Why we do what we do has returned - this time focusing on the use of ultrasound in appendicitis, which has become the test de rigeur these days in most Pediatric Emergency Departments. I won't belabor the point on how important it is to correctly diagnose appendicitis. It peaks between ages 9-12, and can lead to perforation within 36-72 hours. Missed [...]
Continuing onward with the top ten articles presented at the recent AAP NCE in San Diego is yet another secondary analysis of the original PECARN study on clinically important TBI (ciTBI). This time looking at children with isolated loss of consciousness (LOC). The outcomes were ciTBI which resulted in death, neurosurgery, intubation for >24 hours, or hospitalization for ≥2 nights and a comparison [...]
Next up from the top ten articles presented at the recent AAP NCE in San Diego is a secondary analysis from the PECARN head injury study published in Lancet in 2009. I'm sure that most have you have seen a child who hit their head with vomiting as their only symptom. The authors compared children with isolated vomiting versus those with vomiting [...]
Back into the fray once more we go - or should I say back into the colon goes the ileum... Yes, the third article in the top 10 from the 2014 AAP NCE focuses on intussusception. Back when I was an intern™ after a child was reduced with air contrast enema they were subsequently admitted for 24 hours to the [...]
Let's move on to the next in the series of top ten articles presented at the 2014 AAP NCE in San Diego. Again, I'll review the article and briefly and highlight how you can use the results in the ED. By now, most of us have acknowledged that ultrasound is a fantastic imaging modality for the diagnosis of acute appendicitis. It is not, however the [...]
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 [...]
The case An infant presents with swelling of the ankle after being picked up from the babysitter. He has been able to pull to stand and cruise for a while now, but appears to be in pain when he attempts to bear weight after he pulls up to stand. X-Rays reveal the following. Diagnosis This is a metaphyseal corner fracture. [...]
It's no secret that youngsters like Instagram. For the unfamiliar, it is an "online mobile photo-sharing, video-sharing and social networking service that enables its users to take pictures and videos." The Division or Radiology at Cincinnati Children's Hospital Medical Center has set up an education-focused Instagram page with a plethora of great images and cases. Add it to the list [...]
I'm not really going out on a limb when I say that constipation is a common diagnosis in the pediatric emergency department. Now, that being said, not all patients that have a diagnosis of constipation are actually constipated. I have certainly seen scenarios where parents have been told that their child is constipated as an explanation for belly pain when [...]
In children 10 years of age and under 90% of clavicle fractures occur in the middle third, 60 percent of which are nondisplaced. Above age 10, the majority are displaced (as is the case in adults). Immobilization with sling and swathe for 3-4 weeks is generally sufficient for most uncomplicated fractures in prepubertal children. An open fracture should be suspected [...]
