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There are two other kinds of lice that infest people, but they do not live on the head. Head lice are very small, tan-colored insects (less than 1/8 long) that live on human heads. The eggs are tiny (about the size of the eye of a small needle) and grey or white in color. If you find lice or eggs, follow the suggested treatment and prevention plan at the end of this letter. Look for (1) crawling lice in the hair, usually few in number; (2) eggs (nits) glued to the hair, often found at the back of the neck; and (3) scratch marks on the scalp or back of neck at hairline. Spread: Lice are spread by direct person-to-person contact and by sharing personal items such as combs, brushes, hats, scarves, jackets, blankets, sheets, pillowcases, etc. Pets do not become infested, but they may carry the lice from one person to another. All combs, brushes, and similar items must be disinfected by either soaking in lice-killing shampoo for 4 to 10 minutes (depending on the 90 product used), in a 2% Lysol* solution for 1 hour, or by heating in water of at least 130 degrees F for 10 minutes. Clean floors, furniture, mattresses, car seats, and carpeting by thorough vacuuming. Non-washable clothing, linens, and stuffed toys can be dry cleaned or sealed in plastic bags for 2 weeks. Use a lice-killing shampoo or lotion obtained either over the counter at the drugstore or by prescription from your physician. For some medications, a second treatment is recommended 7 to 10 days later to kill nits that may have survived the first treatment. Exclusion: Child should be excluded until the morning after treatment has been accomplished. The earliest and most common symptom of a head lice infestation is itching, particularly in the area behind the ears and at the nape of the neck. But they also can be transferred indirectly among clothing items when coats, hats and scarves hang or are stored touching one another (in cloak rooms or when these items are placed against one another on coat hooks or racks). Head lice also can be spread when infested hair brushes or combs are shared or when infested bedding, towels or shower caps are shared. Once present in a home, school or institutional environment, head lice usually spread rapidly. Head lice depend completely on their host for nourishment; their only source of food is human blood. The prevalence of head lice infestation is no different in individuals with long hair than in those with short hair. They infest persons from all socioeconomic levels, without regard for age, race, sex or standards of personal hygiene.
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In a relaxed infant, a mass is palpable in the upper abdomen at the midline or slightly to the right of the midline. Infants with pyloric stenosis commonly present with dehydration and electrolyte imbalances. Intravenous fluid resuscitation is required urgently: Use normal saline (20 ml/kg bolus) and insert a nasogastric tube Repeat the fluid boluses until the infant is urinating and vital signs have corrected to normal (2 or 3 boluses may be required). Once the fluid and electrolyte abnormalities have been corrected, provide for maintenance for ongoing losses and transfer the patient for urgent management by a qualified surgeon. Oesophageal atresia Failure of oesophageal development is often associated with a fistula from the oesophagus to the trachea. The newborn presents with drooling or regurgitation of the first and subsequent feeds. Place a sump drain in the oesophageal pouch and administer intravenous fluids calculated according to weight. In other instances, a tiny opening discharging a little meconium may be seen at the base of the penis or just inside the vagina. Delay in diagnosis may cause severe abdominal distension, leading to bowel perforation. Place a nasogastric tube, start intravenous fluids and transfer the child to a surgeon. Meningomyelocele (spina bifida) Meningomyelocele is the name given to a small sac that protrudes through a bony defect in the skull or vertebrae. It may be associated with neurological problems (bowel, bladder and motor deficits in the lower extremities) and hydrocephalus. These patients should always be referred: Hydrocephalus will progress without a shunt being placed Meningitis occurs if the spinal defect is open. The defect should be covered with sterile dressings and treated with strict aseptic technique until closure. An infant with cleft lip or palate who is not growing normally should be fed with a spoon. The operation for a cleft lip is best done at 6 months of age and cleft palate at 1 year. Congenital orthopaedic disorders Disability can be avoided with early treatment of two of the most common congenital orthopedic disorders: Talipes equinovarus (club foot) Congenital hip dislocation. In some regions of the world, this problem is uncommon because infants are carried on the mothers back. Underlying malnutrition and weight, for fluids, transfusions immunosuppression from chronic parasitic infections greatly affect wound and drugs is crucial to correct healing and the risk of infection. The initial assessment and priorities apply to Underlying malnutrition and children.
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Note that both small and large bowel are dilated and that the loops have a relatively horizontal 54 orientation. This patient has a paralytic or non-obstructive ileus, with gas extending all the way to the rectum. Localization of gas in the intestine in a dilated segment or region occurs with a confined inflammatory process such as appendicitis (right lower quadrant), cholecystitis (right upper quadrant) or pancreatitis (sentinel loop). Gas may also appear in bile ducts or other extra-luminal locations under certain conditions. These radiographic findings are not specific, but do tend to localize an inflammatory process, and appendicitis should be included in the differential diagnosis. The next figure (#71) is a coned-down view of the right lower quadrant in this same patient. Black arrows point to two oval shaped calcifications in the right lower quadrant consistent with fecaliths of the appendix. Remember that abnormal calcifications are the fifth item on your abdominal film checklist! By the way, I dont mean to imply that plain film radiographs are the imaging modality of choice for suspected appendicitis. Nothing beats clinical suspicion, however, and persistent tenderness at McBernies point is worth laporoscopy or laporotomy. Yellow arrow indicates gas in the biliary ducts system, which occurred after gallstone passage in this patient. Free air in the abdomen can be localized under the diaphragm or in the flank in viscus perforations as seen in upright chest films or decubitus views respectively. It is important to know the history when calling free air since it is to be expected after abdominal surgery or intraperitoneal endoscopy. Also occasionally air can be discovered superimposed between the liver and diaphragm that is not extraluminal but instead within an inter positioned loop of bowel. When that occurs it may be necessary to obtain additional imaging to exclude a perforated hollow viscus. Yellow arrow points to the anterior leaf of the right hemi diaphragm, which has an eventration. Free air would layer out and since haustral markings are evident, the diagnosis of superimpositioned bowel between diaphragm and the dome of the liver can be made with confidence, at least in this case. Yellow arrow points to an abnormal accumulation of gas representing free air under the diaphragm in this patient with a perforated duodenal ulcer. Image courtesy of Netmedicine Medical Photographic Library via the Internet 57 Diffuse free air in the peritoneal cavity outlines the peritoneal reflections if the film is a flat plate only and is often said to give the appearance of a football effect if the pneumoperitoneum is not under tension. In that case the falciform ligament may be outlined as the laces of the football (air) which outlines the entire abdominal cavity. Although the football sign of free air is not entirely rare, it is not common either since most cases of pneumoperitoneum are diagnosed by an upright film of the chest or a lateral decubitus film of the abdomen. Figure 75 shows a pneumoperitoneum under tension in an infant with a perforated hollow viscus.
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