This post was written by Meredith Posner Shuch, a senior resident at Cincinnati Children's Hospital Medical Center as a component of the Emergency Department Procedure Elective. Digital nerve blocks provide anesthesia for many procedures in the ED, including finger lacerations, paronychia drainage, finger reductions, and nail bed repairs [1]. Most of us are familiar with the traditional digital nerve block [...]
In adults calculating the ankle-brachial index (ABI) is a relatively simple way to confirm the clinical suspicion of lower extremity arterial occlusive disease. In pediatric lower extremity limb injury patients where vascular compromise is a concern (think bad fractures, lawnmower calamities) it may also be a helpful test. Technique Measure the systolic blood pressure at the ankle Place a blood pressure cuff [...]
Do you have 7 minutes and 22 seconds to learn more about endotracheal intubation? Of course your do! Watch this brief video I originally made for AAP's PediaLink educational portal that reviews the basic technique of direct laryngoscopy for endotracheal intubation. Edit: I am aware that in the video I flip-flopped the equations for cuffed and uncured [...]
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, [...]
This post was contributed by Lauren Riney, one of the excellent Pediatric Emergency Medicine Fellows at Cincinnati Children's Hospital Medical Center. So you’ve got another procedural sedation to do in the pediatric emergency department. If your ED is anything like ours, your options for sedation include ketamine, ketamine, and, well, more ketamine. The pharmacology of ketamine is totally different from [...]
There are numerous techniques that we can use to improve our likelihood of success in performing a lumbar puncture. There is one that has a bit of nuance to it that I thought would be an excellent theme for my latest Why We Do What We Do post. So, without further ado, let's talk about early stylet removal. I'm also [...]
We do some hand-on practice from time to time during our Pediatric Emergency Medicine education sessions. Today we discussed and practiced using the EZ-IO for interosseous needle insertion. For those of you who weren't able to be in chilly Cincinnati, OH here's a video that we put together a little while back.
PEM Currents returns with an examination of the different topical anesthetics used in Emergency Department. Specifically, by listening to this edition you'll learn about LET, EMLA and LMX and how you can add them to your repertoire for pre-procedure anesthesia in the ED. You can download it on iTunes Or listen right here via the embedded media player [...]
Umbilical granulomas are often an incidental finding on physical exam, but can be the reason a patient presents to the ED. These fleshy pink masses represent incomplete epithelialization of tissue that persists after the cord separates. It has the honor of being the #1 belly button mass in newborns. On exam they are soft, wet and pink and can be [...]
There are multiple topical anesthetics that we use in the ED. The common theme is that all of these drugs with -caine cause sodium channel inhibition in nerves, which blocks axonal transmission leading to the typical numbness and and localized weakness. I admit that it can be a bit confusing as to which one you should use and when. The aim [...]
