About the Editors Contributors Reviewers Preface Foreword 1. ADOLESCENT MEDICINE Krishna Wood, MD, Leonard J. Levine, MD, Marina Catallozzi, Donald F. Schwarz, MD, MPH Anorexia Nervosa Dysfunctional Uterine Bleeding Emergency Contraception Pelvic Inflammatory Disease 2. ALLERGY AND ASTHMA Erin E. McGintee, MD, Nicholas A. Pawlowski, MD Anaphylaxis Asthma Serum Sickness Urticaria/Angioedema 3. ANALGESIA AND SEDATION Suzanne Beno, MD, FRCPC, Jimmy W. Huh, MD Analgesia Assessment of Pain Local Anesthesia Narcotic Analgesics Non-Narcotic Analgesics Non-Pharmacologic Methods of Analgesia Patient Controlled Analgesia (PCA) Sedation Preparation for Sedation Pre-Procedure Sedation Suggestions Post Procedure 4. CALCULATIONS Gary Frank, MD, MS Alveolar - Arterial Oxygen Gradient Absolute Neutrophil Count Anion Gap (Serum) Biostatistics Body Mass Index Body Surface Area (Mosteller Method) Conversions Corrected QT Interval (QTc) Corrected Serum Calcium (for Low Albumin) Corrected Serum Sodium (for Hyperglycemia) Creatinine Clearance (from Timed Urine Collection) Creatinine Clearance (Schwartz Method) Fractional Excretion of Sodium Free Water Deficit Glomerular Filtration Rate (Schwartz Formula) Glucose Infusion Rate Mean Arterial Pressure Osmolality (Serum) 5. CARDIOLOGY Gary Frank, MD, MS, Sara K. Pasquali, MD, Larry A. Rhodes, MD Congenital Heart Disease Aortic Stenosis Atrial Septal Defect Coarctation of the Aorta Endocardial Cushion Defect Hypoplastic Left Heart Syndrome Tetralogy of Fallot Total Anomalous Pulmonary Venous Return Transposition of the Great Arteries Tricuspid Atresia Truncus Arteriosus Ventricular Septal Defect Surgeries for Congenital Heart Disease Acquired Heart Disease Congestive Heart Failure Endocarditis Endocarditis Prophylaxis Myocarditis Pericarditis Electrocardiography Precordial Lead Placement Rate Rhythm Axis P wave PR Interval QRS Complex QT Interval ST Segment T Wave Left Ventricular Hypertophy, ECG signs Right Ventricular Hypertrophy, ECG signs Arrhythmias Atrial Fibrillation Atrial Flutter Atrioventricular Block Long QT Syndrome Premature Atrial Contraction Premature Ventricular Contraction Supraventricular Tachycardia Syncope Ventricular Fibrillation Ventricular Tachycardia Wolff-Parkinson-White Syndrome 6. DERMATOLOGY Sogol Mostoufi-Moab, MD, Albert C. Yan, MD Blistering Disorders Necrotizing Fasciitis Staphylococcal Scalded Skin Syndrome Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Exanthems Acute Urticarial Hypersensitivity Erythema Multiforme (Minor) Vascular Phenomena Complicated Hemangiomas 7. EMERGENCY MEDICINE Andrea Dahlman, MD, Mark D. Joffe, MD Primary and Secondary Survey Primary Survey Secondary Survey Selected Topics in Emergency Medicine Burns Closed Head Injury Concussion Drowning and Near Drowning Hypothermia 8. ENDOCRINOLOGY Francis M. Hoe, MD, Malaka B. Jackson, MD, Adda Grimberg, MD, FAAP Diabetes Mellitus and Diabetic Ketoacidosis Diabetes Mellitus Diabetic Ketoacidosis Hypothalamic-Pituitary-Adrenal Axis Adrenal Insufficiency Congenital Adrenal Hyperplasia Cushing Syndrome Thyroid Disease Congenital Hyperthyroidism Graves Disease Other Selected Topics Cerebral Salt Wasting Diabetes Insipidus