A 3-year-old male presents to the emergency department (ED) complaining of vomiting and diarrhea that has been occurring for 2 days. The mother states that the child has had fewer wet diapers today but has made tears when crying. On physical examination you note no rebound or guarding of the abdomen and determine that the child is moderately dehydrated. Your initial plan is to administer ondansetron and rehydrate the child orally. This is what you have been taught but is it actually efficacious? A just published 2014 JAMA Pediatrics article attempted to answer this question.
A 6-month-old male presents to the emergency department with diarrhea and vomiting. Despite antiemetic therapy, the the child is unable to tolerate oral intake in the ED and so you opt to admit him to the hospital for IV fluids. The pediatric hospitalist requests that you write maintenance fluids prior to admission to the floor. Utilizing the 4-2-1 rule you calculate maintenance needs and choose D5 ½NS as your fluid. This is what you had been taught to utilize in children. It seems appropriate… but is it?
Intracranial injury is the leading cause of death and disability in children. It can arise after severe, moderate, or minor head injury. Children with minor head injury present the greatest diagnostic dilemma for emergency physicians, as they appear well but a small number will develop intracranial injuries. The question that often arises in the ED is:
To CT or not to CT?
The weekend after Thanksgiving, I received the following text from one of my friends: “Bella’s in the hospital. Her legs were hurting, they did tests… It’s leukemia.” Bella is one of my 8 year old daughter’s good friends. All of a sudden my professional world and personal world were colliding. As I looked up from my phone and at my daughter, one of my first thoughts was, how am I going to explain this to my daughter so that she isn’t terrified and understands leukemia?
I was playing bubbles with a 2 yr old when she wanted a turn. Even though I knew the outcome, she said “peeeze” so I said OK. As predicted, she immediately dumped the bubbles on the floor and started laughing. In the corner of the room I heard the quiet voice of her 10 year old brother say to me, “Excuse me, ma’am… you know there’s an app for that”.
To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emergency Medicine (EM) internship year of training. There are 52 articles so that one article can be read at leisure each week of the year. I searched national databases and polled faculty at the University of Washington to identify articles that faculty would expect any EM resident to be familiar with or that they felt were practice-changing in EM. Articles were selected for the final list based on the quality of study design, sample size, and relevance for EM residents.
Early in my career as a Child Life Specialist, I was working with a 4 year old girl who needed her port catheter accessed. She was beginning to panic with rapid breathing and moving around. She was clearly on the verge of screaming at any moment. Her panic made everyone in the room feel anxious. I knew I had to do something, so I got on one knee, looked her in the eye and said, “Just breathe.” Without missing a beat, she leaned in closer to me and said, “I am!”… Touché my little friend.