Fractures are a common sign of abuse. It is impossible to tell from an x-ray alone whether or not a fracture is due to abuse. Fractures of the extremities are the most common skeletal injury in children who have been abused and approximately 80% of fractures due to abuse occur in children under 18 months old.1 In non-mobile children, rib fractures, long bone fractures, and metaphyseal fractures have a high correlation with child abuse. An understanding of the motor development of young children can aid physicians in the identifying fractures due to abuse.
Child abuse is a common cause of pediatric morbidity and mortality. In 2015, over 650,000 children were found to be victims of maltreatment and over 1,500 child deaths occurred due to child abuse or neglect in the United States.1 Children under 1 year of age are at the highest risk of abuse with potential for lifelong sequelae. Emergency department providers are in a unique position to recognize child abuse and take appropriate steps to reduce further injury to children. An understanding of the motor development of young children can aid physicians in the identification of clinical red flags in the history.
Pediatric patients are not just little adults. Placing peripheral IVs in young patients can be challenging and comes with its own set of challenges. Presented are some basic and advanced tips to maximize success in establishing peripheral IV access in pediatric patients using ultrasonography.
Pediatric Emergency Medicine can be intimidating for even some of the most seasoned providers, but Drs. Liz Fierro and Natasha Li (both PEM Fellows at Loma Linda University Health) have you covered! Their interactive infographic, Pocket PEM, reminds readers of some core PEM content, including pediatric fever, bronchiolitis, and the crashing neonate.
Regional nerve blocks of the face and ear can be a wonderful choice of analgesia in a child, particularly for wounds that need to be repaired. The benefits include fewer local injections, improved cosmesis due to less wound margin distortion, and improved analgesia within the nerve region.1,2 The following blog post and brief video tutorial review the key elements of this technique.
The standard for diagnosing pneumonia is a combination of the clinical history, physical examination, and chest x-ray (CXR) findings. However, lung ultrasound (US) has been shown to be a reasonable alternative to CXR in children, and may be an appropriate alternative diagnostic imaging modality in the Emergency Department (ED).
A 3 year-old boy presents with a deep laceration of the distal phalanx, through the nail bed, after slamming his fingers in a car door. He is crying, anxious, and uncooperative. How do you make this situation easier to evaluate and repair?
Nail bed and finger laceration repairs can be challenging, and even more challenging in young patients. Preparation is key to getting a good outcome. Here we present a pediatric trick of the trade on immobilizing a finger for digit or nail bed procedures.