Pediatric Emergency Medicine (PEM) Pearls
Created in 2015, this series is hosted by Dr. Jessica Chow and Dr. Josh Bukowski who are authors and editors for this series which focuses on evidence-based care in the realm of pediatric emergency medicine.
Fiona is a 6 year old female who presents to your emergency department after falling onto her left hand while racing on the playground. X-ray of the left upper extremity reveals a distal radius fracture with minimal displacement and angulation. You plan to place her arm in a splint and arrange for close orthopedic follow-up. The only problem: Fiona is in a lot of pain, especially with any manipulation of her arm, and Dad is worried that she will not be able to tolerate having a splint placed. You consider reaching for an intranasal medication to help Fiona feel more comfortable and to place the splint in a quick, efficient manner.
An 8-year-old is brought in by her parents with shortness of breath and wheezing. She’s been receiving her “rescue inhaler” at home and continues to have symptoms. You examine her and find that she has normal oxygen saturation, mild tachypnea and retractions, and diffuse wheezes. You think that she’s experiencing an acute asthma exacerbation. Given the current pandemic, and a recent report that administering nebulizer treatments to COVID-19 positive patients was correlated with transmission of COVID-19 to healthcare workers , what is the best way to treat the patient?
Paramedics bring in a 5-month-old boy in respiratory distress. He’s crying furiously and has normal tone and color. Thick, copious secretions are coming from his nose. He is tachypneic with diffuse wheezes, crackles, retractions, and nasal flaring. His respiratory rate is 70 and his oxygen saturation is 88% on room air. Would you order a chest radiograph (CXR) for this child?
CXRs are routinely obtained in adults with respiratory symptoms. Children, however, are more sensitive to radiation and can have multiple respiratory infections every year. CXRs can increase cost, length of stay, and may not always be necessary.
This post presents some guidelines on when (and when not) to get a CXR in pediatric patients.
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…)
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…)