SAEM Clinical Image Series: Facial Swelling in a 2 Year Old

Facial swelling


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Chief complaint: Left-sided facial swelling

History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been treating with Tylenol and a children’s cough medication. The patient went to bed, awoke the following morning with facial swelling, and was brought to the emergency department.

He has no allergies, history of trauma to the area, or bug bites. The patient is fully vaccinated including the influenza vaccine.

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2019-08-19T13:11:59-07:00

PEM Pearls: Ultrasound for Diagnosing Occult Supracondylar Fractures

Supracondylar humerus fractures are the most common type of elbow fracture in pediatric patients, most often seen in a fall on an outstretched hand (FOOSH) or a fall on a hyper-extended elbow.​1,2​ If there is no obvious fracture on x-rays, the patient may have an occult fracture; look for secondary radiographic signs including a posterior fat pad sign, an enlarged anterior fat pad or ‘sail sign’, or malalignment. Occult supracondylar fractures (those with initial normal radiographs that are later diagnosed in follow up) make up 2-18% of all the fractures we see in kids.​3​ When x-ray findings are nonspecific but the index of suspicion for fracture remains high, ultrasound may aid in your clinical decision making.

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2019-08-06T22:45:39-07:00

New free P3 app: PECARN Publication Prospectus

P3 PECARN app

One of the gold standard for building and sustaining collaborative, multi-institutional research networks in medicine is the Pediatric Emergency Care Applied Research Network (PECARN) organization. Their efforts on studying pediatric emergency care has resulted some of our specialty’s landmark papers in Lancet, New England Journal of Medicine, JAMA Pediatrics, and Annals of Emergency Medicine. Although we are not officially affiliated with them, we fully support their efforts and wanted to help disseminate their evidence-based findings with an educations. Thus was born the PECARN Publication Prospectus (P3) app project [download free P3 app].

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2019-07-19T20:59:00-07:00

Strep Pharyngitis in Children: Review of the 2012 IDSA Guidelines

strep pharyngitis

Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.

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2019-07-13T06:57:00-07:00

Pediatric Point of Care Ultrasonography ALiEMU Course on Intussusception

intussusception

Our ALiEMU learning management system, which currently houses the AIR series, Capsules series, and In-Training Exam Prep courses, is ready to slowly open the doors to welcome external authors with high quality content. We are thrilled to welcome a UCSF-sponsored pediatric emergency medicine (EM) point of care ultrasonography (POCUS) series, led by Dr. Margaret Lin. The first course is on the intussusception scan, filled with multiple ultrasound scans showing normal variants and two different types of intussusception.

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2019-06-28T13:39:08-07:00

New PECARN Febrile Infant Rule: A 3-Variable Approach for Ages 29-60 Days | Interview with Dr. Kuppermann

PECARN febrile infant rule

The diagnosis and risk stratification of febrile young infants continues to present a clinical challenge. Serious bacterial infection (SBI) rates in infants ≤60 days have continued to be reported between 8-13%. Despite several different classification rules and pathways, we continue to struggle to accurately delineate which infants have SBI and which do not. A paper titled “A Clinical Prediction Rule to Identify Febrile Infants 60 days and Younger at Low Risk for Serious Bacterial Infections” was published in JAMA Pediatrics in February of 2019.​1​ The authors sought to derive a new clinical prediction rule for infants with fever. The research was conducted as part of the Pediatric Emergency Care Applied Research Network (PECARN). We discussed this publication with lead author Dr. Nathan Kuppermann on a podcast and summarize our discussion below. 

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2019-06-19T05:46:49-07:00

Algorithm for ED Evaluation and Management of Pediatric UTI

Pediatric UTI - urine sample

When should urinary tract infections (UTI) be included in the differential diagnosis for febrile infants and young children? The EM Committee on Quality Transformation in the American Academy of Pediatrics (AAP) thoughtfully outlines a clinical algorithm to help guide clinicians towards a standardized, evidence-based approach. Thanks to the expert content team (Drs. Shabnam Jain, Anne Stack, Scott Barron, Pradip Chaudhari, and Kathy Shaw) for sharing this clinical algorithm.

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2019-03-28T21:46:07-07:00