A 4 week-old female infant presents due to yellow discharge from her umbilicus and mom noticing a red mass coming from the umbilical area after changing her diaper today. She is a healthy infant born at 40 weeks by vaginal delivery without complications and weighed 6 lbs 1 oz at birth. She is feeding 4 oz of formula every 3-4 hours. She received immunizations at birth and has an established pediatrician.
The child with a fever and rash in your Emergency Department (ED) may actually have measles. This year, there have been 1,182 cases of measles in the U.S., and counting. This is the highest rate in the past 27 years . Globally, measles kills over a hundred thousand children . In the U.S., one child dies for about every 1,000 cases . Emergency providers must be able to quickly detect short-term complications that can lead to death and distinguish measles from mimics like Kawasaki Disease. It’s no coincidence that this year’s outbreak is in the setting of lower vaccination rates. The CDC now has new vaccine recommendations, and it’s imperative that ED providers join forces with public health providers to prevent future measles cases and deaths (photo credit).(more…)
In pediatrics, the history and physical examination is paramount. But even the most seasoned professional can have a challenge when facing a wiley 2-year-old. What strategies can you use to get in, get out, get the information you need, and maybe even make a (very small) friend in the meantime?(more…)
Amoxicillin is a penicillin derivative antibiotic against susceptible gram positive and gram negative bacteria. It has reasonable coverage for most upper respiratory infections and is used as prophylaxis for asplenia and bacterial endocarditis. This post aims to demystify amoxicillin treatment for common pediatric infections.(more…)
Chief complaint: Left-sided facial swelling
History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been giving Tylenol and a children’s cough medication. The patient went to bed, awoke the following morning with facial swelling, and was brought to the emergency department.
He has no allergies, history of trauma to the area, or bug bites. The patient is fully vaccinated including the influenza vaccine.
Supracondylar humerus fractures are the most common type of elbow fracture in pediatric patients, most often seen in a fall on an outstretched hand (FOOSH) or a fall on a hyper-extended elbow.1,2 If there is no obvious fracture on x-rays, the patient may have an occult fracture; look for secondary radiographic signs including a posterior fat pad sign, an enlarged anterior fat pad or ‘sail sign’, or malalignment. Occult supracondylar fractures (those with initial normal radiographs that are later diagnosed in follow up) make up 2-18% of all the fractures we see in kids.3 When x-ray findings are nonspecific but the index of suspicion for fracture remains high, ultrasound may aid in your clinical decision making.(more…)
One of the gold standard for building and sustaining collaborative, multi-institutional research networks in medicine is the Pediatric Emergency Care Applied Research Network (PECARN) organization. Their efforts on studying pediatric emergency care has resulted some of our specialty’s landmark papers in Lancet, New England Journal of Medicine, JAMA Pediatrics, and Annals of Emergency Medicine. Although we are not officially affiliated with them, we fully support their efforts and wanted to help disseminate their evidence-based findings with an educations. Thus was born the PECARN Publication Prospectus (P3) app project [download free P3 app].
The P3 Project and Team
As with many of our ALiEM initiatives, the P3 project arose from a collaborative sprint effort over a 4 week period in 2019 with prehospital educators, emergency medicine (EM) residents, budding and current pediatric EM fellows, and EM/PEM attending physicians. This app plans to be a “living” catalog of PECARN publications which is updated as their prolific research team continues to publish.
- Phase 1: Extracting the clinically-relevant educational pearls and a brief study summary from each of their 140+ peer-reviewed papers
- Phase 2: Feature expert peer-reviewer commentaries from one of the paper’s authors
- Phase 3: Link high-quality online resources which review or highlight these papers
- Jessica Chow, MD (Chief Resident, Department of Emergency Medicine, UC San Francisco)
- Lamarr Echols, MD (Emergency physician, Northbay Medical Center)
- James Gray, MD (Fellow, Pediatric Emergency Medicine, Cincinnati Children’s Hospital)
- Ryan Hunter, BS NRP FP-C (Paramedic/ Firefighter, Montgomery Co. Fire-EMS; Critical Care Flight Paramedic, U.S. Army National Guard)
- Ginger Locke, BA NRP (Associate Professor of EMS Professions, Austin Community College)
- Floyd Miracle, BS NRP (Clinical Manager, Jessamine County EMS)
- Damian Roland, BMedSci, BMBS, PhD (Honorary Associate Professor and Consultant in Paediatric EM
- Jason Woods, MD (Assistant Professor of Pediatrics, University of Colorado, Children’s Hospital of Colorado
- Michelle Lin, MD (ALiEM Founder; Professor of EM, UC San Francisco)
The P3 app, which is compatible with iOS and Android devices, summarizes each of the 140+ PECARN publications. These papers are subcategorized into learner groups (physicians/advanced practice providers, pharmacists, triage nurses, prehospital providers, and administrators) as well as organ system groups.