Just like you’ll see on the actual exam Based on National Board of Medical Examiner’s format.
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Utilizing a two-step approach for screening young febrile children for UTI Pyelonephritis is the most common serious bacterial infection in children and can have lasting effects, if missed. Diagnosis in febrile children typically requires a urinalysis screen followed by a confirmatory urine culture. In children who are not toilet trained, however, obtaining an accurate urine culture requires a catheterized urine specimen to avoid contamination. Given that the rate of a positive culture in all febrile children is relatively low, this protocol may lead to many unnecessary and painful urinary catheterizations. In this study, researchers at Children’s Hospital of Philadelphia examined a protocol of obtaining an initial urinalysis screen using a noninvasive urine bag. If the screen was positive for nitrites or moderate to large leukocyte esterase, a catheterized urine sample was then obtained for culture. Using this protocol in 828 febrile children, ages 6 to 24 months, who qualified for UTI screening according to AAP guidelines, the researchers were able to reduce catheterization rates from 63% to 30% with no significant change to length of stay and with no missed cases of UTI. These findings suggest that ER providers may be able to institute a two-step protocol using a non-invasive urine bag to reduce the need for urinary catheterization in young children being screened for UTI. (Two-step process for ED UTI screening in febrile young children: Reducing catheterization rates. Lavelle et al., Pediatrics, 2016)
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Boiling it down to the most high yield concepts
- Vascular leak causes local parenchymal injury and edema
- Ventilation:perfusion mismatch
- Tachypnea and hypoxia are common on initial presentation
- More than 80% of children with pulmonary contusion will have extrathoracic injuries
- Radiographic findings are often delayed
- Dependent positioning of the involved lung and positive end expiratory pressure management are important in the treatment
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