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## Mometrix Provide important information, such as indications of child abuse or metabolic/infectious disorders. **Diagnostic studies for ALTE include:** * CBC with serum electrolytes and chemical panel * ECG (12-lead) * Blood, urine, and spinal fluid cultures * Stool culture and botulinum toxin...

## Mometrix Provide important information, such as indications of child abuse or metabolic/infectious disorders. **Diagnostic studies for ALTE include:** * CBC with serum electrolytes and chemical panel * ECG (12-lead) * Blood, urine, and spinal fluid cultures * Stool culture and botulinum toxin testing **Treatment includes** continuing resuscitative efforts and stabilizing the patient if possible. The child with ALTE should be hospitalized for observation, further studies, and apnea monitoring as these children are at increased risk for SIDS. For SIDS patients, the nurse should provide support and information to the family. The protocol for reporting SIDS varies by state but usually involves notification of the coroner's office. ## Home Cardiorespiratory Monitors Some infants may be discharged from the NICU on Cardiorespiratory monitors. These monitors have been shown to be successful in preventing death from apnea for certain infants. These monitors are NOT indicated for the prevention of SIDS in an otherwise healthy newborn. The following events are indications that an infant may be sent home on monitors: * Infant who has apnea of prematurity that has had all other causes of apnea ruled out * Infant who survived an apparent life-threatening event (ALTE) and that event was apnea, cyanosis, choking or gagging * Infant who has had two or more siblings who have died from SIDS * Infant with a tracheostomy Parents/caregivers must have a clear understanding of the reasons for the monitors and how to apply, remove, and care for them. They should have hospital practice and should demonstrate their skills before discharge of the infants. ## Acetaminophen (Tylenol®) Toxicity Acetaminophen (Tylenol®) toxicity from accidental or intentional overdose has high rates of morbidity and mortality caused by liver failure unless promptly treated. **Diagnosis** is by history and acetaminophen level, which should be completed within 8 hours of ingestion if possible. Toxicity is plotted on the Rumack-Matthew nomogram with serum levels>150 requiring antidote. Toxicity occurs with dosage >140 mg/kg in one dose or >7.5g in 24 hours. **Symptoms occur in stages:** * **Initial** - Minor gastro-intestinal upset * **Days 2-3** - Hepatotoxicity with RUQ pain and increased AST, ALT, and bilirubin * **Days 3-4** - Hepatic failure with metabolic acidosis, coagulopathy, renal failure, encephalopathy, nausea, vomiting, and possible death * **Days 5-12** - Recovery period for survivors. **Treatment includes**: * Gl decontamination with activated charcoal (orally or NG) within ≤4 hours * Gastric lavage if within 1 hour (may not be effective in small children because of the size of NG tube).