PEM Pearls: Cardiac causes of pediatric chest pain

Children with chest pain commonly present to the emergency department. Both the child and family members may think their symptoms are due to a serious illness. Among adolescents seen for their chest pain, more than 50% thought they were having a heart attack or that they had cancer.¹ In reality, only 6% of pediatric chest pain has a cardiac etiology.² Nonetheless, extensive and costly emergency department (ED) evaluations are common and there is wide practice variation.³

But prior to reassuring your patient, what can you do to reassure yourself that your patient doesn’t need a more extensive workup? What would make you suspicious for cardiac causes of pediatric chest pain?

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By Delphine Huang, MD|2026-06-16T16:08:30-07:00Dec 14, 2015|Cardiovascular, CME, Pediatrics, PEM Pearls|

Child Whisperer Series: Intellectual and Developmental Disabilities

“Can you help me? I have a patient who is what I like to call, a kid at heart,” asked one of our ED adult nurses. As we walked to the adult side of the ED the nurse let me know that this patient had intellectual and developmental disabilities (IDD). The adult patient required IV access and had already been poked a few times. Although I do not often work with adults, I knew that remembering a few key Child Life principles could help us care for the patient.

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By Kristen Beckler, CTRS, CCLS|2026-06-16T16:08:01-07:00Sep 30, 2015|Child Whisperer Series, Pediatrics|

PEM Pearls: Migraine Treatment for Pediatric EM Patients

You are working your evening shift at the pediatrics emergency department, and you walk into a darkened patient room with a distressed mother and her otherwise healthy 10-year old son who is curled in a ball, holding his head and crying. Her mother tells you that the around-the-clock ibuprofen has barely touched his 2-day headache.

After determining that your patient has no neurologic deficits and that this is most likely a primary headache, what can you do to break his symptoms?

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By Delphine Huang, MD|2017-10-26T14:34:37-07:00Aug 31, 2015|Expert Peer Reviewed (Clinical), Neurology, Pediatrics, PEM Pearls|

Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial

Currently, guidelines recommend therapeutic hypothermia for comatose adults with out-of-hospital cardiac arrest (OHCA). A recent trial of adults with OHCA showed that therapeutic hypothermia with the use of a targeted temperature of 33°C vs maintained therapeutic normothermia of 36°C, did not improve outcomes. There is a paucity of randomized trials of therapeutic hypothermia in children with OHCA, but sometimes adult trials get extrapolated to pediatrics. There are differences between adult and pediatric populations with OHCA, which makes it difficult to extrapolate the results of the adult trials to a pediatric population.

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By Salim Rezaie, MD|2016-12-19T11:45:33-08:00May 25, 2015|Critical Care/ Resus, Pediatrics|

Vancomycin Loading Doses in Pediatric Patients: A Missed Opportunity?

In January 2014, ALiEM featured a must-read post by Bryan Hayes regarding proper dosing of vancomycin in the emergency department, including a special note related to the recommendations regarding consideration of loading doses of vancomycin ranging from 25 to 30 mg/kg in adult patients who are critically ill with a high suspicion for MRSA infection.

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By Nadia Awad, PharmD, BCPS|2016-12-19T15:22:24-08:00May 4, 2015|Expert Peer Reviewed (Clinical), Pediatrics, Tox & Medications|

Trick of the Trade: TRUST ultrasound confirmation of pediatric endotracheal tube placement

Following intubation the confirmation of endotracheal tube placement and depth is essential. While dynamic etCO2 monitoring has revolutionized the confirmation of endotracheal placement, there are still several circumstances in which this modality may be misleading (e.g. prolonged arrest, severe status asthmaticus/PE/pulmonary edema, etCO2 detector contamination with drugs/gastric contents). Additionally, EtCO2 detectors cannot confirm appropriate endotracheal tube depth, leading to delayed recognition of mainstem placement.

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By Mark Tessaro, MD|2021-01-05T14:02:20-08:00Apr 21, 2015|Pediatrics, Ultrasound|

Should you do a Pediatric Emergency Medicine fellowship?

Each year hundreds of residents apply to Pediatric Emergency Medicine (PEM) fellowships. There are multiple reasons that an EM resident might want to undertake a PEM fellowship, but over the last 15 years, fewer Emergency Medicine (EM) residents are applying for PEM fellowships than Pediatric residents, unpublished data suggesting that Pediatric candidates now outnumber EM candidates 20 to 1.

Recently, a group of PEM Fellowship Program Directors formed the “EM-to-PEM task force” of like-minded individuals desiring to promote PEM fellowships to EM residents. A PEM fellowship is an excellent career move for a resident who has a passion for the emergency care and advocacy of children. In this post, we will discuss and review benefits of EM residents undergoing a PEM fellowship.

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By James O’Neill, MD|2016-10-26T17:04:32-07:00Feb 20, 2015|Medical Education, Pediatrics|