PEM Pearls: Metered-Dose Inhaler versus Nebulizer

An 8-year-old is brought in by her parents with shortness of breath and wheezing. She’s been receiving her “rescue inhaler” at home and continues to have symptoms. You examine her and find that she has normal oxygen saturation, mild tachypnea and retractions, and diffuse wheezes. You think that she’s experiencing an acute asthma exacerbation. Given the current pandemic, and a recent report that administering nebulizer treatments to COVID-19 positive patients was correlated with transmission of COVID-19 to healthcare workers [1], what is the best way to treat the patient?

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By Kevin Rolnick, MD|2020-07-01T07:58:37-07:00Jun 24, 2020|PEM Pearls, Tox & Medications|

PEM Pearls: Chest Radiographs for Shortness of Breath

Figure 1: Photo by Tim Bish on Unsplash

Paramedics bring in a 5-month-old boy in respiratory distress. He’s crying furiously and has normal tone and color. Thick, copious secretions are coming from his nose. He is tachypneic with diffuse wheezes, crackles, retractions, and nasal flaring. His respiratory rate is 70 and his oxygen saturation is 88% on room air. Would you order a chest radiograph (CXR) for this child?

CXRs are routinely obtained in adults with respiratory symptoms. Children, however, are more sensitive to radiation and can have multiple respiratory infections every year. CXRs can increase cost, length of stay, and may not always be necessary.

This post presents some guidelines on when (and when not) to get a CXR in pediatric patients.

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By Katrina Stime MD|2026-06-16T16:15:49-07:00May 27, 2020|PEM Pearls, Pulmonary, Radiology|

IDEA Series: Use of gamification through Clue: Pediatric Rash Edition

Emergency Medicine (EM) physicians care for anyone, with anything, at any time. This includes pediatric patients as well as adults. For those without advanced pediatric training, “sick kids” can be quite intimidating. Rashes in the pediatric population are often benign, but in rare cases they portend significant illness. Rashes are also frequent chief complaints; In 2015, there were 1,452,300 pediatric ED visits for “skin and subcutaneous tissue disorders” [1]. We sought to improve the teaching of pediatric rashes in our residency curriculum.

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By Peter Tomaselli, MD|2020-05-05T16:22:24-07:00May 13, 2020|Dermatology, IDEA series, Pediatrics|

ALiEMU New Course: Pediatric Ultrasound-Guided Peripheral IV Access

Did you know that the ALiEMU learning management platform has courses in addition to the AIR Series? We just published the third installment of the pediatric point-of-care ultrasound (POCUS) series, which focuses on peripheral IV access using ultrasonography. Do you use the traditional transverse, transverse with dynamic needle tip visualization, or longitudinal ultrasound technique?

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By Michelle Lin, MD|2020-04-27T14:42:47-07:00May 10, 2020|ALiEMU, Pediatrics, Ultrasound|

Welcoming PECARN to Twitter

Our organization has always been a champion and fan of the Pediatric Emergency Care Applied Research Network (PECARN) research collaborative. We jointly worked on designing their official Head Injury Decision Tool found printed in various emergency departments around the country, featured several PECARN authors on our ALiEM podcast, and provide summaries of their 147-and-growing list of publications in our P3 app. So it follows that we are incredibly honored and thrilled to announce our Twitter collaboration. We will be helping to run their Twitter account. Join @PECARNteam and keep current on their growing list of publications, their clinical take-home points, and even insights from the authors themselves.

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By Michelle Lin, MD|2026-06-16T16:15:54-07:00May 1, 2020|Pediatrics, Social Media & Tech|

SplintER: Knee pain after the jump

$tibial tubercle fractures$ A 15 year-old male presents to the emergency department with left knee pain and swelling after jumping while attempting to dunk a basketball. You obtain a knee x-ray (image 1 courtesy of Mark Hopkins, MD). What is your diagnosis? What patient population is at risk for this injury? What other injuries occur in this anatomical location? What is your emergency department management?

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By Mark Hopkins, MD|2020-02-10T10:13:25-08:00Feb 12, 2020|Expert Peer Reviewed (Clinical), Orthopedic, Pediatrics, SplintER|

SAEM Clinical Image Series: Tick Bite

A 14 year old girl presenting from Mexicali with altered mental status. Her mother reports a rash about a week ago following a tick bite. She had been going to school until 4 days ago when she became very fatigued with associated vomiting, diarrhea, tactile fevers, and headache. She subsequently collapsed at home today and was difficult to arouse which prompted EMS activation. Her mother denies any prior complaint of neck stiffness, shortness of breath, cough, hematemesis, or hematochezia.

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By Nicholas Pokrajac, MD|2020-01-27T07:25:25-08:00Jan 27, 2020|Environmental, Infectious Disease, Pediatrics, SAEM Clinical Images|