Hypoglycemia Rickets Syndrome of Inappropriate Antidiuretic Hormone Tanner Staging 9. FLUIDS AND ELECTROLYTES Gary Frank, MD MS, Vijay Srinivasan, MD, Lisa B. Zaoutis MD Fluid Therapy Maintenance Fluid Therapy Replacement Fluid Therapy Electrolyte Abnormalities Hypocalcemia Hypercalcemia Hypokalemia Hyperkalemia Hyponatremia Hypernatremia 10. GASTROENTEROLOGY Rose C. Graham-Maar, MD, Heather Morein French, MD, David A. Piccoli, MD Esophagus and Stomach Gastroesophageal Reflux Disease Peptic Ulcer Disease Hepatobiliary System Alagille Syndrome Alpha1-Antitrypsin Deficiency Autoimmune Hepatitis Biliary Atresia Gallbladder Disease Glycogen Storage Disease Wilson Disease Small and Large Intestine Celiac Disease Constipation Gastrointestinal Bleeding Inflammatory Bowel Disease Meckel Diverticulum Pancreas Pancreatitis 11. GENETICS Trevor L. Hoffman, MD, PhD, Alix Seif, MD, MPH, Matthew Deardorff, MD, PhD, Paige B. Kaplan, MD, Ian Krantz, MD Beckwith-Wiedemann Syndrome Marfan Syndrome Neurofibromatosis Type 1 Trisomy 13 Trisomy 18 Trisomy 21 Turner Syndrome 12. HEMATOLOGY Char Witmer, MD, Leslie Raffini, MD Anemia Red Blood Cell Indices Differential Diagnosis Based on MCV Glucose-6-Phosphate Dehydrogenase Deficiency Hereditary Spherocytosis Iron Deficiency Anemia Sickle Cell Disease Thalassemias Transient Erythroblastopenia of Childhood Bleeding Disorders Coagulation Studies Hemophilia Vitamin K Deficiency Von Willebrand Disease Thrombocytopenia Differential Diagnosis Idiopathic Thrombocytopenic Purpura Thrombotic Disorders Medications for Anticoagulation Thrombosis Transfusion Medicine Cryoprecipitate Transfusion Fresh Frozen Plasma Transfusion Platelet Transfusion Red Blood Cell Transfusion Transfusion Complications 13. HUMAN IMMUNODEFICIENCY VIRUS Deborah Palmer, MD, Richard M. Rutstein, MD, Theoklis Zaoutis, MD Human Immunodeficiency Virus Infection Fever in HIV Post-Exposure Prophylaxis 14. IMMUNOLOGY Manish J. Butte, MD, PhD, Kathleen E. Sullivan, MD, PhD Approach to Primary Immunodeficiency Major Categories Warning Signs Differential Diagnosis of Neutropenia Diagnostic Approach Common Immunodeficiencies 22q Deletion Dyndromes Ataxia-Telangiectasia Chediak-Higashi Syndrome Chronic Granulomatous Disease Common Variable Immunodeficiency Hyper-IgE Recurrent Infection Syndrome Severe Combined Immunodeficiency Wiskott-Aldrich Syndrome X-linked Agammaglobulinemia 15. INFECTIOUS DISEASES Snehal N. Shah, MD, Asim Aminsharif Ahmed, MD, Jason G. Newland, MD, Sarah Armstrong, MD, Louis M. Bell, MD, and Samir S. Shah, MD (with contributions from Michael F. Maraventano,MD, Rose C. Graham-Maar, MD, Heather Morein French, MD, Pamela G. Fitch, MD, and Judit Saenz- Badillos, MD) Syndromes and Complexes Bite Wound Infections Bronchiolitis Cellulitis Croup Encephalitis Gastroenteritis Infectious Mononucleosis Lymphadenitis and Lymphadenopathy Mastoiditis Meningitis Neonatal Conjunctivitis Osteomyelitis Otitis Media Periorbital/Preseptal and Orbital Cellulitis Pneumonia Retropharyngeal and Peritonsillar Abscess Septic Arthritis Sinusitis Toxic Shock Syndrome Urinary Tract Infection Specific Pathogens Cat Scratch Disease Clostridium Difficile Infection Hepatitis A