Cataracts In Children
Causes and Associated Conditions
Intrauterine Infection
Rubella
Toxoplasmosis
Herpes simplex
Cytomegalovirus
Varicella
Metabolic Disorders
Galactosemia
Galactokinase deficiency
Hypoparathyroidism
Pseudohypoparathyroidism
Diabetes mellitus
Hypoglycemia
Hyperalimentation (vacuoles)
Mannosidosis
Drug-induced
Cortiocosteroids
Chlorpromazine
Ergot
Naphthalene
Triparanol
Inflammatory
Juvenile rheumatoid arthritis
Sarcoidosis
Atopic dermatitis
Trauma
Genetic/Syndromes
Autosomal dominant
Autosomal recessive
X-linked recessive
Down syndrome (trisomy 21)
Trisomy 13
Trisomy 18
Lowe syndrome
Dubovitz syndrome
Hallerman-Streiff syndrome
Alport’s syndrome
Cri du chat syndrome
Cerebrotendinous xanthomatosis
Marinesco-Sjögren syndrome
Myotonic dystrophy
Rothmund-Thomson syndrome
Cockayne’s syndrome
Incontinentia pigmenti
Stickler syndrome
Craniofacial syndromes
Zellweger syndrome
Hallgren syndrome
Laurence-Moon-Bardet-Biedl syndrome
Chondrodysplasia punctata
Refsum’s disease
Congenital ichthyosis
Sclerodactyly
G-6-PD deficiency
Rubinstein-Taybi syndrome
Radiation Injury
Ocular Disease
Retinitis pigmentosa
Aniridia
Persistent Hyperplastic
Primary vitreous
Leber’s congenital amaurosis
Retinopathy of prematurity
Retinoblastoma
dopamine, epinephrine, and dobutamine
improve
cardiac contractility
increase
heart rate
increase
cardiac output.
Digoxin should be avoided.
adverse
effects may result from larger doses
toxicity is
less predictable, depending on myocardial and serum potassium and calcium
levels.
patients with cardiovascular shock have compromised renal
perfusion
digoxin may result in high blood levels because it is
excreted in the kidneys
High after load
Patients may have a increase in systemic vascular resistance
resulting
in high afterload
poor
peripheral perfusion.
afterload-reducing agents =, nitroprusside used in
combination with dopamine.
pulmonary thermo-dilution catheter = measures cardiac index
and to calculate systemic vascular resistance
intra-aortic balloon counter-pulsation
reduces
afterload by mechanical means
increases
diastolic coronary perfusion.
ECMO - extracorporeal membrane oxygenation is useful in
reversible ventricular failure
Assess pulse (central and peripheral) and capillary refill
(assuming extremity is warm): <2 sec is normal, 2 to 5 sec is delayed, and
>5 sec is markedly delayed, suggesting shock. Decreased or altered mental
status may be a sign of inadequate perfusion.
Blood pressure (BP): Measuring blood pressure is one of the
least sensitive measures of adequate circulation in children.
MANAGEMENT
Chest compressions
Fluid resuscitation
If peripheral intravenous (IV) access is not obtained in 90
sec or three attempts, and the patient is <8 years old, then place an
intraosseous (IO) needle
If still unsuccessful, consider central venous access.
Initial fluid should be lactated Ringer’s (LR) or normal
saline (NS).
Administer a bolus with 20 mL/kg over 5 to 15 minutes.
Reassess. If there is no improvement, consider a repeat bolus with 20 mL/kg of
the same fluid.
Reassess. If replacement requires more than 40 mL/kg, or if
there is acute blood loss, consider 5% albumin, plasma, or packed red blood
cells (RBCs) at 10 mL/kg.
If cardiogenic etiology is suspected, fluid resuscitation
may worsen clinical status.
Pharmacotherapy: See inside front and back covers for
guidelines for drugs to be considered in cardiac arrest.
Note: Consider early administration of antibiotics or
corticosteroids if clinically indicated.
MANAGEMENT OF CIRCULATION
Location * Rate
(per min) Compressions: Ventilation
Infants >100
5:1
1 finger-breadth below intermammary line
Children (<8 yr) 100 5:1
2 finger-breadths below intermammary line
Older children 100 15:2
(>8 yr Lower half of sternum
*Depth of compressions should be one third to one half anteroposterior
(AP) diameter of the chest and should produce palpable pulses.
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