During your shifts in the pediatric ED, you may encounter a few patients with adrenal insufficiency or adrenal crisis. Some of the most common causes include those patients with Addison disease, pituitary hypothalamic pathology, and those patients on chronic steroids. When these patients get sick or sustain trauma, it is important to consider giving them a stress dose of hydrocortisone. Patients in adrenal insufficiency or crisis can present with dehydration, weakness, nausea, vomiting, confusion, lethargy, and severe hypotension refractory to vasopressors. 1–3
A 9-year boy was hit in the head during a soccer game and was out for a few seconds. He regained consciousness quickly, but was repetitive for EMS. By the time the patient arrived at the ED, he was back to his normal self. Did this patient sustain a concussion? If so, what discharge instructions, anticipatory guidance, and resources do you have for your patient and his family? Here’s a quick 170-second animated video tutorial to sum up some thing for you.
Below we have listed our selection of the 14 highest quality blog posts related to 5 advanced level questions on pediatric topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:
- Pediatric arrhythmias
- Procedural sedation in pediatrics
- The neonate in distress
- Toddlers with a limp
- Pediatric syncope
In this module, we have 10 AIR-Pro’s and 4 honorable mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net.
This module we also had two editorial board guests trained in Pediatric Emergency Medicine to increase the strength of our recommendations – Dr. Robert Cloutier and Dr. Jason Woods.
PEM Pearls: Assessing Radiation Risk in Children Getting CT Imaging – Managing Risk and Making Medical Decisions
The Case: A 5 year old girl presents to the ED with approximately 24 hours of suprapubic and RLQ abdominal pain. Vital signs are: Temp 38.2 C, HR 110, RR 19, BP 100/60, Oxygen Sat 100% on room air. She has vomited twice but has not had diarrhea. She had a history of constipation a year ago that has resolved and mother denies any urinary symptoms or history of UTI’s. The patient is quiet but nontoxic appearing. Your abdominal exam notes mild to moderate RLQ tenderness but no rebound and normal bowel sounds. You order a urinalysis, which is negative and a RLQ US which ‘does not visualize the appendix’. Your suspicion for possible appendicitis is still intermediate; however, now the patient states she is “a little hungry”. Should you order a CT of the abdomen and pelvis? Uuugh!
“Ugh I have to work Christmas Eve and Christmas day.”
“I hate not being with my family for the holidays.”
“Hanukkah won’t be the same this year if I can’t be with my Dad.”
“New Year’s Eve in the ED, sounds like a blast… said no one ever.”
These are just a few of the comments I have heard over the last few weeks leading up to the holidays. The last one is courtesy of myself. While I complain, deep down I know it’s not so bad. If you look hard enough I have found you can find the holiday spirit all over the Emergency Department. There are also easy tips and tricks to incorporate the spirit in the medicine and care that we provide to our patients.
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?
“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.