Hepatitis B Hepatitis C Lyme Disease Malaria Neonatal Herpes Simplex Virus Infection Pertussis Rickettsial Diseases Tuberculosis Varicella Zoster Infections Fever and Bacteremia Catheter-Related Bloodstream Infections Fever in Neonates Fever of Unknown Origin 16. METABOLISM Ralph J. DeBerardinis, MD, PhD, Irma Payan, RN, CRNP, Neal Sondheimer, MD, PhD, Can Ficicioglu, MD, PhD Fatty Acid Oxidation Disorders and Disorders of Ketone Metabolism General Mitochondrial Disorders Specific Mitochondrial Disorders Urea Cycle Defects General Urea Cycle Defects Specific Urea Cycle Defects Defects of Amino Acid Metabolism Hereditary Tyrosinemia Type 1 Phenylketonuria Defects of Carbohydrate Metabolism Galactosemia Hereditary Fructose Intolerance Organic Acidemias Branched-Chain Organic Acidurias Primary Lactic Acidosis Respiratory Chain Defects Pyruvate Dehydrogenase Deficiency 17. NEONATOLOGY Laura A. Lawler, MD, Andrea A. Berry, MD, Snehal N. Shah MD, Gary Frank, MD, MS, John Casey MD, CM, Mary Catherine Harris, MD APGAR scores Apparent Life Threatening Event Hemolytic Disease: ABO incompatibility Hemolytic Disease: RH incompatibility Infant of a Diabetic Mother Meconium Aspiration Syndrome Neonatal Hyperbilirubinemia Polycythemia TORCH Infections 18. NEPHROLOGY Christine T. Lauren, MD, Sarbattama Sen, MD, Kristen A. Feemster, MD, MPH, Joanne N. Wood, MD, Charles P. McKay, MD (with contributions from Ann E. Salerno, MD) Glomerular Disease Hemolytic Uremic Syndrome IgA Nephropathy Nephrotic Syndrome Post-Infectious Glomerulonephritis Tubular / Interstitial Disease Renal Tubular Acidosis Rhabdomyolysis Urolithiasis Other Renal Diseases Acute Renal Failure Hematuria Hypertension 19. NEUROLOGY Annapurna Poduri, MD, Renee A. Shellhaas, MD, Dennis J. Dlugos, MD, Peter H. Berman, MD, Gihan I. Tennekoon, MD General Principles Acute Weakness Altered Mental Status Ataxia Brain Death Coma Cranial Nerves Acquired Neurologic Disease Acute Disseminated Encephalomyelitis Acute Myopathy Botulism Guillain-Barre Syndrome Increased Intracranial Pressure Multiple Sclerosis Myasthenia Gravis Pseudotumor Cerebri Spinal Cord Emergency Stroke Transverse Myelitis Seizures and Epilepsy General Principles Febrile Seizures Infantile Spasms Neonatal Seizures Status Epilepticus Unprovoked Seizure, First Unprovoked Seizure, Second 20. NUTRITION Brenda Waber, RD, CSP, CNSD, LDN, Colleen Yanni, MS, RD, LDN, Maria R. Mascarenhas, MBBS and the CHOP Committee of Dietitians Assessment of Nutritional Status Enteral Nutrition (Tube Feeds) Parenteral Nutrition 21. ONCOLOGY Nicholas B. Slamon, MD, Rhonda M. Graves, MD, Leslie S. Kersun, MD Malignancies Abdominal Masses Bone Tumors Brain Tumors Leukemia Lymphoma Rhabdomyosarcoma Oncologic Emergencies Fever and Neutropenia Nausea and Vomiting Spinal Cord Compression Superior Vena Cava Syndrome and Superior Mediastinal Syndrome Tumor Lysis Syndrome 22. OPHTHALMOLOGY Judit Saenz-Badillos, MD, Stefanie L. Davidson, MD Glaucoma Hyphema Leukocoria Orbital Fracture 23. ORTHOPEDICS Denise M. Bell, Jennifer Minarcik Hwang, MD, Stephen Ludwig, MD, and John M. Flynn, MD Fractures Clavicle Fractures Femur Fractures Hand Fractures Lateral Humeral Condyle Fractures