Category: Pediatrics
Keywords: Noninvasive, Ventilation, Pediatrics (PubMed Search)
Posted: 6/27/2009 by Don Van Wie, DO
(Updated: 11/3/2024)
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Noninvasive ventilation use in children has been shown in some trials to be a useful tool to avoid intubation in children with asthma.
Since children with asthma who are intubated have a much higher risk for complications including pneumotharaces and pneumomediastinum this can be a very useful tool.
Bi-Pap is usually started with typical settings of 10 for IPAP and 5 for EPAP and can be titrated up as tolerated to levels of up to 25/20 cm H2O and can be delivered with a set rate or a back up rate.
Albuterol and nebulized epiephrine may be delivered through newer BiPAP machines.
Signs that BiPAP is working include decreased Respiratory Rate, decreased retractions and accesory muscle use, improved oxygenation saturation
Noninvasive Ventilation Techniques In The Emergency Department:Applications In Pediatric Patients. Pediatric Emergency Medicine Practice June 2009. Vol 6, No 6
Category: Pediatrics
Keywords: Pediatric cough and cold meds, death (PubMed Search)
Posted: 4/25/2009 by Don Van Wie, DO
(Updated: 11/3/2024)
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Dart R., Paul I., et al. Pediatric Fatalities Associated with OTC (nonprescription) cough and cold medications. Annals of Emergency Medicine. April 2009. Vol 53, No. 4 p 411-417
Category: Pediatrics
Keywords: Heat Stroke, Hyperthermia (PubMed Search)
Posted: 4/14/2009 by Don Van Wie, DO
(Updated: 11/3/2024)
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As we head into the warmer months we should remember that every year there are reports of a toddler left in his car seat for 15 min who comes in uresponsive with hyperthermia.
Heat related illnesses are a continuum from heat cramps to heatstroke. The hallmark of heatstroke is hyperthermia with mental status changes and when identified rapid cooling must be initiated. Mortality for heatstroke is reported as high as 80%.
Children are more susceptible to heat stroke because of a greater surface area to body mass ratio, higher metabolic rates, less developed sweating mechanisms, and inability to always remove themselves from the hot environment.
The quickest and easiest way to cool a conscious patient is by evaporation. Changing water from a liquid to a vapor is an endothermic process. Removal of all clothes, followed by misting or wiping with tepid water of the entire skin is very effective. Having a fan pointed at the child can enhance this method.
Lin, J. Losey, R. Prendergast, H. An Evidence-Based Approach to hyperthermia and other heat-related emergencies. Pediatric Emergency Medicine Practice. April 2009. Vol 6, No 4
Category: Pediatrics
Keywords: Appendicitis, Pediatrics (PubMed Search)
Posted: 3/13/2009 by Don Van Wie, DO
(Updated: 11/3/2024)
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Acute Appendicitis in Childhood: Diagnosis and Treatment in the new Millennium. PEM Practice. December 2008
Category: Pediatrics
Keywords: pediatric seizures (PubMed Search)
Posted: 2/28/2009 by Don Van Wie, DO
(Updated: 11/3/2024)
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Berg C, Schumann H. An Evidence-Based Approach to Pediatric Seizures in the Emergency Department. Pediatric Emergency Medicine Practice. Feb 2009. Vol 6, Number 2.
Category: Pediatrics
Keywords: Pediatric Bradycardia, heart blocks (PubMed Search)
Posted: 1/30/2009 by Don Van Wie, DO
(Updated: 11/3/2024)
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Bradycardia in children is most often caused by hypoxemia but can also be caused by acidosis, elevated ICP, vagal stimulation, heart blocks or overdoses.
First degree heart block in otherwise healthy children can be caused by infectious diseases, myocarditis, rheumatic fever, Lyme disease and congenital heart disease.
Third degree heart block can be congenital, caused by maternal connective tissue disorders such as Lupus, or may result from cardiac surgery.
Any infant presenting with a third degree heart block should have an investigation for neonatal lupus.
Doniger S. Pediatric Dysrhythmias. Pediatric Emergency Medicine Reports. Sept 2008. Vol 13, No 9 (This was edited by a UMMS Combined EM/PEDS graduated Dr. Jim Colletti who is Associate Residency Director, Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN.)
Category: Pediatrics
Keywords: pediatric atrial fibrillation, pediatric arrhythmias (PubMed Search)
Posted: 1/23/2009 by Don Van Wie, DO
(Updated: 11/3/2024)
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The most common arrhythmias in children presenting to the ED are:
Atrial fibrillation in children is irregularly irregular with disorganized atrial activity with atrial rates ranging from 350-600 BPM.
Children at increased risk of developing atrial fibrillation include those with underlying structural heart defects and hyperthyroidism.
Hemodynamically stable children have several treatment options including digoxin, amiodarone, propranolol, esmolol, or procainamide for ventricular rate control.
Hemodynamically unstable children need immediate synchronized cardioversion with 0.5 - 1 J/kg. (don't forget light sedation.)
