Pediatric Emergency Playbook

Pediatric Emergency Playbook
Emergency Medicine | Pediatric Emergency Medicine | Critical Care | Pediatrics | Medical Education | #FOAMed
List or Gist? Inductive Clinical Reasoning: a PEM Primer
Dec 1 • 14 min
Harpoon or Hook? Deductive Clinical Reasoning: a PEM Primer
Nov 1 • 21 min
Knee Pain
Oct 1 • 33 min
Sep 1 • 34 min
Strep Throat
Aug 1 • 41 min
Does Your Patient Have Streptococcal Pharyngitis? No Problem — I’ll just Swab. Not So Fast… Fagan Nomogram for Likelihood Ratios 1. Decide on your pre-test probability of the disease (choose an approximate probability based on our…
Jul 1 • 34 min
How do we make the diagnosis? What now? Concussion in Sport Group Guidelines Concussion Recognition Tool (for coaches, trainers on field) Child Sports Concussion Assessment Tool, 5th Ed. (Child SCAT); Ages 5-12 Sports Concussion Assessment…
EKG Killers: Part Two
Jun 1 • 20 min
EKG Killers: Part One
May 1 • 37 min
Hypertension in Children
Apr 1 • 30 min
References Baracco R et al. Pediatric Hypertensive Emergencies. Curr Hypertens Rep. 2014; 16:456. Belsha CW. Pediatric Hypertension in the Emergency Department. Ann Emerg Med. 2008; 51(3):21-24. Chandar J…
The Fussy Infant
Mar 1 • 46 min
A Social Visit or Your Most Dangerous Presentation Tonight? [Details in Audio] This post and podcast are dedicated to Henry Goldstein, B.Pharm, MBBS for his tireless dedication to all things #FOAMed,…
Airway Master Moves
Feb 1 • 20 min
You know how to intubate safely. You can recite all of the Ps backwards and forwards. Until you can’t. Real-time trouble-shooting. [Details in Audio] This post and podcast are dedicated to Mads Astvad for sharing his enthusiasm,…
Ovarian Torsion
Jan 1 • 24 min
Ovarian torsion is like the MI of the pelvis. Sometimes all it takes is a good story to investigate. When to worry, when to walk it off, and when to work it up: What is the typical presentation of ovarian torsion? There is…
Just Say No To (These) Drugs
Dec 1, 2017 • 25 min
Dogma often dictates routine care. There are times when we have to attend to paradigm shifts. An easy way to save lives? Just say no to (these) drugs: Codeine Normally metabolized into codeine-6-glucuronide (50-70%) and norcodeine…
Blunt Head Trauma
Nov 1, 2017 • 30 min
PECARN Head CT Decision Tool
The Higher Tech Kid in the ED
Oct 1, 2017 • 31 min
Comfortable with G-tubes, tracheostomies, and VP shunts? Good. Get ready for the next level: Vagus Nerve Stimulators, Intrathecal Pumps, and Ventricular Assist Devices. Details in Audio: Vagus Nerve Stimulators For intractable epilepsy;…
Vaccine Preventable Illness Part Two
Sep 1, 2017 • 35 min
The Pediatric Surgical Abdomen
Aug 1, 2017 • 30 min
Abdominal pain is common; so are strongly held myths and legends about what is concerning, and what is not. One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain….
Vaccine Preventable Illness Part One
Jul 1, 2017 • 39 min
MI in Children
Jun 1, 2017 • 36 min
Myocardial infarction (MI) in children is uncommon, but underdiagnosed. This is due to two main factors: the etiologies are varied; and the presenting symptoms are “atypical”. We need a mental metal detector! Case examples…
Neonatal Jaundice
May 1, 2017 • 39 min
Most newborns will have some jaundice. Most jaundice is benign. So, how can we sort through the various presentations and keep our newborns safe? Pathologic Jaundice When a baby is born with jaundice, it’s always bad. This is pathologic…
Foreign Bodies in the Head and Neck
Apr 1, 2017 • 46 min
Children the world over are fascinated with what can possibly “fit” in their orifices. Diagnosis is often delayed. Anxiety abounds before and during evaluation and management. Most common objects:1,2 Food Coins Toys …
Supraglottic Airways
Mar 1, 2017 • 32 min
When you give only after you’re asked, you’ve waited too long. – John Mason First, learn to bag Place a towel roll under the scapulae to align oral, pharyngeal, and tracheal axes: Karsli C. Can J Anesth. 2015. Use airway adjuncts such as…
Urine Trouble
Feb 1, 2017 • 52 min
When should you commit to getting urine? When can you wait? When should you forgo testing altogether? When do I get urine? Symptoms – either typical dysuria, urgency, frequency in a verbal child, or non-descript abdominal pain or vomiting in a…
Pediatric Pain
Jan 1, 2017 • 51 min
N.B.: This month’s show notes are a departure from the usual summary. Below is a reprint (with permission) of a soon-to-be released chapter, Horeczko T. “Acute Pain in Children”. In Management of Pain and Procedural Sedation in Acute Care….
