THE SEVEN HABITS OF HIGHLY EFFECTIVE

PEOPLE
by Stephen R. Covey

Habit 1: Be Proactive
• Ability to control one’s environment, rather that have
it control you.
• Taking initiative doesn’t mean being aggressive, it
means recognizing your responsibility to make
things happen

Habit 2: Begin with the end in mind

• The habit of personal leadership
• Lead oneself towards what you consider your aims
• Based on imagination – the ability to envision, to
see the potential, to create with our minds what we
cannot at present see with our eyes

Habit 3: Put First Things First

• The habit of personal management
• Create a clear, mutual understanding of what needs
to be accomplished, focusing on what, not how;
results not methods
• Spend time. Be patient. Visualize the desired result
Habit 4: Think Win-Win
• The habit of interpersonal relationship
• Achievements are largely dependent on co-
operative efforts with others
• Agreements or solutions are mutually beneficial &
satisfying

Habit 5: Seek first to understand and then to be

understood
• The habit of communication
• Diagnose before you prescribe
• Simple, effective & essential in developing &
maintaining positive relationships in all aspects of
life

Habit 6: Synergize
• The habit of creative cooperation
• “the whole is greater than the sum of its parts”
• See good & potential in other person’s contribution

Habit 7: Sharpen the saw

• The habit self-renewal, of continuous improvement
• Circles & embodies all other habits
MKD computation

Weight x mkd x preparation [mL/mg] = mL per dose

e.g. 12kg x 10mg x 5ml = 5mL per dose

kg 120mg

* If per day, divide total (mL) by the # of divided doses

Dose x preparation x frequency = mkd

weight

* Frequency is not used in Paracetamol computation

1 drop = 1/20 mL
1 teaspoonful = 5 mL
1 tablespoonful = 15 mL
1 wineglassful = 60 mL = 2 ounces
1 glassful = 250 mL = 8 ounces
1 grain = 60 mg
1 pint = 500 mL Paracetamol Drops
1 quart = 1000 mL wt: move 1 decimal point to
1 ounce = 30 mL the left
1 Kg = 2.2 lbs Age Wt
1 lb = 0.45359 Kg 1 10kg
2 12
3 14
4 16
5 18
6 20
BODY TEMPERATURE
Subnormal <36.6°C
Normal 37.4°C
Subfebrile 35.7 – 38.0°C
Fever 38.0°C
High fever >39.5°C
Hyperpyrexia >42.0°C

AGE HR (bpm) BP (mmHg) RR (cpm)

Preterm 120-170 55-75/35-45 40-70
Term 120-160 65-85/45-55 30-60
0-3 mo 100-150 65-85/45-55 35-55
3-6 mo 90-120 70-90/50-65 30-45
6-12 mo 80-120 80-100/55-65 25-40
1-3 yrs 70-110 90-105/55-70 20-30
3-6 yrs 65-110 95-110/60-75 20-25
6-12 yrs 60-95 100-120/60-75 14-22
12-17 yrs 55-85 110-135/65-85 12-18

*BP cuff should cover 2/3 of arm

small cuff: falsely high BP

large cuff: falsely low BP
ABG
pH: 7.35-7.45 HCO3: 22-26mEq/L
pCO2: 35-45 B.E.: +/- 2mEq/L
pO2: 80-100 O2 sat: 97%

Normal Laboratory Values

NB Infant Child
Adolescent
RBC 4.8-7.1 3.8-5.5 3.8-5. M: 4.6-6.2
F: 4.2-5.4
WBC 9-30,000 6-17,500 5-10,000 6-10,000
Neutrophils 61% 61% 60% 60%
Lymphocytes 31% 32% 30% 30%
Hgb (gm %) 14-24 11-20 11-16 M: 14-18
F: 12-16
Hct (%) 44-64 35-49 31-46 M: 40-54
F: 37-47
Platelets 140-300 200-423 150-450 150-450
(thou/mm3)
Reticulocyte 2.6-6.5 0.5-3.1 0-2 0-2
Count (%)
Bleeding time 1-5 min 1-6 1-6 1-6
Clotting time 5-8 min 5-8 5-8 5-8
Prothrombin 12-20 12-14 12-14 12-14
time (sec)
BMI

