Though a meta-analysis shows that racemic epi may help on the initial visit, the AAP recommended that it not be used as a trial therapy for most outpatient providers in its latest clinical practice guideline. You'll see that my original post and recommendation aligns with what the AAP says. Welcome to part 3 of the bronchiolitis series. Parts 1 and 2 are [...]
Though meta-analyses and systematic reviews - see below - have shown that beta agonists may improve symptoms scores they certainly don't affect disease resolution. Thus, since clinical scores are subjective and don't necessarily correlate with objective measurements. When sensitivity analysis is used to weed out weaker studies any effects towards benefit in the meta analyses is mitigated. Thus, the AAP [...]
According to the AAP's 2006 Clinical Practice Guideline, bronchiolitis is the most common lower respiratory tract infection (LRTI) in infants and is caused by a virus - most often RSV in 70-80%, Human metapneumovirus in 10-20%, and then assorted rogues such as Adenovirus, Rhinovirus, Parainfluenza, and Influenza pulling up the rear. Its cardinal pathophysiologic features include;[list type="check"] Acute inflammation Edema and [...]
Cue the Michael Buffer intro... Yes, then age old question surfaces again. This is also probably something that most of us don't think about on a regular basis. many of our patients' parents may swear by on or the other (usually Ibuprofen) but is there any evidence to support the superiority of one agent over another? Let's take a look [...]
Ted Brenkert a faculty colleague of mine here in Cincinnati has completed the first podcast in the PEM Currents series. You can find it by Searching iTunes for "PEM Currents" or clicking this link Visiting www.pemcincinnati.com/podcasts and checking out the 'Grudge Match' post. You can stream the podcast there. Download the audio file This podcast was prepared with anyone who takes [...]
Many of you may have come across the correspondance between BMJ and Roche already regarding Tamiflu. If not, take a moment to look it over, don't worry, I'll wait. http://www.bmj.com/tamiflu/roche OK, welcome back... Here's the bottom line - the flu vaccine is still available in the community and is the best defense. The principal circulating viruses are AH3N2 and are [...]
Tis the season for flu-like symptoms. Many of you will see multiple members of the same family with the flu. But what if it isn't the flu? When should one be worried about carbon monoxide poisoning? Let's take a look at this colorless, odorless, potentially deadly gas. What exactly is CO poisoning? CO is a byproduct of the combustion of [...]
A hyphema is a collection of blood in the anterior chamber and is usually the result of trauma. The eyeball is compressed, and the anterior ciliary body tears, leading to bleeding. The grades are estimated by volume of the anterior chamber I: <1/3 II: 1/3 to 1/2 III: >1/2 IV: complete The higher the grade, the greater the risk for re-bleeding. Ophtho may [...]
[column col="1/2"]What is the Pediatric Appendicitis Score for the following patient? What does this score say about their risk of acute appendicitis? Does he need further testing to confirm the diagnosis? A 7 year old male presents with 18 hours of abdominal pain that was initially periumbilical, but moved to the right lower quadrant. He is not hungry - at [...]
Fractures in any infant or toddler are concerning, but not all fractures are equally associated with non-accidental trauma (NAT). A 2008 systemic review from BMJ reviewed over 30 studies concerned with all manner of fractures in children under 18 years of age. The following was noted: Fractures resulting from abuse were more common in infants (<12 months) and toddler's (age 1-3 [...]
