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 [...]
The Case An 80 pound 12 year old soccer star tripped in a hole while challenging for the ball. Another player on the pitch stumbled in the same (big) hole and landed awkwardly on the first player's leg. Even the fans on the next field over heard the snap. EMS was called and an obviously uncomfortable 12 year old male [...]
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 Watch this brief video I originally made for AAP's PediaLink educational portal that reviews the basic technique of direct laryngoscopy for endotracheal intubation.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 [...]
In contrast to Emergency Departments in which the clientele are mostly grown ups, patients with chest pain in the Pediatric Emergency Department have mostly benign causes. I wanted to review some of the findings associated with benign causes of non traumatic chest pain. Tenderness to palpation of the chest wall In children tenderness of chest chest wall very much suggests [...]
This post originally appeared in a slightly different form on the excellent PEM Fellows Network Blog. Suppose that you are an attending, fellow or senior resident precepting in the ED and your shift has been going well. You supervised a first-time LP—only 2 RBCs (Chardonnay tap?)—and helped with a patellar reduction. With your fellow mojo at an all-time high the last thing [...]
In what has become an annual tradition and a way for me to avoid going to Hallmark I've made yet another anniversary video for my beautiful, amazing lovely wife Kerri.
Another quick hit - when dosing oral midazolam for anxiolysis - like when you're doing a procedure - you can dose above the listed limit of 0.5 mg/kg. In fact, you can dose up to 1 mg/kg! For the child who is preschool and under I will typically give the following dose: 0.7 to 0.8 mg/kg
Though 15mg/kg for acetaminophen are firmly ingrained in your brain, remember that initial and subsequent dosing for the rectal suppository is higher. Rectal Acetaminophen Per Birmingham et al in 2001 the "loading" dose of rectal acetaminophen is 40 mg/kg followed by 20 mg/kg doses every 6 h. The risk of significantly high levels or drug accumulation was not seen over a subsequent 24 hour [...]
If there happened to be a local outbreak of botulism somewhat close to where I worked I'd want to take a look at some resources; Pediatrics in Review: Infant Botulism Medscape: Pediatric Botulism Life in the Fast Lane
The proportion of patients with skin and soft tissue abscesses that are sedated is low, according to one study. Females and patients with employer-based insurance were more likely to be sedated, whereas older patients and African American patients were less likely to be sedated. Uspal et al, Hosp Pediatr, 2015 A retrospective study of febrile infants under 3 months of aguish [...]
