A 3 year old male presents with the chief complaint of "privates swollen." He was previously well until today, and after itching in his underpants in the morning mom checked and saw that her son had "Crazy swelling of his wee wee." He has been able to void normally, and denies pain. He is afebrile and has not had any [...]
This is a follow-up of last week's Briefs on ketamine. How long do you really need to keep a patient NPO prior to moderae/procedural sedation in the ED? Let's look at this issue form a few different angles and explore the evidence since there is such a significant degree of practice variation. Aspiration Risk Certainly the main goal of fasting [...]
Simultaneously in your ED you encounter; A 2 year old male with a complex facial laceration A 9 year old female gymnast you decided to do a back handspring, and in the process fractured her right radius and ulna A 4 year old boy with a screw embedded in his left foot You have fentanyl, midazolam and ketamine in [...]
A surprisingly common complaint that I deal with in the pediatric ED is epistaxis. While I find that many cases come down to worried parents who haven't applied appropriate measures to get the bleeding to stop, I still figured it was a good topic to review since most residents are going to run across a blood nose at some point. [...]
You see a kid that you're pretty sure has Henoch Schonlein Purpura (HSP). OK, you're certain 'cause they have the rash and EVERYTHING. They aren't hypertensive, and their urine is normal. They have belly pain, but no currant jelly stools, and they don't have intussusception because the ultrasound was normal. He is eating and drinking OK, and can walk to [...]
Keeping it short and simple this week folks. Here is a presentation on back pain in the pediatric ED. Just scroll vertically through the slides. You can even download it if you want. Spoiler alert! I will actually be giving this talk live tomorrow at the Cincinnati Children's resident lectures. Back Pain in the Pediatric ED
A 5 year old boy presents to the ED with his parents at 1:15AM. The parents report that they went to their son's room when they heard him screaming. It started all of a sudden, and aside form his attending his cousin's birthday party the day before there was nothing remarkable about his recent history (except for the party - [...]
In many ways the management of sicker patients with suspected croup is more straightforward. Give them steroids early, let the patient protect their own airway and use inhaled racemic epinephrine. But what about the larger majority of kids that you might see in the ED (usually between 10PM and 4AM) who now have a barky cough and that's it. Sure, [...]
A reasonably terrified mom brings her 17 month old boy into the ED after an apparent seizure. She states that her older daughter took a piece of candy away from the toddler, and then her son started to cry, and then "turned blue" and fell to the ground. He had not eaten any candy yet, and did not appear to be [...]
Though readily available, and the reference standard for diagnosing intraabdominal injuries (IAI) the radiation exposure from a CT is not benign - especially in children. Ultrasound in trauma (FAST) is a valuable tool - but moreso in adults as children may have physiologic free fluid and injuries that will not require surgery as compared to grown ups with similar findings. [...]
