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
Orthopedics

Finger Dislocations

It is much more common for children to break a finger than dislocate one. Why? Those darn growth plates. Nevertheless reducing a dislocated digit is one of the most common emergency procedures around and can generally be performed without much difficulty. However there are some situations where you shouldn’t just yank in the digit. Learn about these situations and more in this episode. 

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References

Borchers et al. Common Finger Fractures and Dislocations. Am Fam Physician. 2012 Apr 15;85(8):805-810.

Ahn and Blomberg. Phalanx Dislocations. Ortho Bullets. https://www.orthobullets.com/hand/6038/phalanx-dislocations. Updated 5/17/21. Accessed June 23, 2021.

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Categories
Orthopedics

Patella Dislocations

Reducing a dislocated patella is super satisfying – both for the clinician and the patient. This episode reviews management of this common orthopedic concern so that you can perform a reduction maneuver without needing to call Orthopedics.

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References

Fithian DC,Paxton EW,Stone ML,Silva P,Davis DK,Elias DA,White LM, Epidemiology and natural history of acute patellar dislocation. The American journal of sports medicine. 2004 Jul-Aug;     [PubMed PMID: 15262631]

Jain NP,Khan N,Fithian DC, A treatment algorithm for primary patellar dislocations. Sports health. 2011 Mar;     [PubMed PMID: 23016004]

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Categories
Orthopedics

Nursemaid’s Elbow

Never has there been a more anachronistic name for such a common malady. Hailing from the time when the wealthy had female domestic workers who cared for children within their large household, this outmoded eponym describes a common orthopedic condition that impacts young children. I’ll cast my vote for calling it “pulled elbow” like they do in Australia – because it describes when happens when the radial head subluxes from its usual position nestled in the annular ligament. This episode discusses the diagnosis and management of this can’t miss condition, that I suspect our residents and students aren’t seeing as much as they should. 

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References

Macias CG, Bothner J, Wiebe R. A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Pediatrics. 1998 Jul;102(1):e10. doi: 10.1542/peds.102.1.e10. PMID: 9651462.

Nardi NM, Schaefer TJ. Nursemaid Elbow. [Updated 2020 Nov 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.

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Categories
Adolescent

Adolescent sexual and reproductive health in the ED

This episode features three members of the Pediatric Emergency Care Applied Research Network (PECARN) Adolescent Sexual Health Working Group. PECARN is a network that performs multicenter research related to the emergency care of children. The Adolescent Sexual Health Working Group is focused on researching topics of interest around sexual and reproductive health in the ED. I recently had the pleasure of interviewing three of the study authors and recorded our conversations, then created a podcast episode that hit on some of the highlights of their incredible work. James Gray also helped me put a blog post together that delves into some of the topics in a bit more in depth fashion.

This episode features the contributions of:

Melissa Miller, MD
Associate Professor of Pediatrics
Division of Emergency Medicine
Children’s Mercy Hospital Kansas City

Lauren Chernick, MD, MSc
Assistant Professor of Pediatrics in Emergency Medicine
Columbia University Medical Center

Erin Hoehn, MD
Assistant Professor of Pediatrics
Division of Emergency Medicine
Children’s Hospital of Pittsburgh

Check out the companion blog post at PEMBlog.com

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Key Article

Miller MK, Chernick LS, Goyal MK, et al. A Research Agenda for Emergency Medicine-based Adolescent Sexual and Reproductive Health. Acad Emerg Med. 2019;26(12):1357-1368. doi:10.1111/acem.13809

References

Brown J, Fleming R, Aristzabel J, Gishta R. Does pelvic exam in the emergency department add useful information?. West J Emerg Med. 2011;12(2):208-212.

Farrukh S, Sivitz AB, Onogul B, Patel K, Tejani C. The Additive Value of Pelvic Examinations to History in Predicting Sexually Transmitted Infections for Young Female Patients With Suspected Cervicitis or Pelvic Inflammatory Disease. Ann Emerg Med. 2018 Dec;72(6):703-712.e1. doi: 10.1016/j.annemergmed.2018.05.004. Epub 2018 Jul 2. PMID: 30251627.

Linden JA, Grimmnitz B, Hagopian L, Breaud AH, Langlois BK, Nelson KP, Hart LL, Feldman JA, Brown J, Reid M, Desormeau E, Mitchell PM. Is the Pelvic Examination Still Crucial in Patients Presenting to the Emergency Department With Vaginal Bleeding or Abdominal Pain When an Intrauterine Pregnancy Is Identified on Ultrasonography? A Randomized Controlled Trial. Ann Emerg Med. 2017 Dec;70(6):825-834. doi: 10.1016/j.annemergmed.2017.07.487. Epub 2017 Sep 19. PMID: 28935285.

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Categories
gastroenterology

Magnet Ingestions

This episode focuses on high-powered magnet ingestions in children and was a collaboration with Elizabeth Curtis – @egcurtismd and Libby Ireson – @LibbyIreson, two Categorical Pediatrics Residents at Cincinnati Children’s who served as producers and guest hosts. These rare earth magnets were briefly removed from the market because children swallowed them and, when two magnets attracted across opposing loops of bowel, they sustained intestinal injury. Legal machinations led to their reappearance on the market.

