ABP Pediatric Hospital Medicine cheat sheet

Bronchiolitis: diagnosis is clinical; routine use of bronchodilators, corticosteroids, antibiotics, and chest radiographs is not recommended. Supportive care with hydration and oxygen (target SpO2 >90%) is mainstay.

Community-acquired pneumonia (CAP): In hospitalized children >3 months, empiric therapy for typical bacteria is ampicillin or penicillin; add macrolide if atypical pathogens suspected (e.g., Mycoplasma in school-aged children).

Dehydration assessment: Use Clinical Dehydration Scale (CDS) or WHO scale. Mild (3-5%) = 50 mL/kg ORS; moderate (6-9%) = 100 mL/kg ORS; severe (≥10%) = 20 mL/kg IV boluses.

Asthma exacerbation: First-line is inhaled short-acting beta-agonist (albuterol) via MDI with spacer or nebulizer; add ipratropium in severe cases; systemic corticosteroids within 1 hour for moderate-severe exacerbations.

Fever without source in infants: For 0-28 days, full sepsis workup and empiric antibiotics (ampicillin + gentamicin or cefotaxime) are standard. For 29-90 days, risk stratification (e.g., Rochester criteria) guides workup.

Urinary tract infection (UTI): Obtain urine culture before antibiotics. In febrile infants, parenteral ceftriaxone or cefotaxime is empiric; adjust based on culture. Renal ultrasound recommended for febrile UTI in children <2 years or recurrent UTIs.

Seizure management: Status epilepticus defined as seizure >5 minutes. First-line: benzodiazepines (lorazepam 0.1 mg/kg IV or midazolam 0.2 mg/kg IM). Second-line: fosphenytoin, levetiracetam, or valproate.

Fluid and electrolyte maintenance: Use Holliday-Segar method: 100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day for remaining kg. For isotonic maintenance, use 0.9% NaCl with 5% dextrose.

Neonatal hyperbilirubinemia: Phototherapy threshold depends on age in hours, gestational age, and risk factors. Exchange transfusion considered at higher levels. Kernicterus risk increases with hemolysis, prematurity, and sepsis.

This domain is a placeholder because the source does not enumerate subspecialty domains; content is derived from general pediatric hospital medicine principles.

Handoff communication: Use standardized tools (e.g., I-PASS: Illness severity, Patient summary, Action list, Situation awareness, Synthesis by receiver) to reduce adverse events.

Discharge planning: Ensure follow-up within 48-72 hours for high-risk patients; provide written discharge instructions and medication reconciliation.

Patient safety: Medication errors are common in pediatrics due to weight-based dosing; use computerized order entry and double-check calculations.

Evidence-based medicine: Apply GRADE framework to evaluate strength of recommendations; consider patient values and preferences.

Quality improvement: Use Plan-Do-Study-Act (PDSA) cycles; measure outcomes, process, and balancing measures.

Care coordination: Involve multidisciplinary team (nurses, pharmacists, social work, case management) to address social determinants of health.

Family-centered rounds: Include parents in decision-making; improves satisfaction and reduces errors.

Transition to adult care: Start planning in early adolescence for children with chronic conditions; assess self-management skills.