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.
Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.
Our ALiEMU learning management system, which currently houses the AIR series, Capsules series, and In-Training Exam Prep courses, is ready to slowly open the doors to welcome external authors with high quality content. We are thrilled to welcome a UCSF-sponsored pediatric emergency medicine (EM) point of care ultrasonography (POCUS) series, led by Dr. Margaret Lin. The first course is on the intussusception scan, filled with multiple ultrasound scans showing normal variants and two different types of intussusception.(more…)