Asian Caucasian
Underweight <18.5 <18.5
Normal 18.5 – 22.9 18.5 – 24.9
Overweight ≥ 23.0 25 – 29.9
at risk 23 – 24.9
Obese I 25 – 29.9 30 – 39.9
Obese II ≥ 30 >40
ANTHROPOMETRIC MEASUREMENTS
 Expected Body Weight upto 1 month of age
Term [{age in days) – 10] x 20 + BW (gms)
Preterm [(age in days) – 14] x 15 + BW (gms)
APGAR

GCS SCORING
EXPANDED PROGRAM ON IMMUNIZATION
ACUTE DIARRHEA (at least 3x BM in 24 hrs)

4 Major Mechanisms
1. Poorly absorbed osmotically active substances in
lumen
2. Intestinal ion secretion (increased) or decreased
absorption
3. Outpouring into the lumen of blood, mucus
4. Derangement of intestinal motility

Rotaviral AGE (vomiting first then diarrhea)

ingestion of rotavirus  rotavirus in intestinal villi 
destruction of villi

(secretory diarrhea  absorption,  secretion)  AGE

Assessment of dehydration (skin pinch test)

(+) if > 2 seconds
no dehydration if skin tenting goes back immediately
Etiology of AGE

Bacteria Viruses
Aeromonas Astroviruses
Bacillus cereus Caloviruses
Campylobacter jejuni Norovirus
Clostridium perfringens Enteric adenoviruses
Clostridium difficile Rotavirus
Escherichia coli Cytomegalovirus
Plesiomonas shigelbides Herpes simplex virus
Salmonella
Shigella
Staphylococcus aureus
Vibrio cholerae 01 & 0139
Vibrio parahaemolyticus
Yersinia enterocolitica

Parasites
Balantidium coli
Blastocyctis hominis
Cryptosporidium
Giardia lamblia
Types of Dehydration
Classification of the Severity of Dehydration
DIARRHEA TREATMENT PLAN A

4 Rules of Home Treatment

1. Give extra fluid (as much as the child will take)

> Breastfeed frequently & longer at each feeding
> if the child is exclusively breastfed, give one or more
of the following in addition to breastmilk:
- ORS solution
- food based fluid (e.g. soup, rice, water)
- clean water

How much fluid to be given in addition to the usual fluid

intake:
upto 2 years: 50-100 mL after each loose
stool
2 years or more: 100-200 mL
> give frequent small sips from a cup
> if the child vomits, wait for 10 min then resume
> continue giving extra fluids until diarrhea stops

2. Give Zinc supplements

upto 6 mo: ½ tab or 10mg per day for 10-14 days
6 months or more: 1 tab or 20mg OD x 10-14 days

3. Continue feeding

4. Know when to return

DIARRHEA TREATMENT PLAN B

Recommended amount of ORS over 4 hour period

Age upto 4 mo - 12mo - 2 yrs –

4 mo 12mo 2 yrs 5 yrs

Wt <6kg 6-9.9kg 10-11.9kg 12-19kg

in mL 200-400 400-700 700-900 900-1400

* Use child’s age only when weight is not known

* Approximate amount of ORS (mL)

CHILDS WT (kg) x 25

> if the child wants more ORS than shown, give more
> give frequent small sips from a cup
> if the child vomits, wait for 10 min then resume
> continue breastfeeding whenever the child wants

* After 4 hours
> reassess the child & classify dehydration status
> select the appropriate plan to continue treatment
> begin feeding the child while at the clinic
DIARRHEA TREATMENT PLAN C

Treat severe dehydration QUICKLY!

> start IV fluid immediately

> if the child can drink, give ORS by mouth while the IV
drip is being set up
> give 100mL/kg Lactated Ringer’s solution

Age First give Then give

30mL/kg in: 70mL/kg in:

Infants 1 hour* 5 hours

(<12mo)

Children 30 min* 2 ½ hours

(12mo-5yrs)

* Repeat once if radial pulse is very weak or not detectable

> reassess the child every 15-30 min. if dehydration is not

improving, give IV fluid more rapidly
> also give ORS (~5mL/kg/hr) as soon as the child can
drink [usually after 3-4 hours in infants; 1-2 hours in
children]
> reassess after 6 hrs (infant) & 3 hrs (child)
LUDAN’S METHOD (HYDRATION THERAPY)

HOLIDAY-SEGAR METHOD (MAINTENANCE)

NOTE: Computed Value is in mL/day

Ex) 25kg child
Answer: 1500 + [100] = 1600cc/day
IV-FLUID COMPOSITIONS (Commonly Used for Infants and Children):
 ARI PROTOCOL (PROGRAM FOR THE CONTROL OF ARI)

