When I said I would go into the top ten articles presented at the recent AAP NCE in San Diego I meant it. I plan to tackle each article and briefly review the results and try to drive home how this can impact your practice. First up, a steroid alternative for prednisone die-hards. I've you've been a PEMBlog reader for [...]
In the ED we certainly see a significant number of head injuries. There are an estimated 1.7 million per year in the US. Fortunately most of these are not associated with intracranial bleeding. However, that certainly does not mean that there aren't important diagnoses to consider. Concussions have gained increased attention over the past decade thanks in part to a growing [...]
I've been regularly checking out the PEM Database Online for several years now. It is a good example of a hyper-focused content aggregation site. What do I mean by content aggregation? Well, in general on a website you either create content, share content that other people have produced - or both. The PEMBlog is an example of the latter. I [...]
Certainly you will be seeing some sicker children with bronchiolitis this winter who have issues with feeding. The copious nasal congestion and increased work of breathing may preclude adequate oral intake. Some of these children will merit admission and generally we obtain IV access for hydration. But why can't we use their gut via a nasogastric tube? Logically this makes sense - [...]
I encourage you all to check out the topic review that was posted yesterday on Academic Life in Emergency Medicine. It focuses on the well trodden topic of when to get a head CT in a child with a head injury and offers a great summary of the available literature while providing a good discussion of the limitations. Check it [...]
Something that I feel differentiates experienced from novice providers in the emergency department is a true recognition of the evidence and rationale behind why we do what we do. It is certainly important to recognize the right treatment for a given illness. Perhaps equally important it is necessary to understand the evidence behind the reason that treatment is given in [...]
I recommend this article to anyone who cares for children in their practice - specifically anyone who will interpret CSF results. In 2007 the Pediatric Emergency Medicine Collaborative Research Committee (PECARN) published the following article in JAMA. Link The authors noted that few children who end of being admitted to the hospital on antibiotics with CSF pleocytosis actually have bacterial meningitis [...]
Ever wonder why we give nebulized albuterol in the ED instead of a metered dose inhaler? Haven't you heard form a colleague that "4 to 6 puffs is equivalent to a neb." Perhaps some of this is convention, but there is evidence behind it. In an oldie but goodie form 1993 Idris et al performed a RCT to compare an [...]
Check out this study from Johnson et al. in Pediatrics. In "Association of Race and Ethnicity With Management of Abdominal Pain in the Emergency Department" the authors reviewed NHAMCS data and noted that patients who were categorized as non-Hispanic black were less likely to receive any analgesic (odds ratio [OR]: 0.61; 95% CI: 0.43-0.87) or a narcotic analgesic (OR: 0.38; 95% [...]
Hanson et al. in the latest issue of Pediatrics reviewed data from 2002-2011 and noted that there has been a 92% increase in Sports related head injuries. 3/4 of these patients are male. Though the overall numbers of visits have increased the injury severity (mean ISS 7.8 to 4.8 - β = –0.46; P = .006), and percentage of admissions (χ2 = 9.8, df = 9, P= [...]
