a crib and a bed-like thing and a reclining chair. A TV a bathroom and all the monitors in the world to make sure Des is doing well. Or at least getting better. I do not sleep until 1pm on Friday afternoon, after Tim had gone and collected our cold meds, blankets, toiletries and the like. 

  TO BE CONTINUED BC I AM V TIRED

[nursebettyboop-blog]

Peds

Aniridia is the absence of the iris, usually involving both eyes. It can be congenital or caused by a penetrant injury. Isolated aniridia is a congenital disorder which is not limited to a defect in iris development, but is a panocular condition with macular and optic nerve hypoplasia, cataract, and corneal changes. -Children are 20/20 in vision only when they are 6 years old.

-X-ray can be done to check for growth in those worried about being short

-2 month old:

*97.6 T

*11.7 Lbs

* 24 3/4 height

-15 diapers/day (1 poop a day-mucous/blood..any allergies that mom may be consuming?)

-Nurses 4 times a day (2 hrs each time) MD Baez recommends nursing for 30 min at a time 

-Baby taking vit D

-2 mo f/u after this visit

- Aniridia is the absence of the iris, usually involving both eyes. It can be congenital or caused by a penetrant injury. Isolated aniridia is a congenital disorder which is not limited to a defect in iris development, but is a panocular condition with macular and optic nerve hypoplasia, cataract, and corneal changes.

*spontaneous mutation

*can pass to child

*PX6 gene affected

*Check for Wilms tumor (sonogram)-kidneys

*Ck for MR

*nystagmus

*Risk: glaucoma

*Red reflex? you can see a lot of red when looking into pts eyes bec pupils are so dilated

-Gas X for gas

-Colic: bend babys knees

-In babies 1-6 mo: they grow 0.5 ounce a day

-4 ounces q 3hrs is appropriate 

-RSV-premie/cardiac pts????

-whey

casin 

-croup:

hoarse, seal like cough, adults gets laryngitis, babies get croup, at night..it is worse..baby chokes on phlegm, steam bath/cold air/saline drops into nose help. Will turn into a regular cough. Rx: presnoisolone  PO and vicks helps. IM  presnoisolone for those with stridor. NO honey!

-Inflammed eosinophillic cells via endoscopy due to food allergies: 

*budesonide PO

*Nexium

-Neocate Splash-hypoallergenic amino acids in juice form

*Eosinophilic esophagitis

*Food protein-induced enterocolitis syndromeShort bowel syndrome Malabsorption Gastroesophageal reflux

-Elecare:

*EleCare and EleCare Jr are:Hypoallergenic1,* - Virtually eliminating the potential for an allergic reaction to the formula in multiple-food-allergic children100% free amino acids as the protein sourceClinically shown to be well-tolerated1,2,*in infants and children who cannot tolerate intact or hydrolyzed protein

-pediasure: Minerals and vitamins, shakes

-The Ehlers-Danlos syndromes are a group of connective tissue disorders that can be inherited and are varied both in how affect the body and in their genetic causes. They are generally characterized by joint hypermobility (joints that stretch further than normal), skin hyperextensibility (skin that can be stretched further than normal), and tissue fragility.The Ehlers-Danlos syndromes (EDS) are currently classified into thirteen subtypes. Each EDS subtype has a set of clinical criteria that help guide diagnosis; a patient’s physical signs and symptoms will be matched up to the major and minor criteria to identify the subtype that is the most complete fit. There is substantial symptom overlap between the EDS subtypes and the other connective tissue disorders including hypermobility spectrum disorders, as well as a lot of variability, so a definitive diagnosis for all the EDS subtypes when the gene mutation is known—all but hypermobile EDS (hEDS)—also calls for confirmation by testing to identify the responsible variant for the gene affected in each subtype.

