Welcome to a new PEMBlog feature - Fracture Fridays. Each week I'll post a new case of a common pediatric orthopedic injury. So, without further ado, here we go. 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 [...]
You are seeing a 2 year old boy with a high fever who is irritable and refuses to look up. His parents think he has a sore throat. You are appropriately worried about a retropharyngeal cellulitis/abscess and obtain the following X-Ray. Widened prevertebral soft tissue space consistent with a retropharyngeal cellulitis/abscess Fortunately he is adequately protecting his airway. [...]
Here are some criteria for immediate/urgent referral to a regional burn center: Partial thickness burns >10% BSA in a child <10 years of age Partial thickness burns >20% BSA in a child >10 years of age Full thickness burns >2% BSA Burns to the hands, feet, face or genitals Circumferential burns Burns that overly a joint Burns associated with inhalational [...]
Here's a quick review of the general management principles for DKA. Fill the tank This begins with a 10ml/kg 0.9%NS bolus. This accomplishes the following: Restores circulation Increases glucose uptake in the periphery Increases glomerular filtration Reverses the mounting acidosis In many cases blood glucose rapidly declines following initial fluid resuscitation. Once you've improved perfusion, then start 0.45% saline for maintenance and replacement . [...]
You gotta see the ear drum in a kid with fever and ear pain. It's that simple. And if you thought the screaming, kicking and thrashing was offering enough of a challenge, you also encounter a Shrek-esque accumulation of cerumen. How should you proceed? Check out the handy table below. Technique Advantages Disadvantages Potential Contraindications Irrigation Easy to do Specialized manual [...]
Recently I have seen a few preschoolers with true vertigo - one even told me that it felt like he just "spinned on a baseball bat." For those of you without a clear mental image of what he meant check out this video. Both had a history of recent URI symptoms, and ultimately we diagnosed one with acute otitis media and the [...]
Limp is an abnormal gait and can result from congenital, infectious, inflammatory, traumatic, neoplastic or congenital causes. It can primarily involve the spine, hips/pelvis, abdomen, or musculoskeletal and soft tissues. Certainly you should start with an appropriately thorough H&P. Make sure to ask about: Fever and other symptoms associated with infections Trauma Systemic symptoms (pale skin, fatigue, easy/abnormal bruising and/or [...]
Most of the readers of this blog will have diagnosed at least one case of otitis media. If you haven't then you're not working enough (kidding). You may also have had discussions with parents of children presenting with ear pain (usually at 2AM) about how their child's TM doesn't look like an ear infection right now and that it could look like one in [...]
You are seeing a six year old with a type III supracondylar fracture of the humerus. He fell on his outstretched arm while playing on some monkey bars. He has some mild difficulty flexing his thumb when he makes a fist. Where is his neurapraxia? Answer: The Anterior Interosseous Nerve It is the most common nerve injured in extension type [...]
As promised here are the slides of my presentation on altered mental status in the ED. Remember, the workup is concise, focused, and initially centered around identifying reversible causes (hypoxia, hypoglycemia) before moving on to imaging and lumbar puncture. If you have any questions I'd be happy to address them in the comments. Management of Altered Mental Status in the [...]
