Author: bradsobo

Brad Sobolewski, MD, MEd is a Professor of Pediatric Emergency Medicine and an Associate Director for the Pediatric Residency Training Program at Cincinnati Children's Hospital Medical Center. He is on Twitter @PEMTweets and authors the Pediatric Emergency Medicine site PEMBlog and produces and hosts the PEM Currents: The Pediatric Emergency Medicine Podcast.

Categories
Otolaryngology

Nosebleeds

You will see a child with a nosebleed in the ED. It is a mathematical certainty. Chances are it has already stopped. Even if it hasn’t you can stop it – and figure out why it happened – and provide reassurance and education to the patient and family. Yes, all of those things for one little bleeding nose…

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References

Béquignon E, Teissier N, Gauthier A, et al. Emergency Department care of childhood epistaxis. Emerg Med J 2017; 34:543.

Shay S, Shapiro NL, Bhattacharyya N. Epidemiological characteristics of pediatric epistaxis presenting to the emergency department. Int J Pediatr Otorhinolaryngol. 2017 Dec;103:121-124. PMID: 29224751.

Tunkel DE, Anne S, Payne SC, et al. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg 2020; 162:S1.

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Categories
Surgery

Intussusception

Any list of “Top 10 Emergency Department diagnoses in children you can’t miss” should include intussusception. This episode reviews the diagnosis and management in practical manner that should help you on your next shift. It also features the talents of Kriti Gupta, MD, a Pediatric Emergency Medicine fellow from NewYork Presbyterian Brooklyn Methodist Hospital who is both the producer and host of this episode.

Transcript

The transcript for this episode can be found on PEMBlog

CME & MOC Part 2

We are proud to offer CME and MOC Part 2 from Cincinnati Children’s. Click this link to go to the page for credit. Credit is free and registration is required.

Click here to claim CME and MOC part 2 Credit


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References

Shaw, K. N., Bachur, R. G., Chamberlain, J. M., Lavelle, J., Nagler, J., & Shook, J. E. (2021). Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. Wolters Kluwer. 

Dahan, N., & Francisco, B. (2021, November 3). Pediatric small talk – the rule of 6: Pediatric abdominal surgical emergencies. emDOCs.net – Emergency Medicine Education. Retrieved November 8, 2021, from http://www.emdocs.net/pediatric-small-talk-the-rule-of-6-pediatric-abdominal-surgical-emergencies/. 

Sobolewski, B., PEM Blog Intussusception Part 2: Ultrasound-ing good. (2013, September 11). PEMBlog. Retrieved November 9, 2021, from https://pemcincinnati.com/blog/intussusception-2/ 

Sobolewski, B., Intussusception part 1: The basics. (2013, September 10). PEMBlog. Retrieved November 8, 2021, from https://pemcincinnati.com/blog/intussusception-1/.  

Fox, S. M. (2013, February 28). Intussusception. Pediatric EM Morsels. Retrieved November 10, 2021, from https://pedemmorsels.com/intussusception/.  

Giovanni JE, Hrapcak S, Melgar M, Godfred-Cato S. Global Reports of Intussusception in Infants With SARS-CoV-2 Infection. Pediatr Infect Dis J. 2021 Jan;40(1):e35-e36. doi: 10.1097/INF.0000000000002946. PMID: 33105341; PMCID: PMC7720868.

Ultrasonographic Diagnosis of Intussusception in Children: A Systematic Review and Meta-Analysis. J Ultrasound Med. 2021 Jun;40(6):1077-1084. doi: 10.1002/jum.15504. Epub 2020 Sep 16.

Doo JW, Kim SC. Sedative reduction method for children with intussusception. Medicine (Baltimore). 2020 Jan;99(5):e18956. doi: 10.1097/MD.0000000000018956. PMID: 32000420; PMCID: PMC7004751.

Centers for Disease Control and Prevention. (2018, July 25). Rotavirus vaccination. Centers for Disease Control and Prevention. Retrieved November 14, 2021, from https://www.cdc.gov/vaccines/vpd/rotavirus/index.html. 

Centers for Disease Control and Prevention. (2011, April 22). Vaccines: VPD-VAC/rotavirus/Rotashield and intussusception historical info. Centers for Disease Control and Prevention. Retrieved November 14, 2021, from https://www.cdc.gov/vaccines/vpd-vac/rotavirus/vac-rotashield-historical.htm.

