The child with a fever and rash in your Emergency Department (ED) may actually have measles. This year, there have been 1,182 cases of measles in the U.S., and counting. This is the highest rate in the past 27 years . Globally, measles kills over a hundred thousand children . In the U.S., one child dies for about every 1,000 cases . Emergency providers must be able to quickly detect short-term complications that can lead to death and distinguish measles from mimics like Kawasaki Disease. It’s no coincidence that this year’s outbreak is in the setting of lower vaccination rates. The CDC now has new vaccine recommendations, and it’s imperative that ED providers join forces with public health providers to prevent future measles cases and deaths (photo credit).(more…)
In pediatrics, the history and physical examination is paramount. But even the most seasoned professional can have a challenge when facing a wiley 2-year-old. What strategies can you use to get in, get out, get the information you need, and maybe even make a (very small) friend in the meantime?(more…)
Amoxicillin is a penicillin derivative antibiotic against susceptible gram positive and gram negative bacteria. It has reasonable coverage for most upper respiratory infections and is used as prophylaxis for asplenia and bacterial endocarditis. This post aims to demystify amoxicillin treatment for common pediatric infections.(more…)
Chief complaint: Left-sided facial swelling
History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been giving Tylenol and a children’s cough medication. The patient went to bed, awoke the following morning with facial swelling, and was brought to the emergency department.
He has no allergies, history of trauma to the area, or bug bites. The patient is fully vaccinated including the influenza vaccine.
Supracondylar humerus fractures are the most common type of elbow fracture in pediatric patients, most often seen in a fall on an outstretched hand (FOOSH) or a fall on a hyper-extended elbow.1,2 If there is no obvious fracture on x-rays, the patient may have an occult fracture; look for secondary radiographic signs including a posterior fat pad sign, an enlarged anterior fat pad or ‘sail sign’, or malalignment. Occult supracondylar fractures (those with initial normal radiographs that are later diagnosed in follow up) make up 2-18% of all the fractures we see in kids.3 When x-ray findings are nonspecific but the index of suspicion for fracture remains high, ultrasound may aid in your clinical decision making.(more…)
One of the gold standard for building and sustaining collaborative, multi-institutional research networks in medicine is the Pediatric Emergency Care Applied Research Network (PECARN) organization. Their efforts on studying pediatric emergency care has resulted some of our specialty’s landmark papers in Lancet, New England Journal of Medicine, JAMA Pediatrics, and Annals of Emergency Medicine. Although we are not officially affiliated with them, we fully support their efforts and wanted to help disseminate their evidence-based findings with an educations. Thus was born the PECARN Publication Prospectus (P3) app project [download free P3 app].(more…)
Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.(more…)