This episode is equal parts clinical advice and advocacy in action and will help you discuss these potentially dangerous magnets with families and manage a child in case they swallow one.

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References

CPSC Safety Alert (2007) “Ingested Magnets Can Cause Serious Intestinal Injuries” https://www.cpsc.gov/s3fs-public/5221.pdf   

AAP (2017) “Dangers of Magnetic Toys.” https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Dangers-of-Magnetic-Toys-and-Fake-Piercings.aspx   

Middelberg, L. K., Funk, A. R., Hays, H. L., McKenzie, L. B., Rudolph, B., & Spiller, H. A. (2021). Magnet Injuries in Children: An Analysis of the National Poison Data System From 2008-2019. The Journal of Pediatrics, 0(0). https://doi.org/10.1016/j.jpeds.2021.01.052 

Strickland M, Rosenfield D, Fecteau A. Magnetic foreign body injuries: a large pediatric hospital experience. J Pediatr. 2014 Aug;165(2):332-5. doi: 10.1016/j.jpeds.2014.04.002. Epub 2014 May 16. PMID: 24836391. 

De Roo AC, Thompson MC, Chounthirath T, Xiang H, Cowles NA, Shmuylovskaya L, Smith GA. Rare-earth magnet ingestion-related injuries among children, 2000-2012. Clin Pediatr (Phila). 2013 Nov;52(11):1006-13. doi: 10.1177/0009922813507129. PMID: 24137035. 

Mandhan, P., Alsalihi, M., Mammoo, S., & Ali, M. J. (2014). Troubling toys: rare-earth magnet ingestion in children causing bowel perforations. Case reports in pediatrics, 2014. 

Reeves, P. T., Nylund, C. M., Krishnamurthy, J., Noel, R. A., & Abbas, M. I. (2018). Trends of magnet ingestion in children, an ironic attraction. Journal of pediatric gastroenterology and nutrition, 66(5), e116-e121. 

Spiller, H. (2019) “The Dangers of Magnet Toys.” Nationwide Children’s Hospital www.nationwidechildrens.org/family-resources-education/700childrens/2019/12/magnet-toys

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Categories
Resuscitation

Drowning

With the warm weather upon us here in the Northern Hemisphere it will soon be time for the pools to open. This episode is therefore incredibly timely, and focuses on the spectrum of submersion injuries and their management. Learn about drowning physiology, when to admit to the hospital, and how to assess the child who went under water unexpectedly but looks fine from this episode’s special co-host and producer, Joe Finney, MD a PGY-5 Pediatric Emergency Medicine and EMS fellow from Washington University in Saint Louis, MO. You can connect will Joe via email at Josephfinney@wustl.edu.

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References

A65. NICU, PICU AND CHRONIC VENTILATION. American Thoracic Society International Conference Meetings Abstracts American Thoracic Society International Conference Meetings Abstracts, www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A2198. 

Zuckerman GB, Gregory PM, Santos-Damiani SM. Predictors of Death and Neurologic Impairment in Pediatric Submersion Injuries: The Pediatric Risk of Mortality Score. Arch Pediatr Adolesc Med. 1998;152(2):134–140. doi:10.1001/archpedi.152.2.134

Watson RS, Cummings P, Quan L, Bratton S, Weiss NS. Cervical spine injuries among submersion victims. J Trauma. 2001 Oct;51(4):658-62. doi: 10.1097/00005373-200110000-00006. PMID: 11586155.

Gonzalez-Luis G, Pons M, Cambra FJ, Martin JM, Palomeque A. Use of the Pediatric Risk of Mortality Score as predictor of death and serious neurologic damage in children after submersion. Pediatr Emerg Care. 2001 Dec;17(6):405-9. doi: 10.1097/00006565-200112000-00002. PMID: 11753182.

Noel S. Zuckerbraun, Richard A. Saladino, Pediatric Drowning: Current Management Strategies for Immediate Care, Clinical Pediatric Emergency Medicine, Volume 6, Issue 1, 2005, Pages 49-56, ISSN 1522-8401, https://doi.org/10.1016/j.cpem.2004.12.001. (https://www.sciencedirect.com/science/article/pii/S1522840104000874)

Szpilman D, Morgan PJ. Management for the Drowning Patient. Chest. 2020 Oct 14:S0012-3692(20)34896-0. doi: 10.1016/j.chest.2020.10.007. Epub ahead of print. PMID: 33065105.

Noonan L, Howrey R, Ginsburg CM. Freshwater submersion injuries in children: a retrospective review of seventy-five hospitalized patients. Pediatrics. 1996 Sep;98(3 Pt 1):368-71. PMID: 8784358.

Quan L, Kinder D. Pediatric submersions: prehospital predictors of outcome. Pediatrics. 1992 Dec;90(6):909-13. PMID: 1437433.

Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases. Chest. 1997 Sep;112(3):660-5. doi: 10.1378/chest.112.3.660. PMID: 9315798.