Child Age 2months up to 5years

Young Infants <2months
ETIOLOGY OF PNEUMONIA

> Bacterial
- Streptococcus pneumoniae
- Group B streptococci (neonates)
- Group A streptococci
- Mycoplasma pnemoniae (adolescents)
- Chlamydia trachomatis (infants)
- Mixed anearobes (aspiration pneumonia)
- Gram negative enteric (nosocomial pneumonia)

> Viral
- Respiratory syncitial virus
- Parainfluenza type 1-3 (Croup)
- Influenza types A, B
- Adenovirus
- Metapneumovirus

> Fungal
- Histoplasma capsulatum (bird, bat contact)
- Cryptococcus neoformans (bird contact)
- Aspergillus sp. (immunosuppressed)
- Mucormycosis (immunosuppressed)
- Coccidioides immitis
- Blastomyces dermatitides
- Pneumocystis carinii (immunosuppressed, HIV,
steroids)
ATYPICAL PNEUMONIA: extrpulmonary manifestations,
low grade fever, patchy diffuse infiltrates, poor
response to Penicillin, negative sputum gram stain

Etiologic Agents Grouped by Age

> Neonates (<1mo)

- GBS
- E. coli
- other gram (-) bacilli
- Streptococcus pneumoniae
- Haemophilus influenzae (Type B)

> 1-3 mo
* Febrile pneumonia
- RSV
- Other respiratory viruses
- Streptococcus pneumoniae
- Haemophilus influenzae (Type B)

* Afebrile pneumonia
- Chlamydia trachomatis
- Mycoplasma homilis
- CMV
> 3-12 mo
- RSV
- Other respiratory viruses
- Streptococcus pneumoniae
- Haemophilus influenzae (Type B)
- C. trachomatis
- M. pneumoniae
- Group A Streptococcus

> 2-5 yrs

- RSV
- Other respiratory viruses
- Streptococcus pneumoniae
- Haemophilus influenzae (Type B)
- C. trachomatis
- M. pneumoniae
- Group A Streptococcus
- Staph aureus

 2-5 yrs
- Streptococcus pneumoniae
- Haemophilus influenzae (Type B)
- C. trachomatis
- M. pneumoniae
- Group A Streptococcus
- Staph aureus
Dengue Pathophysiology
DENGUE

> Mode of transmission: mosquito bite (man as reservior)

> Vector: Aedes aegypti
> Factors affecting transmission:
- breeding sites, high human population density,
mobile viremic human beings
> Age incidence peaks at 4-6 yrs
> Incubation period: 4-6 days
> Serotypes:
- Type 2 – most common
- Types 1& 3
- Type 4 – least common but most severe

> Main pathophysiologic changes:

a. increase in vascular permeability

extravasation of plasma
- hemoconcentration
- 3rd spacing of fluids

b. abnormal hemostasis
- vasculopathy
- thrombocytopenia
- coagulopathy
Dengue Fever Syndrome (DFS)
Biphasic fever (2-7 days) with 2 or more of the ff:
1. headache
2. myalgia or arthralgia
3. retroorbital pain
4. hemorrhagic manifestations
[petechiae, purpura, (+) torniquet test]
5. leukopenia

Dengue Hemorrhagic Fever (DHF)

1. fever, persistently high grade (2-7 days)
2. hemorrhagic manifestations
- (+) torniquet test
- petechiae, ecchymoses, purpura
- bleeding from mucusa, GIT, puncture sites
- melena, hematemesis
3. Thrombocytopenia (< 100,000/mm3)
4. Hemoconcentration
- hematocrit >40% or rise of >20% from baseline
- a drop in >20% Hct (from baseline) following
volume replacement
- signs of plasma leakage
[pleural effusion, ascites, hypoproteinemia]
Dengue Shock Syndrome
Manifestations of DHF plus signs of circulatory failure
1. rapid & weak pulse
2. narrow pulse pressure (<20mmHg)
3. hypotension for age
4. cold, clammy skin & irritability / restlessness

DANGER SIGNS OF DHF

1. abdominal pain (intense & sustained)
2. persistent vomiting
3. abrupt change from fever to hypothermia with
sweating
4. restlessness or somnolence

Grading of Dengue Hemorrhagic Fever

Torniquet Test: SBP + DBP = mean BP for 5 minutes
2
if ≥20 petechial rash per sq. inch on antecubital fossa
(+) test

Herman’s Rash:
> usually appears after fever lysed
> initially appears on the lower extremities
> not a common finding among dengue patients
> “an island of white in an ocean of red”

