1. In a young patient, athlete, with development of UE DVT and symptoms consistent with chronic PE, like SOB and even hemoptysis, and perhaps CT findings of what could be old consolidated blood in dependent parts of the lung, think paget-schroetter syndrome. Hypertrophy of the anterior scalene or subclavian muscle, and/or excessive movement of the clavicle and first rib against the axillary v, (i.e. in young athletes like baseball pitchers or mechanics who have their hands up a lot). Repetitive crushing of the vein leads to vessel inflammation, damage, and eventually intimal hypertrophy. The tissue surrounding the vessel, normally loose, can become fibrotic and further worsen damage.(J Vasc Surg)
2. Treatment for paget-schroetter is generally agreed to be anticoagulation followed by surgery to remove first rib and anterior scalene. Surgery is the definitive treatment; without it, the symptoms/clots inevitably recur. They used to wait 6 mos before surgery, but there's some data out now that it can be done immediately upon diagnosis with no difference in outcome. With regard to how to manage the clot/prevent more thrombosis before definitive surgical treatment, one retrospective study out of Hopkins (n=110) compared endovascular intervention (thrombolysis/venoplasty) and vs medical management (usu warfarin, sometimes lovenox) before surgery, and found no difference in eventual outcomes. (J vasc surg) Of course as a retrospective chart review study at a big referral center, there was neither randomization nor homogeneity in the type or duration of intervention. Stent/balloon angioplasty usually leads to worse outcomes, as it creates an even more thrombogenic surface that will inevitably clot off again;  (Ann thorac surg).
3. Acyclovir hits the kidneys really hard (crystallizing in the tubules) so if you're going to give it, blast the patient with IV fluids to get it out and increase solubility, and do not use any other drug that harms the kidneys like NSAIDs. I.e. even if they're spiking past 104 and you're maxed out on acetaminophen (15mg/kg in kids q4, 90mg/kg/day), do not give NSAIDs. Treating fever is a comfort thing anyways; even up to 104, there's little evidence that it leads to increased morbidity or mortality.
4. If a newborn is at high risk for kernicterus due to UCB, you can give them light therapy, which is a blue-light (560nm). You can give them one lamp at 65uW, or two lamps, and/or a reflective blanket to lie on. Absolute contraindication for phototherapy: porphyria cutanea tarda. If their UCB is really high (ballpark >25, although it depends on age), you can exchange transfuse.
5. Bhutani nomogram scale (for bili) doesn't reliably begin until around 24 hours of age, so measurements earlier than that will not find clinical correlates on this scale.
6. Major risk factors for kernicterus (i.e. factors that can cause your bili to go up high, or increase suddenly):
--Sepsis & associated factors: temperature instability (esp hypothermia since many newborns can't mount a fever), lethargy/hypotonia, acidosis
--G6PD
--Hypoalbuminemia (<3). You don't want to just infuse albumin-- too much colloidal infusion will dry out tissues by drawing all the fluid intravascularly, also the increased intravascular pressures will damage friable/sensitive vessels in lungs and brain and may lead to pulm or cerebral edema.
--ABO incompatibility (def exchange transfuse to get mom's antibodies out)
--Perinatal hypoxia-- i.e. nuchal cord.
7. Minor risk factors:
--Family hx
--Race
--Bleeds-- i.e. cephalohematoma
--IDM (polycythemia)
--many others
8. Wait 1-10 minutes between albuterol inhaler treatments: the first one gets the bronchioles open, so the second can go further. 4 puffs of MDI/spacer = 1 neb
9. Serologies for coxsackie are an inefficient allocation of limited hospital resources: there are dozens of variants of coxsackie that you have to send for, plus sensitivity and specificity are not great. If you really want an answer, you're better off with a PCR or a viral culture (takes forever).
10. Neck/Axillary LAD more likely viral, inguinal more likely bacterial.