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Discharge Recommendations and Follow-up
If the patient meets the discharge criteria, discharge after providing the patient with the discharge information. The Headache Action Plan may be helpful in creating a discharge plan. The patient...
Patient's Pain
Is the patient's pain assessed to be >3? Assess the patient's comfort level using an age and developmentally appropriate pain scale. Children's Mercy Kansas City uses the following pain...
Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C)
If you are concerned you may have a patient with MIS-C, please consult ID. An individual aged <21 years presenting with feveri, laboratory evidence of inflammationii, and evidence of clinically severe...
ADHD Patient / Caregiver Resources
National resources: CDC CHADD Understood.org Local resources: CHADD Local Chapter (ADHDKC) Behavioral Parent Training Groups: Understanding and Managing ADHD (CMH) ADHD Services (CMH) Lift up KC...
Low Dose Systemic Thrombolysis
tPA 0.03-0.06 mg/kg/hr x 24 hours (max hourly dose 2 mg/hr) If on heparin: decrease heparin dose to 5-10 units/kg/hr. If on direct thrombin inhibitor (DTI) decrease rate by 50%. Heparin and/or DTI lab...
Bruising
Children’s Mercy obtained permission to use this picture for educational purposes. These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is...
Pharyngitis Images
For Children's Mercy providers: Streptococcal pharyngitis image 1 (tonsils with palatal petechiae) Streptococcal pharyngitis image 2 (palatal petechiae) Streptococcal pharyngitis image 3 (tonsillar...
High Dose Systemic Thrombolysis
tPA 0.1-0.6 mg/kg/hr x6 hrs Adult dosing for pts >16 yrs and > 60 kg: Alteplase 100 mg over 2 hrs IV (if no concurrent anticoagulation therapy). These pathways do not establish a standard of care to...
Shock
Shock is defined as use of vasoactive agents such as: -Epinephrine/norepinephrine, dopamine, dobutamine, milrinone, nitroprusside.
Criteria for Insulin Drip Discontinuation
Discontinue insulin when: Bicarbonate level is ≥17mmol/L. Anion gap is normalized. And/or blood ketones are negative to small. Once the insulin drip is stopped, discontinue D10NS with additives ...
Toddler Tibia Fracture: Evidence Supporting 3rd View
Tenenbein, M., Reed, M. H., & Black, G. B. (1990). The toddler's fracture revisited. The American Journal of Emergency Medicine, 8(3), 208-211. 10.1016/0735-6757(90)90324-s These pathways do not...
Nonviable Tissue
Children’s Mercy obtained permission to use this picture for educational purposes. These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is...
Oral Cephalosporins - Wise Use of Antibiotics - October 2022
Oral broad-spectrum cephalosporins, such as cefdinir, are some of the most inappropriately prescribed antibiotic classes in pediatrics. They should not be used routinely to escalate therapy for patients...
SSTI: Cellulitis or Erysipelas (Images)
For Children's Mercy providers: https://www-visualdx-com.ezproxy.cmh.edu/visualdx/diagnosis/cellulitis?moduleId=103&diagnosisId=51263&lang=en_US#view=text&gid=1&pid=2...
SSTI: Antibiotic Dosing
Abscess: PO: Clindamycin 10 mg/kg/dose PO TID (max 450 mg/dose). Alternative therapy: TMP-SMX 4-6 mg/kg/dose (trimethoprim component) PO BID (max 160 mg TMP/dose). IV: Clindamycin. Cellulitis or Erysipelas...
6. Asthma Outpatient Management
Initial visit tables/ Follow-up tables/ Step therapy tables Initial visit Tables/ Follow up Tables/ Step Therapy tables are included. These tables are used to highlight the similarities and differences...
Severity of Asthma Exacerbation
Mild Moderate Severe Respiratory Rate 2-3 yrs: <34/min 4-5 yrs: <30/min 6-12 yrs: <26/min >12 yrs: <23/min 2-3 yrs: 35-39/min 4-5 yrs: 31-35/min 6-12 yrs: 27-30/min...
Antihypertensive(s) and/or Lifestyle Modifications
Severe BP elevation means a BP consistently ≥ 99th percentile. Consult Nephrology if ≥ 2 doeses in 24 hours required to normalize BP.
Initiation and Maintenance
Initiation of enoxaparin therapy: Obtain blood for baseline CBC, PT, PTT. Calculate enoxaparin dose (mg) based on age, weight and indication. See Table 1. Table 1 - Initial Dosing of Enoxaparin...