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  • Pediatric Limp Differential Diagnosis Guide

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    infinityonward
    118 tayangan12 halaman
    This document provides guidance on evaluating and managing a limping child. It lists numerous potential causes of limping organized by category such as infection, inflammation, neoplasm, and vascular or structural issues. It describes factors to consider in the history such as acute vs chronic presentation, aggravating/relieving factors, and associated symptoms. Examination findings involving various body systems are outlined. It provides guidance on basic tests, when to aspirate a joint, appropriate imaging, and additional tests depending in the suspected condition. Management recommendations are provided for emergent, urgent and outpatient situations depending on the condition. References for additional information are also included.

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    Approach to the Limping Child

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    This document provides guidance on evaluating and managing a limping child. It lists numerous potential causes of limping organized by category such as infection, inflammation, neoplasm, and vascular or structural issues. It describes factors to consider in the history such as acute vs chronic presentation, aggravating/relieving factors, and associated symptoms. Examination findings involving various body systems are outlined. It provides guidance on basic tests, when to aspirate a joint, appropriate imaging, and additional tests depending in the suspected condition. Management recommendations are provided for emergent, urgent and outpatient situations depending on the condition. References for additional information are also included.

    Hak Cipta:

    Attribution Non-Commercial (BY-NC)
    Unduh sebagai PPTX, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    118 tayangan12 halaman

    Pediatric Limp Differential Diagnosis Guide

    Diunggah oleh

    infinityonward
    This document provides guidance on evaluating and managing a limping child. It lists numerous potential causes of limping organized by category such as infection, inflammation, neoplasm, and vascular or structural issues. It describes factors to consider in the history such as acute vs chronic presentation, aggravating/relieving factors, and associated symptoms. Examination findings involving various body systems are outlined. It provides guidance on basic tests, when to aspirate a joint, appropriate imaging, and additional tests depending in the suspected condition. Management recommendations are provided for emergent, urgent and outpatient situations depending on the condition. References for additional information are also included.

    Hak Cipta:

    Attribution Non-Commercial (BY-NC)
    Unduh sebagai PPTX, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 12

    GI/GU LIMP Weakness CP MD Spinal Cord Lesion GBS Peripheral neuro Disuse/immobility Trauma Hemarthroses Salter-harris # Greenstick # Soft

    tissue Pain Infection Septic arthritis Osteomyelitis Discitis Abscess Cellulitis Inflammation JIA Reactive HSP Rheumatic fever Transient synovitis

    Neoplasm

    Structural/mechanical Leg length discrepancy SCFE Osgood-Schlatter Patellofemoral

    vascular

    Legg-Calve-Perthes Sickle- Cell

    Acute vs chronic Course Pain/painless

    Triggers

    Trauma

    Aggravating/Relieving
    Activity, medications,

    OPQRST Bilateral/unilateral Waking at night

    Other Symptoms:

    Infection Activity/footware Meds

    head, back, hip, knee, ankle, etc.

    Fever, wt loss, anorexia Bladder/bowel Neuro: parasthesias,

    Consider the possibility of abuse

    weakness, paralysis GU discharge Derm

    PMed Hx:

    Pregnancy/Dev:

    Recent infection GI, GU, viral. Cancer Previous injury/surgery Obesity Soft tissue/bone disorders Neuro Endo Hypothyroid, hypogonadism (increase SCFE risk) History of hip dysplasias, club feet, CP, MD

    Nutrition
    gross deficiencies.

    Meds/All/Vax Family Hx:

    MSK Ehler-Danlos, Marfans, MD Inflammatory IBD/AS/psoriatic arthritis (HLA B27), JIA Neuro Heme bleeding disorders, hemoglobinopathies,

    General: sick/well, obese Vitals: fever, tachy, shocky HEENT: uveitis, CVS: carditis Resp GI & GU: r/o referred pain. MSK/Neuro: back, hip, knee, ankle

    Derm: rashes Special: Gowers sign, leg length (ASIS to MM), Galeazzi, FABER

    SEADS, bulk, tone, tenderness power, ROM, sensation, reflexes, pulses Weight bear, gait

    Basic bloodwork:
    CBC, CRP, ESR. When you suspect rheum, septic joint or onco.

    When to aspirate a joint:


    Fever >38.5 ESR >40/CRP >20 WBC elevation >12 Cant weight bear

    Send aspirate for cell count, gram stain/culture,

    protein, glucose.

    Imaging:
    XR reasonable in majority of trauma Keep in mind Salter-Harris I not readily

    apparent on XR Bilateral hip films if ?SCFE MRI or bone scan for suspected osteomyelitis MRI/CT for suspected spinal pathology U/S to assess effusion (still need aspirate if suspected infn)

    Other:
    Septic joint, reactive arthritis: consider urine

    for C&G. stool culture, Rheum: ANA, antiDSdna, HLAB27, Rheumatic Fever: throat culture, ASOT Blood/Bone culture: osteo Bleeding: PTT, INR Sickle: peripheral smear

    Emergent (admission required)


    Septic arthritis: >5: Cloxacillin x 3-4 weeks. <5: Cefuroxime x 3-4 weeks. Sexually active: Cefotaxime x 7 days. Osteomyelitis: Cloxacillin x 4-6 weeks. Vanco if MRSA suspected. SCFE: ortho referral for pinning. Neoplastic: onco referral, staging. Acute neurologicaI, sickle cell, abscesses, etc.

    Urgent:
    Splint suspected Salter-Harris I Casting of fractures Abx for cellulitis

    Outpatient: (NSAIDs, +/- referral)


    Rheum Legg-Calve-Perthes Transient Synovitis/Myositis Overuse Minor Trauma

    Sawyer, J.R., Kapoor, M., The Limping Child: A Systematic Approach to Diagnosis, Am Fam Physician. 2009 Feb 1;79(3):215-224.

    http://www.aafp.org/afp/2009/0201/p215.html http://www.uptodate.com/contents/approach-to-the-child-with-alimp?source=related_link

    Clark, M.C., Approach to the child with a limp.

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