Think about what you do in the ED? Do you recognize how the following studies have impacted your practice? National Emergency X-Radiography Utilization Study Multicenter, prospective, observational study of patients with blunt trauma for whom cervical spine X-rays were obtained. Get C-spine films if: Patients with abnormal neurologic examination Distracting or painful injury (like a femur fracture) Depressed or altered [...]
First of all, the proper and effective treatment of a cutaneous abscess is ALWAYS incision and drainage. With that out of the way, let us address the more controversial question. Should a child be prescribed antibiotics after I&D? We'll look at the evidence as it stands then address the main question in a scenario-based approach. Certainly MRSA is the main [...]
A school age child presents with a lesion on their cheek that has been oozing blood for the past several hours. The parents noted a small red bump several weeks prior to presentation, but he says that it just started bleeding in class. The school officials were freaked out and called an ambulance - mom and dad meet you in [...]
Hematemesis in the newborn period can be alarming for parents and doctors. In this edition of Briefs we are going to look specifically at bloody emesis only in the neonatal period - age less than 4 weeks. Obviously the initial questions should focus on the quantity and character of the vomiting. Was it spontaneous? After feeds? Streaks of red versus [...]
Physicians aren’t great at differentiating bacterial versus viral conjunctivitis. Especially in kids this leads to the provision of antibiotics regardless of etiology. This post will discuss antibiotics agents and therapeutic considerations - including return to school/daycare. Whether you are a network anchor or 4 year old preschooler conjunctivitis will lead to some pretty disruptive symptoms. Neonatal conjunctivitis is another issue [...]
Many a migraine headache is encountered in the ED. The evidence is reasonably clear that the antiemetics (prochlorperazine/metoclopramide - Compazine/Reglan) combined with ketorolac (Toradol) will treat >90% of patients effectively. What about those that don't respond and are still in (dramatic pause) status migrainosus. The intravenous dose is 15-20 mg/kg IV (max of 1 gram). It turns out that a [...]
This week on Briefs I wanted to present - with limited comment - a synopsis of the NEXUS and Canadian C-Spine rules. In general, the most common reason we end up getting cervical spine films in the Peds ED is for midline C-Spine pain. I trust you'd all agree that it is important to understand why we do this, and can [...]
No, this edition of Briefs was not an excuse to use a tongue twister as the title. It is however viral season. An viruses can cause (through some undetermined mechanism) a condition called acute cerebellar ataxia which generally occurs in children less than 5 years of age. It manifests in a wobble (or per the parents "drunk") gait. Dysmetria, nystagmus and [...]
Happy Halloween everyone. I thought I'd "celebrate" by posting about some rare but still clinically important spider bites. The two that get the most press in United States are the black widow (Latrodectus mactans) and brown recluse (Loxosceles reclusa). Fortunately, there are only approximately 500 bytes a year in the United States and deaths are very rare. Black Widow Spiders Black [...]
This week on Briefs I wanted to share with you a presentation I put together on EKGs in the Pediatric ED. I decided to focus on chief complaint as a reason to obtain the study - chest pain and syncope specifically. Enjoy! Electrocardiograms in the Pediatric ED