Recommended Guidelines for Transfusion:

Transfuse:
- PC < 100,000 with signs of bleeding
- PC < 20,000 even if asymptomatic
- use FFP if without overt bleeding
- FWB in cases with overt bleeding or signs of
hypovolemia

> if PT & PTT are abnormal: FFP

> if PTT only: cryprecipitate

Leukopenia in dengue: probable etiology is Pseudomonas

therefore: give Meropenem or Ceftazidime
MANAGEMENT OF DENGUE
A. Vital Signs and Laboratory Monitoring (Vital Signs and Laboratory Monitoring)
Monitor BP, Pulse Rate
We have to watch out for Shock (Hypotension)
Management of Hemorrhage
URINARY TRACT INFECTION

Suggestive UTI:
- Pyuria: WBC ≥ 5/HPF or 10mm3
- Absence of pyuria doesn’t rule out UTI
- Pyuria can be present w/o UTI

Presumptive UTI:
- (-) urine culture
- lower colony counts may be due to:
* overhydration
* recent bladder emptying
* previous antibiotic intake

Proven or Confirmed UTI:

- (+) urine culture ≥ 100,000 cfu/mL urine of a single
organism
- multiple organisms in culture may indicate a
contaminated sample
ACUTE GLOMERULONEPHRITIS (PSAGN)

Antecedent Infection (2-3 weeks)


Ag-Ab complexes + complement (ASO)

Ag-Ab deposition in GBM Ab binding to

Glomerular Ab
C3

Proliferation deposition

Hematuria

Decreased Glomerular surface area

Oliguria;
Decreased GFR
Normal or
increased
Activation of RAAS Creatinine

Na+ & H2O retention

Edema,
HPN
Fluid overload

Circulatory congestion  EDEMA CHF;

Pulmonary
edema
ACUTE GLOMERULONEPHRITIS

Complications of AGN
- CHF 2° to fluid overload
- HPN encephalopathy
- ARF due to  GFR

STAGES of AGN
- Oliguric phase [7-10days] – complications sets in
- Diuretic phase [7-10days] – recovery starts
- Convalescent phase [7-10days] – ptts usually sent
home
Prognosis
- Gross hematuria 2-3 weeks
- Proteinuria 3-6 weeks
- C3: 8-12 weeks
- microscopic hematuria: 6-12 mo

> Hyperkalemia may be seen due to Na+ retention

> Ca++ decreases in PSAGN
>  in ASO titer
- normal within 2 weeks
- peaks after 2 weeks
- more pronounced in pharyngeal infection than in
cutaneous
 RHEUMATIC FEVER

• JONES CRITERIA:
• A. Major Manifestations
– Carditis (50-60%)
– Polyarthritis (70%)
– Chorea (15-20%)
– Erythema Marginatum (3%)
– Subcutaneous Nodules (1%)

• B. Minor Manifestations
– Arthralgia
– Fever
– Laboratory Findings of:
• Elevated Acute Phase Reactants (ESR / CRP)
• Prolonged PR interval

• C. PLUS Supporting Evidence of Antecedent Group-A

Strep Infection
– (+) Throat Culture or Rapid Strep-Ag Test
– Elevated or Rising Strep-AB Test
TREATMENT OF RHEUMATIC FEVER
• A. Antibiotic Therapy
– 10 days of Oral Penicillin or Erythromycin
– IM Injection of Benzethine Penicillin

• **NOTE: Sumapen = Oral Penicillin!

• B. Anti-Inflammatory Therapy
• 1. Aspirin (if Arthritis, NOT Carditis)
• Acute: 100mg/kg/day in 4 doses x 3-5days
• Then, 75mg/kg/day in 4 doses x 4 weeks

• 2. Prednisone
• 2mg/kg/day in 4 doses x 2-3weeks
• Then, 5mg/24hrs every 2-3 days
PREVENTON

A. Primary Prevention
10 days of Oral Penicillin or Erythromycin
IM Injection of Benzethine Penicillin

B. Secondary Prevention

C. Duration of Chemoprophylaxis
KAWASAKI DISEASE

CDC-CRITERIA FOR DIAGNOSIS: ADOPTED FROM

KAWASAKI (ALL SHOULD BE PRESENT)

A) HIGH Grade Fever (>38.5 Rectally) PRESENT for AT

LEAST 5-days without other Explanation
“High Grade Fever of at least 5 days”
DOES NOT Respond to any kind of Antibiotic!

