November Week 2
You are on call at Arlington and get called to the ER to see a 4 year old with a 2 day history of vomiting and diarrhea. Before you get to the ER, you go over some things in your head…
1. What would make me admit this kid?
A. Positive Rotavirus stool test
B. Vomiting apple juice in the ER
C. Tachycardia, dry mucus membranes, and capillary refill of 3 seconds
2. Why is his 2 month old brother not so sick?
A. Because 1 dose of the vaccine he just got conveys ~50% immunity according to a study in El Salvador
B. Because he still has some of his mother’s antibodies
C. Because the incubation period is 1-3 days and we just might not be seeing it yet
D. All of the above.
You are SAR float and hear than one of our beloved Gold patients with an isolated bowel transplant is in the ER with gastroenteritis. You admit the kid, fluid resuscitate him with normal saline, and make some fancy maintenance fluids based on his old TPN. The next night, you learn that it’s Rotavirus. What nifty therapeutic options should you propose for this immunocompomised child when you’re rounding at midnight with Dr. K?
B. PO Ig
You are in CYAS seeing one of Dr. Morel’s beloved patients with congenital HIV, a 2 month old baby girl. Do you give the baby the Rotavirus vaccine?
A. Yes, there is no increased risk, and viral shedding is 7 days, just like the general population
B. No, it can cause severe gastroenteritis with viral shedding up to 6 months
You are the Gray intern pre-rounding on C53, and you’re trying to decide which kids to see first based on the likelihood of nosocomial transmission of their infection to other patients. Put these kids in the order you decide is best:
A 3 year old boy with Rotavirus gastroenteritis
A 7 month old ex-36 wga baby girl with RSV bronchioloitis
A 16 year old boy with influenza A pneumonia who just stepped down from PICU yesterday
How many kids in the USA are admitted to the hospital for Rotavirus?
How many kids die each year in the USA from Rotavirus?
What percentage of kids in the USA have had a case of Rotavirus by age 5 years?
How many of them are hospitalized for it?
Case by Dr. Meaghan Nigra