Little Patients, Big Medicine Podcast: Lactate in Pediatric Sepsis

The first recording from Little Patients, Big Medicine: the Pediatric Emergency Medicine (PEM) Podcast. This is an exciting interview with Dr. Halden Scott, a PEM physician at Children’s Hospital Colorado, about the use of lactate measurement in pediatric sepsis. Dr. Scott is one of the premier pediatric sepsis researchers, with a specific focus on the use of lactate measurement in the ED. We talk about the Sepsis-3 definitions and whether pediatrics will eventually follow them, Dr. Scott’s previous work on lactate use in the pediatric ED, and her new article published in March of 2017 on the association between elevated lactate in the ED and 30-day mortality in children. ^1–6
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By Jason Woods, MD|2017-06-30T05:59:23-07:00Jun 7, 2017|Infectious Disease, Pediatrics|

PEM Pearls: Search & Rescue of Ear Foreign Bodies – Picking the Right Tool

While ear foreign bodies can happen at any age, the majority occur in children less than 7 years of age.¹ The younger the patient, the less likely they are cooperative with the exam and, therefore, the less chance of successful foreign body removal. The first attempt at removal is the best, so it is important to make it count. Similarly, different types of foreign bodies call for different “tools” for removal. It is important to understand when to attempt removal in the emergency department (ED) and what tools are available. This blog post will help you optimize your first pass success at foreign body removal by understanding what tools are at your disposal.

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By Josh Bukowski, MD|2017-10-26T14:32:51-07:00May 8, 2017|ENT, Pediatrics, PEM Pearls|

PEM Pearls: 2017 AAP Section of EM’s Guide to Pediatric Community Acquired Pneumonia

Pediatric community-acquired pneumonia (CAP) is an acute, common, and potentially serious infection of the pulmonary parenchyma in children. In November 2010, the American Academy of Pediatrics endorsed “The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.” [PDF]¹Based on this guideline, the American Academy of Pediatrics (AAP) Section on Emergency Medicine’s Committee on Quality Transformation developed a clinical algorithm for CAP in the ED setting.

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By Shabnam Jain, MD, MPH|2019-09-05T17:28:22-07:00Mar 16, 2017|Pediatrics, PEM Pearls, Pulmonary|

PEM Pearls: Pediatric Sepsis Management – Understanding the Basics

Just as in adults, pediatric sepsis is a complex topic with continued research. In the United States, there are an estimated 75,000 cases per year of pediatric severe sepsis with an in-hospital mortality of 5-10%.^1,2 This is one of the deadliest conditions treated in children. In addition, after the Rory Staunton case, New York State passed regulations requiring all hospitals to have pediatric specific recognition, treatment, and data reporting systems. Several other states have adopted, or are considering, similar requirements. Thus it is critical that emergency physicians understand at least the basics of pediatric sepsis management.

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By Jason Woods, MD|2017-10-26T14:33:06-07:00Mar 1, 2017|Infectious Disease, Pediatrics, PEM Pearls|

PEM Pearls: Calming techniques while repairing a laceration

Most children who come into the Emergency Department present with pain or experience pain during their ED stay.¹,²,³ Pain and distress during a procedure can leave a lasting impact on a child and contribute to mistrust of the medical system and compliance with future procedures.¹ ,⁴,⁵ Children who use active forms of coping report less pain and distress during a procedure.³ To help with coping, when feasible, involve parents or family, nursing and a child life specialist. If the parents are willing, try to get them involved in all parts of the medical procedure.²,³ This includes positioning the patient with a parent in a secure parental-hugging hold or maintaining close physical contact throughout the procedure.⁶ This can easily replace immobilization of a child or the use of restraints which can cause increased fear and escalate the degree of anxiety in a child.²

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By Ashley Foster, MD|2019-02-19T18:54:16-08:00Feb 7, 2017|Pediatrics, PEM Pearls, Trauma, Tricks of the Trade|

PEM Pearls: Brief Resolved Unexplained Events (BRUE)

A 2-month old boy was brought in by his mother after an episode of the child’s face turning blue and a pause in breathing. Mom reports this lasted a few seconds. The mother was terrified, so she brought the baby to the ED.

Sometimes infants briefly stop breathing or go limp. How do we determine if an infant is low-risk for serious illness? Earlier last year, the American Academy of Pediatrics (AAP) released guidelines on the evaluation and management of Brief Resolved Unexplained Events (BRUE, replacing a 30-year old label “apparent life-threatening event” or ALTEs).^¹
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By Jessica L. Chow, MD MPH|2017-10-26T14:33:24-07:00Feb 1, 2017|Pediatrics, PEM Pearls|

PV Card: Algorithm for acute bronchiolitis management

Bronchiolitis is a common lower respiratory tract infection in children less than 2 years old, and especially in those 3-6 months old. In a collaboration with the American Academy of Pediatrics’ (AAP) Section on Emergency Medicine Committee on Quality Transformation, we present a PV card summarizing the Section’s “Clinical Algorithm for Bronchiolitis in the Emergency Department Setting” (reproduced with permission).¹ Dr. Shabnam Jain sums it up best in her expert peer review below: “In bronchiolitis, less is more.”
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By Michelle Lin, MD|2021-10-04T09:31:54-07:00Nov 7, 2016|ALiEM Cards, Expert Peer Reviewed (Clinical), Pediatrics, Pulmonary|

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