B) Presence of 4 of the 5 Criteria:

1) Bilateral CONGESTION of the Ocular
Conjunctiva (seen in 94%)
2) Changes of the Lips and Oral Cavity (At least
ONE)
3) Changes of the Extremities (At least ONE)
4) Polymorphous Exanthem (92%)
5) Cervical Adenopathy = Non-Suppurative
Cervical Adenopathy (should be >1.5cm) in 42%
KAWASAKI DISEASE

HARADA Criteria
- used to determine whether IVIg should be given
- assessed within 9 days from onset of illness

1. WBC > 12,000

2. PC <350,000
3. CRP > 3+
4. Hct <35%
5. Albumin <3.5 g/dL
6. Age 12 months
7. Gender: male

•IVIg is given if ≥ 4 of 7 are fulfilled

•If < 4 with continuing acute symptoms,

risk score must be reassessed daily
TREATMENT: Currently Recommended Protocol:

A. IV-Immunoglobulin

2g/kg Regimen Infusion EQUALLY Effective in

Prevention of Aneurysms and Superior to 4-day
Regimen with respect to Amelioration of
Inflammation as measured by days of Fever, ESR,
CRP, Platelet Count, Hgb, and Albumin.

NOTE: There is a TIME FRAME of 10 days

B. Aspirin

HIGH Dose ASA (80-100mg/kg/day divided q 6h) should

be given Initially in Conjunction with IV-IG
THEN
Reduced to Low Dose Aspirin (3-5mg/kg/day)
AND
Continued until Cardiac Evaluation COMPLETED
(approximately 1-2 months AFTER Onset of Disease)
 SEIZURES

> Seizures: sudden event caused by abrupt, uncontrolled,

hypersynchronous discharges of neurons

> Epilepsy: tendency for recurrent seizures that are

unprovoked by an immediate cause

> Status epilepticus: >30min or back-to-back w/o return

to baseline

> Etiology:
- V ascular : AVM, stroke, hemorrhage
- I nfections : meningitis, encephalitis
- T raumatic :
- A utoimmune : SLE, vasculitis, ADEM
- M etabolic : electrolyte imbalance
- I diopathic : “idiopathic epilepsy”
- N eoplastic : space occupying lesion
- S tructural : cortical malformation, prior stroke
- S yndrome : genetic disorder
TYPES OF SEIZURES

A. Partial Seizures (Focal / Local)

– Simple Partial
– Complex Partial (Partial Seizure + Impaired
Consciousness)
– Partial Seizures evolving to Tonic-Clonic
Convulsion)

B. Generalized Seizures
– Absence (Petit mal)
– Myoclonic
– Clonic
– Tonic
– Tonic-Clonic
– Atonic

SIMPLE FEBRILE SEIZURE vs. COMPLEX FEBRILE

SEIZURE
Febrile Seizure: “A seizure in association with a febrile
illness in the absence of a CNS infection or acute
electrolyte imbalance in children older than 1 month of
age without prior afebrile seizures”
CLASSIFICATION BY CAUSE

A. Acute Symptomatic (shortly after an acute insult)

– Infection
– Hypoglycemia, low sodium, low calcium
– Head trauma
– Toxic ingestion

B. Remote Symptomatic
– Pre-existing brain abnormality or insult
– Brain injury (head trauma, low oxygen)
– Meningitis
– Stroke
– Tumor
– Developmental brain abnormality

C. Idiopathic
– No history of preceding insult
– Likely “genetic” component
SIMPLE FEBRILE SEIZURE

A. Criteria for an SFS

– < 15 minutes
– Generalized-tonic-clonic
– Fever > 100.4 rectal to 101 F (38 to 38.4 C)
– No recurrence in 24 hours
– No post-ictal neuro abnormalities (e.g. Todd’s
paresis)
– Most common 6 months to 5 years
– Normal development
– No CNS infection or prior afebrile seizures

B. Risk Factors
– Febrile seizure in 1st/2nd degree relative
– Neonatal nursery stay of >30 days
– Developmental delay
– Height of temperature

C. Risk Factors for Epilepsy (2 to 10% will go on to

have epilepsy)
– Developmental delay
– Complex FS (possibly > 1 complex feature)
– 5% > 30 mins => _ of all childhood status
– Family History of Epilepsy
– Duration of fever
 BRONCHIAL ASTHMA (GINA GUIDELINES)

