The foundation in any pediatric resuscitation is the length-based estimation of the patient’s lean body weight. Once determined, equipments and medications are sized and dosed, respectively, according to that weight. You can use electronic resources such as PEMSoft (Pediatric Emergency Medicine Software) or the more traditional paper-based Broselow tape.
The most common cause of stridor in pediatric patients is croup, or laryngotracheobronchitis. The distinct high-pitched, seal-like,”barky” cough can be heard from outside the patient’s room often.
Check out the clip above that I randomly found on YouTube. Go to the 1:15 mark (near the end) to hear the barking cough. Poor but cute kid.
What is the current treatment regimen? Did you know that the traditional treatment with cool mist or humidified air have shown to be of no added benefit?
PV Card: Croup
Go to the ALiEM Cards site for more resources.
Have you heard of the Modified Centor Score for strep pharyngitis? Interestingly, it has been validated in adults and children. The methodology builds on the traditional Centor Score by incorporating the patient’s age, because this disease is more prevalent in kids than adults. In fact, you actually lose a scoring point if you are older than 44 years old.
In this installment of the Paucis Verbis (In a Few Words) e-card series, the topic is Pediatric Blunt Head Trauma.
This a particularly relevant topic given the recent press and discussions about CT irradiation and the cancer risk especially in pediatric patients. It’s also relevant since Dr. Nate Kuppermann (UC Davis) just gave Grand Rounds at our UCSF-SFGH EM residency program. He first-authored a landmark 2009 Lancet article on minor head injury in kids.
Remember back in the day when we made simple toys for pediatric patients to focus on during the physical exam? Remember the inflated medical glove +/- a face drawn on it?
I just encountered a FREE iPhone application (Eye Handbook), which has a lot of useful features. I currently only use the Pediatric Fixation animations. They can be found under the “Testing” section. Kids (and often adults too!) become mesmerized and distracted by the cartoon animations.
With this hot summer season in California, kids have been running around and getting into all sorts of orthopedic troubles. Monkey bars are a common culprit. In treating pediatric patients in the ED, it’s worth spending an extra few minutes on the subtle style points.
Trick of the Trade:
Splint the buddy bear
You should consider keeping a stash of stuffed teddy bears in the ED for those patients, whom you splint or cast. It is a nice touch to have the patient go home with a teddy bear with the same “injury” and splint/cast.
It’s the little touches that will make your patient’s day a little less sucky.