Trick of the Trade: A flexible pediatric ear curette

Having you had trouble seeing a pediatric patient’s tympanic membrane because of impacted cerumen? Scared from that last time you used a rigid curette and caused bleeding in the ear canal? The parents are worried that you hit the brain…

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By Michelle Lin, MD|2019-01-28T22:12:54-08:00Sep 18, 2012|Pediatrics, Tricks of the Trade|

Paucis Verbis: Kawasaki Disease

Kawasaki Disease can be easy to diagnose when you have the pediatric patient, who presents with all 5 of the classic clinical findings. What happens when you have the prerequisite fever for ≥5 days, but only 2-3 clinical criteria?

What ARE the 5 classic findings?
When do you do waitful watching?
When do you perform an echo?
When do you treat empirically?

Check out the nice flowchart below which addresses these questions. They summarize the most recent (2004) American Heart Association’s consensus group’s recommendations.

PV Card: Kawasaki Disease (AHA 2004)

Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

Newburger J, Takahashi M, Gerber M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747-2771. [PubMed]

By Michelle Lin, MD|2021-10-10T19:08:53-07:00Mar 23, 2012|ALiEM Cards, Cardiovascular, Pediatrics|

Paucis Verbis: Pediatric fever without a source (3 mo-3 yr)

In part 3 of this “Pediatric Fever Without a Source” Paucis Verbis cards, we now cover febrile infants 3 months to 3 years old (PV cards for birth-28 days and 29 days-3 months old).

Notes:

The algorithm below is a guideline for NON-toxic patients. More ill-appearing children require a more broad workup.
For the under-immunized (<2 PCV immunizations) and temperature ≥39.5C, blood cultures may be falling out of favor in the near future, because the incidence of blood culture contaminants is close to exceeding the true incidence of occult bacteremia.

PV Card: Pediatric Fever Without a Source (3 Months-3 Years)

Go to ALiEM (PV) Cards for more resources.

Thanks to Dr. Hemal Kanzaria (UCSF-SFGH resident) for helping design this PV card and Dr. Christine Cho, Dr. Andi Marmor, and Dr. Ellen Laves (UCSF Pediatrics) for the content.

By Michelle Lin, MD|2021-10-11T15:10:11-07:00Feb 10, 2012|ALiEM Cards, Pediatrics|

Paucis Verbis: Fever without a source (29 days-3 months old)

In part 2 of this “Pediatric Fever Without a Source” Paucis Verbis cards, we now cover febrile infants aged 29 days to 3 months (PV card for birth-28 days). Note that there is no single correct answer in how to manage these patients. There can be a wide variation in practices, partly because of the slightly different criteria used by the 3 studies. The overarching principle is that “high risk” infants get admitted with IV ceftriaxone and “low risk” infants get discharged with close follow-up +/- a ceftriaxone IV or IM dose. The line between these two risk categories is the grey area.

Where I practice, we tend to follow a modified version of the Rochester criteria, where a lumbar puncture and antibiotics aren’t always required for this age group (unlike the Boston criteria).

PV Card: Pediatric Fever Without a Source (29 Days-3 Months)

Go to ALiEM (PV) Cards for more resources.

Keep a lookout for future PV cards which will address fevers without a source in pediatric patients aged 3 months-3 years old.

Thanks to Dr. Hemal Kanzaria (UCSF-SFGH resident) for helping design this PV card and Dr. Christine Cho, Dr. Andi Marmor, and Dr. Ellen Laves (UCSF Pediatrics) for the content.

By Michelle Lin, MD|2021-12-21T13:34:31-08:00Feb 3, 2012|ALiEM Cards, Pediatrics|

Paucis Verbis: Pediatric fever without a source (Birth-28 days)

Pediatric patients commonly are brought to the Emergency Department for a fever without a source. Management of these patients depends on the patient’s age. Today’s PV card focuses on the youngest age group: Birth-to-28 days.

QUESTION to everyone:

Do you correct your age calculation for prematurity? Premature neonates are more at risk for SBI, but I’ve seen varying practices.

PV Card: Pediatric Fever Without a Source (Birth-28 Days Old)

Go to ALiEM (PV) Cards for more resources.

Keep a lookout for future PV cards which will address fevers without a source in pediatric patients aged 29 days-3 months and 3 months-3 years old.

Thanks to Dr. Hemal Kanzaria (UCSF-SFGH resident) for helping design this PV card and Dr. Christine Cho, Dr. Andi Marmor, and Dr. Ellen Laves (UCSF Pediatrics) for the content.

By Michelle Lin, MD|2021-10-11T15:15:20-07:00Jan 27, 2012|ALiEM Cards, Pediatrics|

Trick of the Trade: Pediatric ear exam

Performing a physical exam on frightened pediatric patients can often be challenging. I am always thrilled to add more child-whisperer techniques to my arsenal of tricks. I have written in the past about:

Balloonimals iPhone app to grossly assess peak flow
Candleflame iPhone app to grossly assess peak flow
Eye Handbook iPhone app with pediatric fixation animation targets
Casting/splinting your buddy bear

What’s your trick on performing an otoscope exam of the ears?

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By Michelle Lin, MD|2019-02-19T18:08:03-08:00Sep 20, 2011|ENT, Pediatrics, Tricks of the Trade|

Trick of the Trade: Balloon animals in the ED

Back in July 2010, I wrote about using the Candleflame app to encourage pediatric patients to take deep breaths for a pulmonary exam. This app has also been useful in helping me roughly gauge the patient’s peak flow.

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By Michelle Lin, MD|2026-06-16T16:03:04-07:00Aug 3, 2011|Pediatrics, Tricks of the Trade|