Let's move onto the final part in the osteo series - treatment. Editors note: small corrections were made on 3-14-14 with the addition of information of ortho consultation and the delay of antibiotics and changing cephalexin to cefazolin. Thanks to Dr. Indi Trehan for alerting me to the errata. Choosing the right antibiotic If you think its osteo, then start [...]
By now you've likely seen parts one, two and three. Moving in a logical direction part four will focus on imaging, As you'd imagine, radiographic studies are supremely important in the diagnosis of osteo. Let's take a look by modality shall we? Plain films The bottom line is that it can take up to 2-3 weeks for the typical osteo [...]
If you've been following along with parts 1 and 2, then part 3 is the next logical step- because, um, counting? Let's look at laboratory studies in osteo. It may come as no surprise that the initial labs that end up being most helpful are CRP, ESR and blood culture. Pääkkönen et al noted that both ESR and CRP were highly sensitive at [...]
Welcome back to the Osteo series - Whereas part one focused mainly on etiology, part 2 delves into making the diagnosis with a good history and physical. I should really say that your history and physical helps increase your index of suspicion - since osteo can be quite elusive especially in the early stages. Harkening back to part one, it [...]
Thus begins the PEMBlog series on Osteomyelitis. In each edition I'll tackle a different question - ranging from diagnosis to therapy and hopefully review most of the finer points. There is no better place to begin than at the start. Osteo as it will now be known (because I don't feel like typing the myelitis part) is a bacterial infection [...]
Here is a summary of clinical prediction models in pediatric community acquired pneumonia and the signs and symptoms most suggestive of pneumonia. The take home point is that there is such a wide variability that you should only test/treat if your clinical suspicion is high. All four of these articles are worth a look. Lynch et al. - Pediatrics 2004 [...]
Check out the Storify summary of today's pneumonia lecture [View the story "February 21st pneumonia live tweet" on Storify]
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 - [...]
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 [...]
In general it is a good idea to be familiar with the clinical practice guidelines of the American Academy of Pediatrics. We see enough UTIs in the ED that it is always helpful to review. Check it out here The big take home points are: Diagnosis is MOST supported by pyuria and >50,000 colonies/mL on culture Follow up should occur [...]
