Many of us have seen a patient in the ED with a "stiff neck." Though parental concerns range from fears of meningitis (because they Googled...) to injuries, many cases are simply torticollis. Let's dive in - gently... What is it? AKA wry neck, torticollis refers to a condition whereby the neck is twisted laterally. The head is tilted to one [...]
A 14 year old girl with a history of hypertension secondary to chronic nephritis presents with tongue swelling. Her physical exam is unremarkable aside from a swollen tongue and lips. Her phonation is abnormal due to the swollen tongue. She denies any history if allergic reactions to medications in the past. She has no vomiting, wheezing, cough, difficulty breathing or [...]
Check out this study from Johnson et al. in Pediatrics. In "Association of Race and Ethnicity With Management of Abdominal Pain in the Emergency Department" the authors reviewed NHAMCS data and noted that patients who were categorized as non-Hispanic black were less likely to receive any analgesic (odds ratio [OR]: 0.61; 95% CI: 0.43-0.87) or a narcotic analgesic (OR: 0.38; 95% [...]
Hanson et al. in the latest issue of Pediatrics reviewed data from 2002-2011 and noted that there has been a 92% increase in Sports related head injuries. 3/4 of these patients are male. Though the overall numbers of visits have increased the injury severity (mean ISS 7.8 to 4.8 - β = –0.46; P = .006), and percentage of admissions (χ2 = 9.8, df = 9, P= [...]
There are many ways to repair a wound. Please use this table as a reference to help guide selection of materials and a guide for removal. *Consider use of Fast Absorbing Gut (5-0/6-0) on Ear, Eyelid, Eyebrow, Nose, Lip and Face if anticipated difficulty with suture removal (Note: follow up still required for wound evaluation) NOTE: If cartilage involved, strongly [...]
PEM Currents cuts to the tooth of the matter in an effort to help you brush up on dental trauma. Ted Brenkert has been chomping at the bit to fill the cavities in your brain with useful knowledge. Check it out on iTunes here - or listen live via the SoundCloud player embedded in this post. Enjoy!
First of all, let's make one thing perfectly clear. ALTE is not a diagnosis, rather it is a chief complaint - an event that occurred because of something else preceding it. Most are insignificant in the long term health of the child, but the prevalence is 0.5 to 1%, which makes them common enough to merit a thorough history and [...]
Interesting prospective study out of Philadelphia where Samuels-Kalow et al looked at dosing errors after discharge. 145/210 parent-child dyads that were discharged home after initial screening completed a post-discharge phone interview. The interviewer was bilingual. The investigators found that: 46 patients (23%) had an acetaminophen dosing error Spanish-speaking parents were significantly more likely to have a dosing error (OR=3.7; 95% [...]
A young man comes to the ED with severe pain in his nose - specifically the left nostril. He states that he was punched in the face yesterday while "minding his own business." The initial swelling over his nose has improved, and he states that the initial nose bleed stopped. The pain in his nose was so severe that it [...]
Check out all four posts of the intussusception series right here. Part 1: The basics Part 2: Ultrasound-ing good Part 3: Air it out Part 4: Stuck in the middle with you (small bowel-small bowel)