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Categories
Urology

Urinary retention

This episode of PEM Currents: The Pediatric Emergency Medicine Podcast is a brief review of the management of urinary retention in children. The most common causes are UTI and constipation – but you must be aware of neurological problems and assure that you history is thorough and your physical exam complete.

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References

Burla MJ, Benjamin J. Pediatric Urinary Retention in the Emergency Department: A Concerning Symptom with Etiology Outside the Bladder. J Emerg Med. 2016 Feb;50(2):e53-6. PMID: 26482829.

Peter JR, Steinhardt GF. Acute urinary retention in children. Pediatr Emerg Care. 1993 Aug;9(4):205-7. PMID: 8367356.

Gatti JM, Perez-Brayfield M, Kirsch AJ, Smith EA, Massad HC, Broecker BH. Acute urinary retention in children. J Urol. 2001 Mar;165(3):918-21. PMID: 11176514.

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Categories
Hematology

DVT

Your time is valuable and so is mine. That’s why I’m sharing brief, focused podcast episodes that will hone in on a single problem. This time, it’s deep venous thromboses (DVT). Learn how to suspect them in the first place and make the diagnosis.

PEMBlog.com

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I am proud to offer CME and MOC Part II through Cincinnati Children’s for listening to my podcast. All you have to do is listen to these four brief episodes that were released in the last couple of months, and then complete the multiple choice questions at the following link. Note that registration is open to any provider seeking physician CME even if you are not a Cincinnati Children’s employee.

The link to the CME for these episodes are: https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

The episodes included in this CME / MOC Part II program are:

Cannabis Hyperemesis Syndrome – 10/29/2021

Ovarian Torsion – 11/3/2021

Stress Dose Steroids – 11/9/2021

DVT 11/29/2021

That CME link again is – https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

References

Jaffray J, Young G. Deep vein thrombosis in pediatric patients. Pediatr Blood Cancer. 2018 Mar;65(3). PMID: 29115714.

Rodríguez-Fanjul J, Trenchs V, Muñoz-Santanach D, de Sevilla MF, Toll T, Blanch J, Luaces C. Deep vein thrombosis: rare cases of diagnoses in a pediatric emergency department. Pediatr Emerg Care. 2011 May;27(5):417-9. PMID: 21546806.

Waheed SM, Kudaravalli P, Hotwagner DT. Deep Vein Thrombosis. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507708/

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Categories
Resuscitation

Stress Dose Steroids

Your time is valuable and so is mine. That’s why I’m sharing brief, focused podcast episodes that will hone in on a single problem. This time, it’s stress dose steroids. Learn about how to give them and to not worry about tons of body surface area related math when you have a sick child in front of you.

PEMBlog.com

Follow @PEMTweets on Twitter

I am proud to offer CME and MOC Part II through Cincinnati Children’s for listening to my podcast. All you have to do is listen to these four brief episodes that were released in the last couple of months, and then complete the multiple choice questions at the following link. Note that registration is open to any provider seeking physician CME even if you are not a Cincinnati Children’s employee.

The link to the CME for these episodes are: https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

The episodes included in this CME / MOC Part II program are:

Cannabis Hyperemesis Syndrome – 10/29/2021

Ovarian Torsion – 11/3/2021

Stress Dose Steroids – 11/9/2021

DVT 11/29/2021

That CME link again is – https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

References

Huan D and Tat S. PEM Pearls: Hydrocortisone stress-dosing in adrenal insufficiency for children. Academic Life in Emergency Medicine. https://www.aliem.com/pem-pearls-hydrocortisone-stress-dosing-adrenal-insufficiency-children/ May 2, 2016

Miller BS, Spencer SP, Geffner ME, Gourgari E, Lahoti A, Kamboj MK, Stanley TL, Uli NK, Wicklow BA, Sarafoglou K1. Emergency management of adrenal insufficiency in children: advocating for treatment options in outpatient and field settings. J Investig Med. 2019 Feb 28. PMID: 30819831. 

Podcast: Play in new window | Download (Duration: 5:51 — 8.0MB)

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Categories
Gynecology Surgery

Ovarian Torsion

Your time is valuable and so is mine. That’s why I’m sharing brief, focused podcast episodes that will hone in on a single problem. This time, it’s ovarian torsion. Learn about the presentation, diagnosis, and treatment of this can’t miss surgical condition.

PEMBlog.com

Follow @PEMTweets on Twitter

Check out the Facebook page

I am proud to offer CME and MOC Part II through Cincinnati Children’s for listening to my podcast. All you have to do is listen to these four brief episodes that were released in the last couple of months, and then complete the multiple choice questions at the following link. Note that registration is open to any provider seeking physician CME even if you are not a Cincinnati Children’s employee.