Controlled Partly Uncontrolled

controlled
Day none > 2x per wk 3 or more
symptoms symptoms of
Limitation of none any Partly
activities Controlled
Asthma in
Nocturnal Sx none any any week
(awakening)
Need for < 2x per wk > 2x per wk
reliever
Lung function normal < 80%

Exacerbation none > 1x per yr 1x / week

 Tuberculosis (Treatment)
I. Pulmonary TB

A. Fully susceptible M. tuberculosis, no history of previous

anti-TB drugs, low local persistence of primary
resistance to Isoniazid (H)
 2HRZ OD then 4HR OD or 3x/wk DOT

B. Microbial susceptibility unknown or initial drug

resistance suspected (e.g. cavitary), previous anti-TB
use, close contact w/ resistant source case or living in
high areas w/ high pulmonary resistance to H.

 2HRZ + E/S OD, then 4 HR + E/S OD or 3x/wekk

DOT

I. Extrapulmonary TB

Same in PTB

For severe life threatening disease (e.g. miliary, meningitis,

bone, etc)
☤ 2HRZ + E/S OD, then 10HR + E/S OD or 3x/wk
DOT
 H.E.A.D.S.S.S.
Home Environment
☤ With whom does the adolescent live?
☤ Any recent changes in the living situation?
☤ How are things among siblings?
☤ Are parents employed?
☤ Are there things in the family he/she wants to change?

Employment and Education

☤ Currently at school? Favorite subjects?
☤ Patient performing academically?
☤ Have been truant/expelled from school?
☤ Problems with classmates/teachers?
☤ Currently employed?
☤ Future education/employment goals?

Activities
☤ What he/she does in spare time?
☤ Patient does for fun?
☤ Whom does patient spend spare time?
☤ Hobbies, interests, close friends?
 H.E.A.D.S.S.S.
Drugs
☤ Used tobacco/alcohol/steroids?
☤ Illicit drugs? Frequency? Amount? Affected daily activiities?
☤ Still using? Friends using/selling?

Sexual activities
☤ Sexual orientation?
☤ GF/BF? Typical date?
☤ Sexually active? When started? # of persons?
Contraceptives? Pregnancies? STDs?

Suicide/Depression
☤ Ever sad/tearful/unmotivated/hopeless?
☤ Thought of hurting self/others?
☤ Suicide plans?

Safety
☤ Use seatbelts/helmets?
☤ Enter into high risk situations?
☤ Member of frat/sorority/orgs?
☤ Firearm at home?
 Respiratory Distress Syndrome
(Hyaline Membrane Disease)

☤ Male, preterm, low BW, maternal DM, & perinatal asphyxia

☤ Corticosteroids:
• most successful method to induce fetal lung maturation
• Administered 24-48 hours before delivery decrease incidence
of RDS
• Most effective before 34 weeks AOG

☤ Microscopically: diffuse atelectasis, eosinophilic membrane

Pathophysiology:
1. Impaired/delayed surfactant synthesis & secretion
2. V/Q (ventilation/perfusion) imbalance due to deficiency of
surfactant and decreased lung compliance
3. Hypoxemia and systemic hypoperfusion
4. Respiratory and metabolic acidosis
5. Pulmonary vasoconstriction
6. Impaired endothelial &epithelial integrity
7. Proteinous exudate
8. RDS
 Respiratory Distress Syndrome
(Hyaline Membrane Disease)
Clinical Features:
1. Tachypnea, nasal flaring, subcostal and intercostal
retractions, cyanosis, grunting
2. Pallor – from anemia, peripheral vasoconstriction
3. Onset – within 6 hours of life
Peak severity – days 2-3
Recovery – 72 hours

Retractions:
☤ Due to (-) intrapleural pressure produced by interaction b/w
contraction of diaphragm & other respiratory muscles and
mechanical properties of the lungs & chest wall
Nasal flaring:
☤ Due to contraction of alae nasi muscles leading to marked reduction
in nasal resistance
Grunting:
☤ Expiration through partially closed vocal cords
Initial expiration: glottis closedlungs w/ gasinc. transpulmo P w/o
airflow
Last part of expiration: gas expelled against partially closed cords
Cyanosis:
☤ Central – tongue & mnucosa (imp. Indicator of impaired gas
exchange); depends on total amount of desaturated Hgb
 F.R.I.C.H.M.O.N.D.

☤ Fluids
☤ Respiration
☤ Infection
☤ Cardiac
☤ Hematologic
☤ Metabolic
☤ Output & Input [cc/kg/h] N: 1-2
☤ Neuro
☤ Diet