Another quick hit - when dosing oral midazolam for anxiolysis - like when you're doing a procedure - you can dose above the listed limit of 0.5 mg/kg. In fact, you can dose up to 1 mg/kg! For the child who is preschool and under I will typically give the following dose: 0.7 to 0.8 mg/kg
Though 15mg/kg for acetaminophen are firmly ingrained in your brain, remember that initial and subsequent dosing for the rectal suppository is higher. Rectal Acetaminophen Per Birmingham et al in 2001 the "loading" dose of rectal acetaminophen is 40 mg/kg followed by 20 mg/kg doses every 6 h. The risk of significantly high levels or drug accumulation was not seen over a subsequent 24 hour [...]
If there happened to be a local outbreak of botulism somewhat close to where I worked I'd want to take a look at some resources; Pediatrics in Review: Infant Botulism Medscape: Pediatric Botulism Life in the Fast Lane
FYI - Had to back down to a simple layout since I was having some issues with the formatting - hoping to have it sorted out soon. Sorry for any inconvenience. Annnnnnnd everything is fixed... ;-)
The proportion of patients with skin and soft tissue abscesses that are sedated is low, according to one study. Females and patients with employer-based insurance were more likely to be sedated, whereas older patients and African American patients were less likely to be sedated. Uspal et al, Hosp Pediatr, 2015 A retrospective study of febrile infants under 3 months of aguish [...]
Migraines are a common sight during any shift in the ED. I have written about them before, and the benefits of antiemetics and depakote are reasonably well documented. A treatment for refractory headaches that seems to be gaining favor recently is IV magnesium. You may be familiar with Mag and its use in asthma exacerbation, or (gasp) preeclampsia - but [...]
Seriously, I can never manage to remember the differences between Monteggia and Galeazzi fractures - especially when it shows up on standardized tests. So, this edition of Fracture Fridays focuses on differentiating the two. Essentially, when one forearm bone breaks and is displaced, angulated and foreshortened something happens to the other one - usually a fracture - but sometimes a [...]
The case A 15 year old skateboarder totally screws up a rail grind. After posting his wipeout to YouTube his friends call his mom, who notices that he has been unable to walk on his ankle - probably because of how ridiculously swollen it is. A gnarly swollen ankle You get an XRay, because that's what you do... [...]
Why we do what we do has returned - this time focusing on the use of ultrasound in appendicitis, which has become the test de rigeur these days in most Pediatric Emergency Departments. I won't belabor the point on how important it is to correctly diagnose appendicitis. It peaks between ages 9-12, and can lead to perforation within 36-72 hours. Missed [...]
Another informative post by Lauren Riney, one of the excellent Pediatric Emergency Medicine Fellows at Cincinnati Children's Hospital Medical Center. When is ketamine ABSOLUTELY contraindicated? Age younger than 3 months (primarily for risk of airway complications) Schizophrenia (studies show this condition may be exacerbated with ketamine administration) The list of relative contraindications is much longer: Anything that may increase the risk of laryngospasm (major procedures stimulating the posterior pharynx, [...]