Best RR, Harris BHL, Walsh JL, Manfield T. Pediatric Drowning: A Standard Operating Procedure to Aid the Prehospital Management of Pediatric Cardiac Arrest Resulting From Submersion. Pediatr Emerg Care. 2020 Mar;36(3):143-146. doi: 10.1097/PEC.0000000000001169. PMID: 28486266.

Davey M, Callinan S, Nertney L. Identifying Risk Factors Associated with Fatal Drowning Accidents in the Paediatric Population: A Review of International Evidence. Cureus. 2019 Nov 19;11(11):e6201. doi: 10.7759/cureus.6201. PMID: 31890403; PMCID: PMC6919957.

Habib DM, Tecklenburg FW, Webb SA, Anas NG, Perkin RM. Prediction of childhood drowning and near-drowning morbidity and mortality. Pediatr Emerg Care. 1996 Aug;12(4):255-8. doi: 10.1097/00006565-199608000-00005. PMID: 8858647.

Son KL, Hwang SK, Choi HJ. Clinical features and prognostic factors in drowning children: a regional experience. Korean J Pediatr. 2016 May;59(5):212-7. doi: 10.3345/kjp.2016.59.5.212. Epub 2016 May 31. PMID: 27279885; PMCID: PMC4897156.

“Almost 800 Kids Drown Each Year; More than Half Are Under Age 5.” Safe Kids Worldwide, 29 June 2016, safekids.org/press-release/almost-800-kids-drown-each-year-more-half-are-under-age-5.

“Drowning Prevention.” Services.aap.org, services.aap.org/en/news-room/campaigns-and-toolkits/drowning-prevention/.

“WISQARS (Web-Based Injury Statistics Query and Reporting System)|Injury Center|CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 July 2020, www.cdc.gov/injury/wisqars/. 

Idris AH, Berg RA, Bierens J, Bossaert L, Branche CM, Gabrielli A, Graves SA, Handley AJ, Hoelle R, Morley PT, Papa L, Pepe PE, Quan L, Szpilman D, Wigginton JG, Modell JH. Recommended guidelines for uniform reporting of data from drowning: the “Utstein style.”Circulation. 2003; 108:2565–2574. doi: 10.1161/01.CIR.0000099581.70012.68

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Categories
Toxicology

Toxicology Season 2 Episode 3: Nicotine

This is Season 2 of the Toxicology podcast series that Seattle Childrens’ Toxicologist Suzan Mazor, MD and I put together. This three episode season turns its focus to drugs of abuse – continuing with this episode on nicotine toxicity – the final episode of this #ToxTuesdays season.

I am now proud to offer CME through Cincinnati Children’s. To claim visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

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References

American College of Medical Toxicology: Nicotine

CDC: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

Yale medicine – E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI). YaleMedicine.org

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Categories
Toxicology

Toxicology Season 2 Episode 2: Marijuana

This is Season 2 of the Toxicology podcast series that Seattle Childrens’ Toxicologist Suzan Mazor, MD and I put together. It is a joint effort so to speak. This three episode season turns its focus to drugs of abuse – continuing with this episode on marijuana toxicity. So, let’s weed out the bad information, hash out the details, and learn about cannabinoid toxicity in this #ToxTuesdays episode.

I am now proud to offer CME through Cincinnati Children’s. To claim visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

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References

Graham et al. Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series, PEDIATRICS, 2017.

Wang, Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization, J Med Toxicol. 2017 Mar; 13(1): 99–105.

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Categories
Toxicology

Toxicology Season 2 Episode 1: Opioids

This is Season 2 of the Toxicology podcast series that Seattle Childrens’ Toxicologist Suzan Mazor, MD and I put together. This three episode season turns its focus to drugs of abuse – beginning with this episode on opioid toxicity. So, slow your breathing, constrict your pupils, and focus in for the return of #ToxTuesdays.

I am now proud to offer CME through Cincinnati Children’s. To claim CME & ABP MOC Part 2, visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

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References

Allen, et al. Prescription Opioid Exposures Among Children and Adolescents in the United States, PEDIATRICS, 2017.

Boyer, Management of Opioid Analgesic Overdose, NEJM, 2012.

Forti, Opiate Overdose, Pediatrics in Review January 2007, 28 (1) 35-36; DOI: https://doi.org/10.1542/pir.28-1-35.

Matson et al. Opioid Use in Children, J Pediatr Pharmacol Ther. 2019 Jan-Feb; 24(1): 72–75.

www.takebackyourmeds.org

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Categories
Cardiology

Return to sports following COVID-19

Even though we won’t be “clearing” patients in the ED we still need to be familiar with return to sports recommendations for children and adolescents who have had COVID-19. Remember, these are just recommendations and are based off of practice patterns at many centers and on the AAP guideline. Consult with your local hospital and Cardiology groups for up to date information. The information in this episode is intended for any young person (21 and under) who tests positive for COVID-19 and wants to return to sports. It is structured based on the severity of initial presenting symptoms.

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References

COVID-19 Interim Guidance: Return to Sports. American Academy of Pediatrics. December 17, 2020. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/. Accessed 12/23/2020.

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