The link to the CME for these episodes are: https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

The episodes included in this CME / MOC Part II program are:

Cannabis Hyperemesis Syndrome – 10/29/2021

Ovarian Torsion – 11/3/2021

Stress Dose Steroids – 11/9/2021

DVT 11/29/2021

That CME link again is – https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

References

Schmitt ER, Ngai SS, Gausche-Hill M, Renslo R. Twist and shout! Pediatric ovarian torsion clinical update and case discussion. Pediatr Emerg Care. 2013 Apr;29(4):518-23; quiz 524-6. PMID: 23558274.

Guile SL, Mathai JK. Ovarian Torsion. [Updated 2021 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560675/

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Categories
Adolescent

Cannabis Hyperemesis Syndrome

Your time is valuable and so is mine. That’s why I’m sharing brief, focused podcast episodes that will hone in on a single problem. This time, it’s cannabis hyperemesis syndrome (aka Cannabinoid Hyperemesis Syndrome). Learn about the presentation, diagnosis, and treatment of this surprisingly common malady.

PEMBlog.com

Follow @PEMTweets on Twitter

Check out the Facebook page

I am proud to offer CME and MOC Part II through Cincinnati Children’s for listening to my podcast. All you have to do is listen to these four brief episodes that were released in the last couple of months, and then complete the multiple choice questions at the following link. Note that registration is open to any provider seeking physician CME even if you are not a Cincinnati Children’s employee.

The link to the CME for these episodes are: https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

The episodes included in this CME / MOC Part II program are:

Cannabis Hyperemesis Syndrome – 10/29/2021

Ovarian Torsion – 11/3/2021

Stress Dose Steroids – 11/9/2021

DVT 11/29/2021

That CME link again is – https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

References

McConachie SM, Caputo RA, Wilhelm SM, Kale-Pradhan PB. Efficacy of Capsaicin for the Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review. Ann Pharmacother. 2019 May 18:1060028019852601. PMID: 31104487

Witsil JC, Mycyk MB. Haloperidol, a Novel Treatment for Cannabinoid Hyperemesis Syndrome. Am J Ther. 2017 Jan/Feb;24(1):e64-e67. PMID: 25393073.

Galli JA, Sawaya RA, Friedenberg FK. Cannabinoid hyperemesis syndrome. Curr Drug Abuse Rev. 2011;4(4):241-249. doi:10.2174/1874473711104040241

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Categories
Trauma

Firearm Safety

This episode was produced with Libby Ireson (@LibbyIreson on Twitter), Pediatric Resident at Cincinnati Children’s and is being released in conjunction with the 2021 Day of Action promoting firearm safety and speaking out against gun violence. The goals of this episode are to:

  1. Report statistics of pediatric firearm-related injuries/deaths in the United States 
  2. Review the American Academy of Pediatrics’ recommendations on firearm safety 
  3. Discuss strategies for counseling your patients and families on firearm safety
  4. Talk about how we can support patients and families who are victim or survivors of gun violence 

The link to the PEMBlog post, including a full transcript is here.

The American Academy of Pediatrics’ Gun Safety Campaign Toolkit

Resources

The Brady Center’s ASK Campaign

The Everytown for Gun Safety BeSMART Campaign

If you or anyone you know is considering suicide, please reach out for help. You can reach the National Suicide Prevention Hotline via phone at 1-800-273-6255 or by texting 741-741. 

For more Pediatric Emergency Medicine education check out…

PEMBlog.com

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References

Campbell BT, Thaker S, Fallat ME, et al. A Multicenter Evaluation of a Firearm Safety Intervention in the Pediatric Outpatient Setting. J Pediatr Surg. 2020 Jan;55(1):140-145.

“Gun Violence is a Public Health Crisis.” The American Public Health Association.

“Youth Firearm Injury and Death.” The Farley Health Policy Center. 

Parikh K, Silver A, Patel SJ et al. Pediatric Firearm-Related Injuries in the United States. Hosp Pediatr. 2017 Jun;7(6):303-312.

Schaechter, Judy. “Guns in the Home.” HealthyChildren.org, The American Academy of Pediatrics.

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Categories
Trauma

Concussions

Concussions and closed head injuries are incredibly common in the Pediatric Emergency Department and in general Emergency Department, especially as we head into fall contact sports season. In this episode, featuring Brielle Stanton, MD, a Pediatric Emergency Medicine fellow from The UPMC Children’s Hospital of Pittsburgh, you will earn how to differentiate clinically important traumatic brain injuries from milder trauma – specifically when to get a CT, and how to diagnose and manage concussions.

