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.
Spinal epidural abscess (SEA) is a rare but potentially catastrophic cause of back pain. Classically these patients are described as having back pain, fever, and clear neurologic deficits. In reality, patients often present with less obvious symptoms which often leads to a delay in diagnosis. Missed cases of SEA are a source of significant risk to both the patient and the provider. To improve outcomes and minimize risk, providers must identify and promptly evaluate patients who are at increased risk of developing a SEA.
Case: A 18-year-old male with no medical history presents to the emergency department (ED) complaining of “feeling like I am having a heart attack” which started suddenly 1 hour ago. The patient ate from a food truck the night before and developed several episodes of forceful vomiting prior to arrival in the ED. What finding in this supine chest radiograph aids in the diagnosis? Click on image for a larger view.
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…)
With several new diabetes medications available, it is important to know which ones are likely to cause hypoglycemia after overdose. Based on mechanism of action and reported cases, the likelihood of hypoglycemia after overdose is listed below by drug class. 1
Keep in mind that other drugs can interact with antidiabetic medications resulting in hypoglycemia. The following table applies only to single agent ingestion/administration.
In this next ultrasound installment in the PV Card series, Drs. Victoria Koskenoja, Heidi Kimberly, and Mike Stone succinctly summarize the focused abdominal aorta ultrasound to assess for an abdominal aortic aneurysm (AAA). These can serve as key reference cards when you do your next AAA scan. Don’t miss the last card with tips on optimizing the view and common pitfalls.
Go to ALiEM (PV) Cards for more resources.
Keeping in line with the recent ultrasound posts this month, Dr. Mike Stone’s star team is releasing a series of Paucis Verbis cards on the basics of bedside ultrasonography. Here is the first in the series on the Focused Assessment with Sonography in Trauma (FAST) by Drs. Wilma Chan, John Eicken, and Mike Stone.
Go to ALiEM (PV) Cards for more resources.