*genetic testing

* JointsJoint hypermobility; loose/unstable joints which are prone to frequent dislocations and/or subluxations; joint pain; hyperextensible joints (they move beyond the joint’s normal range); early onset of osteoarthritis.SkinSoft velvety-like skin; variable skin hyper-extensibility; fragile skin that tears or bruises easily (bruising may be severe); severe scarring; slow and poor wound healing; development of molluscoid pseudo tumors (fleshy lesions associated with scars over pressure areas).Miscellaneous/Less CommonChronic, early onset, debilitating musculoskeletal pain (usually associated with the Hypermobility Type); arterial/intestinal/uterine fragility or rupture (usually associated with the Vascular Type); scoliosis at birth and scleral fragility (associated with the Kyphoscoliosis Type); poor muscle tone (associated with the Arthrochalasia Type); mitral valve prolapse; and gum disease.Each type of Ehlers-Danlos syndrome is defined as a distinct problem in connective tissue. Connective tissue is what the body uses to provide strength and elasticity; normal connective tissue holds strong proteins that allow tissue to be stretched but not beyond its limit, and then safely return that tissue to normal. Connective tissue is found throughout the body, and Ehlers-Danlos syndromes are structural problems. An analogy: If one builds a house with faulty materials, say half the necessary wood or with soft aluminum nails, it is certain there will be problems. Some problems are more likely to show up than others, but because those materials were used everywhere and are not necessarily visible, one can be surprised by where a problem shows up or how serious it is.It is much the same thing with an Ehlers-Danlos Syndrome and connective tissue.The connective tissue a person with EDS is built with is not structured the way it should be. With a badly-constructed or processed connective tissue, some or all of the tissue in the EDS-affected body can be pulled beyond normal limits which causes damage. Connective tissue can be found almost anywhere, in skin, muscles, tendons and ligaments, blood vessels, organs, gums, eyes, and so on.The problems resulting from one’s body being built out of a protein that behaves unreliably can be widespread and in a wide range of severity. It shows up in places that seem unrelated until the underlying connection to an Ehlers-Danlos syndrome is recognized.

-Biophysical profile

Learn about and keep track of your baby's health. Special ultrasoundmethods are used to keep track of movement, increases in heart rate with movement (nonstress test), muscle tone, breathing rate, and the amount of amniotic fluid (amniotic fluid index) surrounding your baby. If these five areas are within a normal range, your baby is considered to be in good health.Check on your baby's health if you have:Hyperthyroidism.Bleeding problems.Lupus.Chronic kidney disease.Type 1 diabetes or gestational diabetes.High blood pressure (hypertension).Preeclampsia.A small amount of amniotic fluid (oligohydramnios) or too much amniotic fluid (polyhydramnios).A multiple pregnancy (such as twins or triplets).A pregnancy that has gone past your due date, between 40 and 42 weeks.

- The term broncholithiasis is used to denote the presence of calcified or ossified material within the lumen of the bronchus (1). A broncholith is usually formed by erosion by and extrusion of a calcified adjacent lymph node into the bronchial lumen and is usually associated with long-standing foci of necrotizing granulomatous lymphadenitis (Fig 1). Other causes of broncholithiasis include (a)aspiration of bone tissue or in situ calcification of aspirated foreign material; (b) erosion by and extrusion of calcified or ossified bronchial cartilage plates; and (c) migration to a bronchus of calcified material from a distant site, such as a pleural plaque or the kidney (via a nephrobronchial fistula) (1). Some authors expanded the definition to include those cases in which peribronchial calcified lymph nodes distort the bronchial tree without extrusion of the lymph node into the bronchus (2,3).

*dry unproductive cough, poor PO intake, No N/V/D, fever (104) with fatigue, poor sleep from, cough, congestion, mouth breathing, stinky odor, BMxfew times a day, green nasal discharge, wheezing (Albuterol was given). 

*Dx with flu if child has already had this for about a week

*Flu that is over 48 hours, cant iven tamiflu

*Augmentin 

*This pt has hx of febrile seizures, mom was giving motrin and tylenol alternatively to break fever but the fever wont go away

*give abx for 24 hours before kid can go back to school.