Trick of the Trade: TRUST ultrasound confirmation of pediatric endotracheal tube placement

Following intubation the confirmation of endotracheal tube placement and depth is essential. While dynamic etCO2 monitoring has revolutionized the confirmation of endotracheal placement, there are still several circumstances in which this modality may be misleading (e.g. prolonged arrest, severe status asthmaticus/PE/pulmonary edema, etCO2 detector contamination with drugs/gastric contents). Additionally, EtCO2 detectors cannot confirm appropriate endotracheal tube depth, leading to delayed recognition of mainstem placement.

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By Mark Tessaro, MD|2021-01-05T14:02:20-08:00Apr 21, 2015|Pediatrics, Ultrasound|

Should you do a Pediatric Emergency Medicine fellowship?

Each year hundreds of residents apply to Pediatric Emergency Medicine (PEM) fellowships. There are multiple reasons that an EM resident might want to undertake a PEM fellowship, but over the last 15 years, fewer Emergency Medicine (EM) residents are applying for PEM fellowships than Pediatric residents, unpublished data suggesting that Pediatric candidates now outnumber EM candidates 20 to 1.

Recently, a group of PEM Fellowship Program Directors formed the “EM-to-PEM task force” of like-minded individuals desiring to promote PEM fellowships to EM residents. A PEM fellowship is an excellent career move for a resident who has a passion for the emergency care and advocacy of children. In this post, we will discuss and review benefits of EM residents undergoing a PEM fellowship.

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By James O’Neill, MD|2016-10-26T17:04:32-07:00Feb 20, 2015|Medical Education, Pediatrics|

Diagnose on Sight: 6 year old with elbow pain

Case: A previously healthy 6 year old male presents with left elbow pain after wrestling with a friend. What is the diagnosis? Click on image for a larger view.

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By Jeff Riddell, MD|2016-12-22T20:05:33-08:00Oct 22, 2014|Diagnose on Sight, Orthopedic, Pediatrics|

Bleeding and Hemophilia in the Pediatric ED

Bleeding as a chief complaint in the pediatric emergency department is something that many healthcare providers will come across. Some of these children may have inherited bleeding disorders that we must be aware of in order to provide the best care possible. Below is a basic review of hemophilia and what we should know and do in the emergency department.

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By Sarah Melendez, MD|2016-11-11T19:22:20-08:00Sep 29, 2014|Expert Peer Reviewed (Clinical), Heme-Oncology, Pediatrics|

Vomiting in Kids After Head Trauma: To CT or Not to CT?

A 6-year-old male is brought to the emergency department (ED) after falling from the monkey bars at a local playground. Physical examination reveals no scalp hematoma, and the child appears alert and well oriented. You decide to observe him over the next 30 minutes hours to determine if he develops any disconcerting symptoms. After 15 minutes of observation within the ED the patient has an episode of vomiting witnessed by the nurses. The patient’s mother wants to know if this means he has failed his observation period and needs to receive a head CT. Your answer? (more…)

By William Paolo, MD|2016-12-16T12:06:29-08:00Sep 18, 2014|Pediatrics, Trauma|

Child Whisperer Series: After the Pediatric Code Blue

“We need to debrief” said the nurse manager after the medical team walked out of the critical care room after pronouncing a child who died after a traumatic accident. The social worker pointed at me (I am a Child Life Specialist) and looked at her and said “It’s our code blue now. We have to wait. We have a job to do”. Which was her way of saying we still had a lot of work to do with the family. At that point I walked in a room with the social worker and devastated parents, where the patient’s brother waited. He looked at me with big eyes and wanted to know if his sibling was ok. Not a conversation I would wish upon my worst enemy.

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By Kristen Beckler, CTRS, CCLS|2016-11-11T17:13:19-08:00Jul 24, 2014|Pediatrics|

Ondansetron: Has it reduced need for IV rehydration in vomiting kids?

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.

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By William Paolo, MD|2016-11-11T19:20:56-08:00May 22, 2014|Gastrointestinal, Pediatrics|

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