Migraines are a common sight during any shift in the ED. I have written about them before, and the benefits of antiemetics and depakote are reasonably well documented. A treatment for refractory headaches that seems to be gaining favor recently is IV magnesium. You may be familiar with Mag and its use in asthma exacerbation, or (gasp) preeclampsia - but [...]
Seriously, I can never manage to remember the differences between Monteggia and Galeazzi fractures - especially when it shows up on standardized tests. So, this edition of Fracture Fridays focuses on differentiating the two. Essentially, when one forearm bone breaks and is displaced, angulated and foreshortened something happens to the other one - usually a fracture - but sometimes a [...]
The case A 15 year old skateboarder totally screws up a rail grind. After posting his wipeout to YouTube his friends call his mom, who notices that he has been unable to walk on his ankle - probably because of how ridiculously swollen it is. A gnarly swollen ankle You get an XRay, because that's what you do... [...]
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 [...]
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 [...]
I have delved into similar topics before, but I wanted to highlight something I read on Academic Life in Emergency Medicine this weekend. They have been running a series entitled "How I work smarter" that features leaders in the field talking about various aspects of their careers. This weekend's entry from Dr. Rick Body contained a powerful bit of advice [...]
The case A preschooler was riding his big sister's "girl" bike, crashed it and landed on his outstretched hand. A true FOOSH if you will (fell on outstretched hand). His mom brought him to the ED because he was having trouble holding his iPad with the injured arm. An X-Ray is obtained. The Diagnosis This is a buckle or torus [...]
I'm delighted to share the latest PEM Currents podcast! I recently sat down with Todd Florin, one of the faculty physicians at Cincinnati Children's Hospital Medical Center and talked about bronchiolitis, delving into the controversies around the use of hypertonic saline, albuterol and more. Todd also recommended that all of my listeners check out the current AAP Bronchiolitis Guideline, which [...]
Whenever you order a lab you must ask yourself the following questions? Why am I ordering this test? What am I going to do with the result? Given that PCT has become a frequently ordered test for many of you I wanted to answer some straightforward questions, and dive into the body of evidence to help support your decision making [...]