PEMBlog.com

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Resources

MD Calc: Pediatric Head Injury/Trauma Algorithm

MD Calc: Glasgow Coma Scale

Healthy Children: Concussions: What parents Need to Know

CDC: Heads Up

References

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70. doi: 10.1016/S0140-6736(09)61558-0. Epub 2009 Sep 14. Erratum in: Lancet. 2014 Jan 25;383(9914):308. PMID: 19758692.

Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE. Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice. Arch Dis Child. 2014 May;99(5):427-31. doi: 10.1136/archdischild-2013-305004. Epub 2014 Jan 15. PMID: 24431418.

Lumba-Brown A, Yeates KO, Sarmiento K, Breiding MJ, Haegerich TM, Gioia GA, Turner M, Benzel EC, Suskauer SJ, Giza CC, Joseph M, Broomand C, Weissman B, Gordon W, Wright DW, Moser RS, McAvoy K, Ewing-Cobbs L, Duhaime AC, Putukian M, Holshouser B, Paulk D, Wade SL, Herring SA, Halstead M, Keenan HT, Choe M, Christian CW, Guskiewicz K, Raksin PB, Gregory A, Mucha A, Taylor HG, Callahan JM, DeWitt J, Collins MW, Kirkwood MW, Ragheb J, Ellenbogen RG, Spinks TJ, Ganiats TG, Sabelhaus LJ, Altenhofen K, Hoffman R, Getchius T, Gronseth G, Donnell Z, O’Connor RE, Timmons SD. Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children. JAMA Pediatr. 2018 Nov 1;172(11):e182853. doi: 10.1001/jamapediatrics.2018.2853. Epub 2018 Nov 5. Erratum in: JAMA Pediatr. 2018 Nov 1;172(11):1104. PMID: 30193284; PMCID: PMC7006878.

Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE. Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice. Arch Dis Child. 2014 May;99(5):427-31. doi: 10.1136/archdischild-2013-305004. Epub 2014 Jan 15. PMID: 24431418.

Zuckerbraun NS, Atabaki S, Collins MW, Thomas D, Gioia GA. Use of modified acute concussion evaluation tools in the emergency department. Pediatrics. 2014 Apr;133(4):635-42. doi: 10.1542/peds.2013-2600. Epub 2014 Mar 10. PMID: 24616361.

Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, Berrington de González A. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012 Aug 4;380(9840):499-505. doi: 10.1016/S0140-6736(12)60815-0. Epub 2012 Jun 7. PMID: 22681860; PMCID: PMC3418594.

Miglioretti DL, Johnson E, Williams A, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013;167(8):700-707. doi:10.1001/jamapediatrics.2013.311

Mannix R, Bazarian JJ. Managing Pediatric Concussion in the Emergency Department. Ann Emerg Med. 2020 Jun;75(6):762-766. doi: 10.1016/j.annemergmed.2019.12.025. Epub 2020 Feb 17. PMID: 32081385.

Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, Aglipay M, Sangha G, Boutis K, Beer D, Craig W, Burns E, Farion KJ, Mikrogianakis A, Barlow K, Dubrovsky AS, Meeuwisse W, Gioia G, Meehan WP 3rd, Beauchamp MH, Kamil Y, Grool AM, Hoshizaki B, Anderson P, Brooks BL, Yeates KO, Vassilyadi M, Klassen T, Keightley M, Richer L, DeMatteo C, Osmond MH; Pediatric Emergency Research Canada (PERC) Concussion Team. Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED. JAMA. 2016 Mar 8;315(10):1014-25. doi: 10.1001/jama.2016.1203. Erratum in: JAMA. 2016 Jun 21;315(23):2624. PMID: 26954410.

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Categories
Orthopedics

Shoulder Dislocations

What’s the best maneuver for reducing a dislocated shoulder? My guess is as good as yours. There are multiple maneuvers that work – and work well for anterior (AKA anterior-inferior) dislocations. This episode reviews how to manage shoulder dislocations in the Pediatric population.

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References

Fox, Shoulder Dislocations. Pediatric EM Morsels. July 31, 2015. https://pedemmorsels.com/shoulder-dislocation/. Accessed June 23, 2021. 

Zacchilli MA Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010 Mar;92(3):542-9. PMID: 20194311.

Podcast: Play in new window | Download (Duration: 11:52 — 16.3MB)

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