23 12, 2015

Child Whisperer Series: Making the Most of the Holidays in the ED

“Ugh I have to work Christmas Eve and Christmas day.”Child Whisperer Series: Making the Most of Holidays in the ED
“I hate not being with my family for the holidays.”
“Hanukkah won’t be the same this year if I can’t be with my Dad.”
“New Year’s Eve in the ED, sounds like a blast… said no one ever.”

These are just a few of the comments I have heard over the last few weeks leading up to the holidays. The last one is courtesy of myself. While I complain, deep down I know it’s not so bad. If you look hard enough I have found you can find the holiday spirit all over the Emergency Department. There are also easy tips and tricks to incorporate the spirit in the medicine and care that we provide to our patients.

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14 12, 2015

PEM Pearls: Cardiac causes of pediatric chest pain

Doctor examining girlChildren with chest pain commonly present to the emergency department. Both the child and family members may think their symptoms are due to a serious illness. Among adolescents seen for their chest pain, more than 50% thought they were having a heart attack or that they had cancer.1 In reality, only 6% of pediatric chest pain has a cardiac etiology.2 Nonetheless, extensive and costly emergency department (ED) evaluations are common and there is wide practice variation.3

But prior to reassuring your patient, what can you do to reassure yourself that your patient doesn’t need a more extensive workup? What would make you suspicious for cardiac causes of pediatric chest pain?

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30 09, 2015

Child Whisperer Series: Intellectual and Developmental Disabilities

NeedleCartoon“Can you help me? I have a patient who is what I like to call, a kid at heart,” asked one of our ED adult nurses. As we walked to the adult side of the ED the nurse let me know that this patient had intellectual and developmental disabilities (IDD). The adult patient required IV access and had already been poked a few times. Although I do not often work with adults, I knew that remembering a few key Child Life principles could help us care for the patient.

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31 08, 2015

PEM Pearls: Migraine Treatment for Pediatric EM Patients

migraine treatment for pediatric em patients © Can Stock Photo / SergiyNYou are working your evening shift at the pediatrics emergency department, and you walk into a darkened patient room with a distressed mother and her otherwise healthy 10-year old son who is curled in a ball, holding his head and crying. Her mother tells you that the around-the-clock ibuprofen has barely touched his 2-day headache.

After determining that your patient has no neurologic deficits and that this is most likely a primary headache, what can you do to break his symptoms?

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25 05, 2015

Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial

Therapeutic HypothermiaCurrently, guidelines recommend therapeutic hypothermia for comatose adults with out-of-hospital cardiac arrest (OHCA). A recent trial of adults with OHCA showed that therapeutic hypothermia with the use of a targeted temperature of 33°C vs maintained therapeutic normothermia of 36°C, did not improve outcomes. There is a paucity of randomized trials of therapeutic hypothermia in children with OHCA, but sometimes adult trials get extrapolated to pediatrics. There are differences between adult and pediatric populations with OHCA, which makes it difficult to extrapolate the results of the adult trials to a pediatric population.

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4 05, 2015

Vancomycin Loading Doses in Pediatric Patients: A Missed Opportunity?

Pediatric Syringe Pump

In January 2014, ALiEM featured a must-read post by Bryan Hayes regarding proper dosing of vancomycin in the emergency department, including a special note related to the recommendations regarding consideration of loading doses of vancomycin ranging from 25 to 30 mg/kg in adult patients who are critically ill with a high suspicion for MRSA infection.

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21 04, 2015

Trick of the Trade: Ultrasound confirmation of pediatric endotracheal tube placement – TRUST your tube

ultrasound confirmation of pediatric endotracheal tube placementFollowing 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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