Paucis Verbis: Kawasaki Disease

Kawasaki Disease can be easy to diagnose when you have the pediatric patient, who presents with all 5 of the classic clinical findings. What happens when you have the prerequisite fever for ≥5 days, but only 2-3 clinical criteria?

What ARE the 5 classic findings?
When do you do waitful watching?
When do you perform an echo?
When do you treat empirically?

Check out the nice flowchart below which addresses these questions. They summarize the most recent (2004) American Heart Association’s consensus group’s recommendations.

PV Card: Kawasaki Disease (AHA 2004)

Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

Newburger J, Takahashi M, Gerber M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747-2771. [PubMed]

By Michelle Lin, MD|2021-10-10T19:08:53-07:00Mar 23, 2012|ALiEM Cards, Cardiovascular, Pediatrics|

Trick of the Trade: Pelvic speculum for peritonsillar abscess

Peritonsillar abscess drainage in the ED continues to be one of my favorite procedures to perform. There are several tricks to increase your chances for a successful aspiration. One trick involves using a curved laryngoscope to help depress the tongue AND provide a bright light source.

What if you don’t have a laryngoscope readily available?

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By Michelle Lin, MD|2019-01-28T23:36:17-08:00Mar 20, 2012|ENT, Tricks of the Trade|

Trick of the Trade: Irrigation fluid is key – but not in your eye!

High pressure irrigation of wounds is critical in reducing the rate of wound infection. There are a variety of commercial irrigation kits which include splash guards. If you are irrigating correctly and generating at least 8 PSI of pressure, some irrigation fluid should splash up and out of the wound. Be careful not to splash irrigation fluid in your eyes.

What if you don’t have a commercial irrigation setup?

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By Michelle Lin, MD|2019-02-19T18:07:59-08:00Mar 13, 2012|Tricks of the Trade|

Paucis Verbis: Continuous Infusions

I have always been envious of the residents who carry around the Continuous Infusions cheat-sheet card, which was created by the UCSF Critical Care Units as part of a campaign for Safe Medication Prescriptions. I want one! So I finally managed to wrangle one away for a few minutes and xerox copy it. Here is the abbreviated card, after paring down the list to just ED-focused medications.

PV Card: Continuous Infusions

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-10T19:14:04-07:00Mar 9, 2012|ALiEM Cards, Tox & Medications|

Trick of the Trade: Another magnet trick for metallic FB removal

Last week, I talked about the use of Rare Earth Magnets for removing metallic foreign bodies. Sometimes a straight magnet though isn’t quite strong enough to grab a metallic foreign body. If only you had a small magnetic hemostat.

This week Dr. Catherine Perry (Culpepper Memorial Hospital) and Dr. Kolapo DaSilva (PGY-2 at UVA) emailed me with a creative solution. They encountered a patient with a BB pellet lodged deeply in the soft tissue. Small mosquito clamps couldn’t get around the BB. A cardiac magnet alone caused the BB to tent the skin up.

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By Michelle Lin, MD|2019-01-28T22:25:49-08:00Mar 6, 2012|Tricks of the Trade|

Trick of the Trade: Rare earth magnets for metallic FB removal

NasalFB

A child presents to your Emergency Department with a small button battery up her nose. Your usual tricks fail:

Occluding the other nostril and having the mother blow in the patient’s mouth forcefully.
Using a small curette or forceps to scoop or pull it out.

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By Michelle Lin, MD|2019-01-28T22:25:39-08:00Feb 28, 2012|Tricks of the Trade|

Paucis Verbis: Anaphylaxis

Anaphylaxis is one of the most under-appreciated and under-treated conditions in the Emergency Department. A common misperception is that you need hypotension to diagnose it. Below is a brief summary of the diagnostic criteria and ED treatment protocol. Immediate administration of IM epinephrine is critical.

A major challenge is deciding which patients can go home and which need to be admitted, because of the risk of “rebound” or a biphasic anaphylactic response. This may occur as late as 72 hours later, but typically occur within the first 24 hours. There isn’t a good answer for this.

What’s your practice in dispositioning these patients? Personally, I admit at least those patients who present with severe hypotension, require more than 1 epinephrine dose, or have poor social support.

NOTE: Unlike the photo on the top, warn patients NOT to rest their thumb on the device because of the risk inadvertent needle puncture.

PV Card: Anaphylaxis

Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.

References

Arnold J, Williams P. Anaphylaxis: recognition and management. Am Fam Physician. 2011;84(10):1111-1118. [PubMed]
Simons FER. Anaphylaxis. Journal of Allergy and Clinical Immunology. 2010;125(2):S161-S181. doi: 10.1016/j.jaci.2009.12.981

By Michelle Lin, MD|2021-10-10T19:17:26-07:00Feb 24, 2012|ALiEM Cards, Allergy-Immunology|

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