Dec 1, 2016 • 37 min
“By the pricking of my thumbs, Something wheezing this way comes.” — Witches in Macbeth, with apologies to William Shakespeare “Bronchiolitis is like a pneumonia you can’t treat. We support, while the patient heals.” — Coach, still…
Pediatric Elbow Injuries
Nov 1, 2016 • 41 min
Johnny has fallen on an outstretched hand, and comes to you with a swollen, painful elbow. Position of comfort, analgesia, xrays, and now what? What am I seeing — or not seeing — here? First a refresher on radiographic…
GI Bleeding in Children
Oct 1, 2016 • 33 min
Blood in the vomit. Blood in the stool. Blood in the diaper. How far do I go in my investigation? What do I really have to worry about? The differential diagnosis of GI bleeding in children is broad. (Here is the complete differential…
Pediatric Headache: Some Relief for All
Sep 1, 2016 • 30 min
Seemingly vague, but potentially dangerous… common, but possibly with consequences… …or maybe just plain frustrating. Let’s talk risk stratification, diagnosis, and management. Primary or Secondary? We can make headache as easy or as…
Subcutaneous Rehydration
Aug 1, 2016 • 29 min
Have you ever been in any of these situations? ⇒ You have a stable child who just needs fluids, but no laboratory tests ⇒ You’ve tried PO hydration, to no avail, despite anti-emetics ⇒ You’re poking the…
Jul 1, 2016 • 33 min
“She won’t walk”, or “He just looks like he’s limping”. So many things can be going on — how do we tackle this chief complaint? You’re dreading a big work-up. You almost want to tell the kid – please, STOP LIMPING… STOP LIMPING! S –…
Approach to Shock
Jun 1, 2016 • 38 min
Do we recognize shock early enough? How do we prioritize our interventions? How can we tell whether we’re making our patient better or worse? World wide, shock is a leading cause of morbidity and mortality in children, mostly for…
Altered Mental Status in Children
May 1, 2016 • 36 min
How do you approach the child who may be altered? Altered mental status in children can be subtle. Look for age-specific behaviors that range from irritability to anger to sleepiness to decreased interaction. In the altered child,…
Big Labs, Little People
Apr 1, 2016 • 31 min
Troponin, BNP, D-Dimer, and Lactate in Children
Multisystem Trauma in Children, Part Two: Massive Transfusion, Trauma Imaging, and Resuscitative Pearls
Mar 1, 2016 • 37 min
A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. On arrival, he was in…
Multisystem Trauma in Children, Part One: Airway, Chest Tubes, and Resuscitative Thoracotomy
Feb 1, 2016 • 35 min
Traumatized children need your full attention. Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more. Two main reasons: Children have specific injury…
Vomiting in the Young Child: Nothing or Nightmare
Jan 1, 2016 • 47 min
In the young child, vomiting is the great imitator: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral. To help us organize, below is a review of can’t-miss diagnoses by age. The…
Electrical Injuries: Hertz So Bad
Dec 1, 2015 • 35 min
Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. A targeted history usually gets you the information you need. Four main things to find out: 1. Household…
Adventures in RSI
Nov 1, 2015 • 51 min
Pediatric airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks: episteme, or theoretical knowledge, techne, or technical knowledge, and phronesis, or practical wisdom, also called prudence. Here…
The Technologically Dependent Child in the ED
Oct 1, 2015 • 35 min
EMS is bringing you a child with a VP shunt, port-a-cath, trached on a vent, seizing, hypotensive, and now desaturating – ETA – 3 minutes. Are you ready? Medicine is evolving. As technology advances, we need to meet the challenge of…
Intranasal Medications
Sep 1, 2015 • 33 min
Intranasal medications, if understood and employed properly, are a great choice to avoid and IV or as a bridge until IV access is obtained. Learn the strengths and limits of intranasal fentanyl, midazolam, ketamine, and dexmedetomidine. Pain…
Pediatric Status Epilepticus
Sep 1, 2015 • 24 min
Do you have a plan for your little patient when he just won’t stop seizing? What do you do when your typical treatment is not enough? Get up-to-date in the understanding and management of pediatric status epilepticus. Definition of status…
The Undifferentiated Sick Infant
Sep 1, 2015 • 31 min
You have all of the skills you need to care for an acutely ill infant. Learn a few pearls to make this a smoother endeavor. The Pediatric Assessment Triangle is a rapid, global assessment tool using only visual and auditory clues to make…