Medial Humeral Epicondyle Fractures Physis (Growth Plate) Fractures Proximal Humerus Fractures Supracondylar Fracture of Humerus Common Orthopedic Issues Compartment Syndrome Developmental Dysplasia of the Hip Legg-Calve-Perthes Disease Transient Synovitis 24. OTOLARYNGOLOGY Marc Eisen, MD, PhD, Steven D. Handler, MD, MBE Adenotonsillary Hypertrophy Branchial Cleft Anomalies Cleft Lip/Palate Epistaxis Foreign Body Aspiration/Ingestion Laryngomalacia Tracheostomy Vocal Cord Paralysis 25. PROCEDURES Nicholas Tsarouhas, MD (with contributions from Linda L. Brown, MD, Lauren Daly, MD, Reza Daugherty, MD, Marla J. Friedman, DO, Karen J. O'Connell, MD, Vivian Hwang, MD) Endotracheal Intubation Femoral Venous Catheterization Intraosseous Line Placement Laceration Repair Lumbar Puncture Pneumothorax Needle Decompression Suprapubic Bladder Aspiration Tube Thoracostomy Umbilical Vessel Catheterization 26. PSYCHIATRY Amy Kim, MD, Anthony L. Rostain, MD, MA Agitation/Aggression Psychosis Suicidality 27. PULMONOLOGY David Hehir, MD, Michael F. Maraventano, MD, Suzanne Dawid, MD, PhD, Howard B. Panitch, MD Pulmonary Diseases and Syndromes Acute Respiratory Distress Syndrome Cystic Fibrosis Hemoptysis Obstructive Sleep Apnea Mechanical Ventilation and Pulmonary Assessment Blood Gas Interpretation Mechanical Ventilation Pulmonary Function Tests 28. RHEUMATOLOGY Pamela G. Fitch, MD, Elise R. DeVore, MD, Jeffrey C. Klick, MD, Jon M. Burnham, MD DermatoMyositis Henoch-Schonlein Purpura Juvenile Rheumatoid Arthritis Kawasaki Disease Rheumatic Fever Systemic Lupus Erythematosis 29. SURGERY Amy L. Winkelstein, MD, Mercedes Blackstone, MD, Suzanne Dawid, MD, PhD, Michael Nance, MD (with contributions from James P. Franciosi, MD, MS, Leonard J. Levine, MD, and Gary Frank, MD, MS) Neonatal Surgery Congenital Diaphragmatic Hernia Esophageal Atresia & Tracheoesophageal Fistula Gastroschisis Omphalocele General Surgery Appendicitis Hirschsprung's Disease Inguinal Hernia Intussusception Malrotation and Midgut Volulus Perirectal Abcess Pneumothorax Pyloric Stenosis Urologic Surgery Ovarian Torsion Testicular Torsion 30. TOXICOLOGY Rebecca Collier MD, Diane P. Calello MD, Fred M. Henretig MD Decontamination and Enhanced Elimination Activated Charcoal Cathartics Gastric Lavage Hemodialysis Hemoperfusion Multiple-Dose Activated Charcoal Syrup of Ipecac Whole Bowel Irrigation Specific Poisonings Acetaminophen (APAP) Amphetamines Anti-Histamines Beta Blockers Calcium Channel Blockers Carbamazepine Carbon Monoxide Caustics Clonidine Cocaine Digoxin Ethanol Ethylene glycol Hydrocarbons Iron Isopropyl Alcohol Lead Methanol Opioids Organophosphates Phenothiazines Phenytoin Salicylates (Aspirin) Selective Serotonin Uptake Inhibitors Tricyclic Antidepressants APPENDICES Appendix A: Normal Pediatric Vital Signs Appendix B: Neonatal Code Appendix C: PALS Algorithms Pediatric Bradycardia Algorithm Pediatric Tachycardia Algorithm for Infants and Children with Rapid Rhythm and Adequate Perfusion Pediatric Tachycardia Algorithm for Infants and Children with Rapid Rhythm and Poor Perfusion Pediatric Pulseless Arrest Algorithm Algorithm for Stabilization of Infants and Children after Arrest