1. Criteria for diagnosing DKA
-have to have diabetes (blood gluc>200)
-have to have acidosis... from ketones... (pH<7.3 or bicarb<15)
...hence "diabetic... keto...acidosis..."
2. DKA severity is based on degree of acidosis: 
-Mild: pH 7.2-7.3 / bicarb 10-15
-Moderate: pH 7.1-7.2 / bicarb 5-10
-Severe: pH <7.1, bicarb <5
You can get a sense of how insulin deprived the person is by the severity of DKA. Usually their A1Cs will be pretty high (>10-11). If they have a relatively good A1C and they're presenting in DKA, it means they didn't take their insulin recently (intentionally/accidental), or they're really acutely sick from something else. Monitor urine for ketones-- need to have 2 voids that are negative for ketones before they're OK to get off IV fluids and go home.
3. For pain management in sickle cell pain crises: a good regimen is alternating max dose toradol (30mg IV) with tylenol. If that doesn't work, go to opiates.
-"aplastic crisis" in sickle cell does not mean pancytopenia, it means severe anemia with low retics, with nl white cells/platelets, can be caused by parvo.
-"hyperhemolytic crisis" = severe anemia with high retics
-"splenic sequestration crises" are exactly what they sound like. They are terrifying, with a 10-15% mortality rate: kids can hemorrhage into their spleens (and/or livers), and in the span of an hour, lose half of their hematocrit and crash. Monitor vitals (esp BP) and hct hourly, if they are in shock, push crystalloids with one hand, get O- blood stat with the other, and if you can't stabilize, with third hand call surgeons while wheeling towards OR for splenectomy. If you can stabilize, do prophylactic splenectomy when pt is fully chipper and HDS-- splenic sequestration have a 50% recurrence rate, so splenectomy is indicated after first event.
4. Retrocecal appendicitis can mimic pyelonephritis. The WBCs can migrate into the ureters and cause pyuria, can present with back pain.
5. Antibiotics Pearls:
-Omnicef covers HiB better than amox in someone who isn't vaccinated.
-The treatment for uncomplicated cellulitis is 7-10 days of PO antibiotics. 
6. Systolic heart murmurs:
-Holosystolic: "blood is going somewhere it shouldn't", since there should be no movement of blood during isovolumetric contraction/relaxation at the beginning and end of diastole. DDx: VSD, AV valve regurg
-Mid Systolic ejection: must r/o HOCM.
---Benign: "increased flow across normal valves"-- fever, anemia, states that produce increased cardiac output (hyperthyroid, anemia) or super healthy young people who just have very high CO baseline. Also can be still's (LLSB, louder supine, age 2-6), PPS (pulmonic window, radiates everywhere, kids <6 mos of age, more common after respiratory illness. )
---Pathologic: outflow tract obstruction: aortic/pulmonic stenosis, HOCM
-Early Systolic ejection: small, muscular VSD, closes upon heart contraction
7. Diastolic Heart Murmurs: always pathologic
-Early diastole: A/P valve regurg
-Mid diastole: increased flow across M/T valves,
-Late diastole: stenotic AV valves.
8. Continuous Heart Murmur:
-PDA, AVM/fistula
-Venous hum: from blood crashing through jugular vein. Diagnosis: Press finger over jugular, sound stops.
9. If you have a sick newborn (<2 weeks old) who presents with a sepsis-like picture, always keep duct-dependent heart defect high on your differential; the two can present with very similar clinical features. Your threshold for giving prostaglandins should be low, because they have very few side effects.
10. Asthma controllers:
-When someone is not well controlled on med-dose inhaled steroids, add LABA before going to high-dose steroids.
-Singular: 20-30% nonresponders. Esp good for asthma/allergic rhinitis or cough-predominant asthma types.