Algorithm for ED Evaluation and Management of Pediatric UTI

When should urinary tract infections (UTI) be included in the differential diagnosis for febrile infants and young children? The EM Committee on Quality Transformation in the American Academy of Pediatrics (AAP) thoughtfully outlines a clinical algorithm to help guide clinicians towards a standardized, evidence-based approach. Thanks to the expert content team (Drs. Shabnam Jain, Anne Stack, Scott Barron, Pradip Chaudhari, and Kathy Shaw) for sharing this clinical algorithm.

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By Shabnam Jain, MD, MPH|2019-03-28T21:46:07-07:00Jan 10, 2019|Genitourinary, Infectious Disease, Pediatrics|

The Problem

Although umbilical catheterization can be a lifesaving technique in the emergent management of a critically ill neonate, it is performed infrequently in the ED.¹ Simulation has emerged as a key teaching modality for residents to gain both proficiency and competency with this important procedure.²,³ Commercially available umbilical catheterization models are available, but costly, and often require an expensive investment (over $1,000 for a single trainer).⁴ This expense may discourage residency programs from acquiring the trainer and offering it to learners. In an effort to minimize this barrier to learning, a team from Kings County Hospital “home built” their own umbilical catheterization model. Their work was recently published in the Journal of Education and Teaching Emergency Medicine (JETem), and the ALiEM IDEA Series is proud to have recently teamed up with this journal to periodically share their innovations with our readership!

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By Caitlin Feeks, DO|2018-12-14T19:46:41-08:00Dec 15, 2018|IDEA series, Pediatrics|

Case of a Lethargic Child: Developing a Differential Diagnosis

A 2-year-old previously healthy boy presents to the emergency department (ED) acting sleepier than usual. Yesterday, he was in his usual state of health, but this morning he didn’t wake up at his usual time of 6 am. When his father went to his room at 7 am, the child was lying in bed. He opened his eyes to look at his father, but did not get out of bed. The mother and father deny any trauma, fever, or seizure activity.

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By Aaron Kornblith, MD|2018-11-22T15:23:48-08:00Nov 28, 2018|Pediatrics, Tox & Medications|

PECARN Study: Accuracy of Urinalysis for Febrile Infants ≤60 Days Old

The reported accuracy of the urinalysis (UA) for diagnosing urinary tract infections (UTI) is febrile infants ≤ 60 days has been widely variable. Some guidelines specifically exclude these patients due to this variability or recommend urine culture as the primary test.¹

Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger, published in Pediatrics in February of 2018, addressed this topic head-on.² The authors sought to evaluate the accuracy of the UA by analyzing data in a planned secondary analysis of a prospectively collected data set, as part of the Pediatric Emergency Care Applied Research Network (PECARN). We review this publication and present a behind-the-scenes podcast interview with lead author Dr. Leah Tzimenatos.
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By Jason Woods, MD|2021-07-01T21:07:41-07:00Sep 27, 2018|Infectious Disease, Pediatrics|

Trick of the Trade: Hair tourniquet removal using depilatory cream

A hair tourniquet occurs when a strand of hair coils around a patient’s appendage. It can cause damage to the skin, nerves, or affect blood supply. It is more common in infants as their skin appendages are small which allows for hair or thread to trap inside. Because in some cases these pediatric patients can present with inconsolable crying, it is important to perform a thorough physical examination to evaluate for the presence of such a hair tourniquet. We present a simple trick for removing a hair tourniquet using depilatory cream!

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By Layla Abubshait, MD|2021-05-13T09:38:51-07:00Sep 5, 2018|Pediatrics, Tricks of the Trade|

PEM Practice Changing Paper: Clinical Trial of Fluid Infusion Rates for Pediatric DKA

Most protocols for managing pediatric patients with diabetic ketoacidosis (DKA) are based on a theoretical association between fluid resuscitation and subsequent neurological decline. Although the evidence for an association between IV fluids and cerebral edema comes from retrospective reviews, for over 20 years, it is an accepted teaching principle of pediatric DKA.

Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis, published just days ago in the New England Journal of Medicine, challenges this teaching with the first randomized controlled trial designed to investigate the relationship between IV fluids and cerebral edema. We review this publication and present a behind-the-scenes podcast interview with lead authors Dr. Nathan Kuppermann and Dr. Nicole Glaser from the Pediatric Emergency Care Applied Research Network (PECARN). (more…)

By Derek Monette, MD|2021-07-01T21:14:43-07:00Jun 15, 2018|Critical Care/ Resus, Endocrine-Metabolic, Neurology, Pediatrics|

PEM Pearls: Red Flags for Child Abuse – Case 2

Fractures are a common sign of abuse. It is impossible to tell from an x-ray alone whether or not a fracture is due to abuse. Fractures of the extremities are the most common skeletal injury in children who have been abused and approximately 80% of fractures due to abuse occur in children under 18 months old.¹ In non-mobile children, rib fractures, long bone fractures, and metaphyseal fractures have a high correlation with child abuse. An understanding of the motor development of young children can aid physicians in the identifying fractures due to abuse.