References:
Sacchetti A, Moyer V, Baricella R, et al. Primary cardiac arrhythmias in children. Pediatr Emerg Care 1999;15:95-98
Doniger S. Pediatric Dysrhythmias. Pediatric Emergency Medicine Reports. Sept 2008. Vol 13, No 9 (This was edited by a UMMS Combined EM/PEDS graduated Dr. Jim Colletti who is Associate Residency Director, Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN.)
Sacchetti A, Moyer V, Baricella R, et al. Primary cardiac arrhythmias in children. Pediatr Emerg Care 1999;15:95-98
Doniger S. Pediatric Dysrhythmias. Pediatric Emergency Medicine Reports. Sept 2008. Vol 13, No 9 (This was edited by a UMMS Combined EM/PEDS graduated Dr. Jim Colletti who is Associate Residency Director, Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN.)
Category: Pediatrics
Keywords: SVT, pediatric tachycardia (PubMed Search)
Posted: 1/16/2009 by Don Van Wie, DO
(Emailed: 1/17/2009)
(Updated: 11/3/2024)
Click here to contact Don Van Wie, DO
Six indications that would lead you to suspect SVT in children:
Remember in the stable child treat withe Adenosine 0.1mg/kg rapid IV push followed by rapid flush.
In the unstable child treat with synchronized cardioversion 0.5 -1 Joules/kg.
Category: Pediatrics
Keywords: Pediatric Burns (PubMed Search)
Posted: 1/10/2009 by Don Van Wie, DO
(Updated: 11/3/2024)
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Granger,Estrada,Abramo. An Evidence-Based Approach to Pediatric Burns. Pediatric Emergency Medicine Practice. Jan 2009. Vol6,No 1
Category: Pediatrics
Keywords: pediatric procedual sedation, ketamine (PubMed Search)
Posted: 1/3/2009 by Don Van Wie, DO
(Updated: 11/3/2024)
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Next time you have to do a full septic work up on a 2 month old with a fever of 104 F consider giving Ketamine 3mg/kg IM before even starting. Then you can obtain your cath urine, IV, and LP with a calm pain free patient!!
Ketamine induces a catatonic state that provides sedation, analgesia, and amnesia. It does not affect pharyngeal-laryngeal reflexes and the patient maintains a patent airway. This makes it very useful when fasting is not assured.
Route Onset Duration Dose
IM 3-5 min 20-30min 3-5 mg/kg
IV 1 min 5-10 min 1-2 mg/kg
Category: Pediatrics
Keywords: Proprofol,pediatrics,pediatric procedural sedation (PubMed Search)
Posted: 12/26/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
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Propofol is an IV hypnotic that is made in a soy-based emulsion containing soybean oil, egg lecithin, and glycerol. It has a very rapid onset time (10-50 seconds) and a brief duration of action making it ideal for ED sedation. Children have a more rapid metabolism of propofol than adults. Propofol has been shown to be safe and effective for Pediatric ED sedation in several studies.
Pearls on Propofol
Lopez M, Beltran G. Pediatric Procedural Sedation. Pediatric Emergency Medicine Reports. Dec 2008.
Category: Pediatrics
Keywords: RSV,Bronchiolitis,apnea (PubMed Search)
Posted: 12/19/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
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Bronchiolitis:Diagnosis and Treatment of an Increasingly Common Seasonal Presentation. Pediatric Emergency Medicine Reports. Nov 2008. Volume 13, Number 11
Category: Pediatrics
Keywords: SIDS (PubMed Search)
Posted: 11/28/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
Click here to contact Don Van Wie, DO
SIDS
Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than 1 year that remains unexplained after a thorough case investigation, including the performance of a complete autopsy, examination of the scene of death, and review of the clinical history.
SIDS is the single most common cause of death in infants aged 1 mo to 1 yr
Education is key for prevention of these tragic events:
Following the "Back to Sleep" campaign, federal SIDS researchers have conducted annual surveys to examine how infant sleep practices and SIDS rates have changed. The rate of prone sleeping for infants decreased from approximately 75% in 1992 to a low of 11.3% in 2002
Since 1992, SIDS rates have fallen approximately 58%. In 2002, the National Center for Health Statistics reported a total of 2295 SIDS deaths nationwide for a SIDS rate in the United States of 0.51 per 1000 live births.
Bed-sharing may lead to compromise of the infants' airway because the infant may be suffocated by soft, loose bedding or a sleeping adult.
Cosleeping on a couch or sofa is associated with an unusually high risk for SIDS and should be avoided.
Category: Pediatrics
Keywords: bacterial conjunctivitis (PubMed Search)
Posted: 10/31/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
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How do we know if we really need to put all those red eyes sent in from daycare centers and schools on antibiotics? The following study shows us why.
Bacterial Conjunctivitis in Children
Patel, P.Clinical Features of Bacterial Conjunctivitis in
Children. Academic Emergency Medicine 2007; 14:1–5a 2007
Category: Pediatrics
Keywords: Erythema Infectiosum,parvovirus B-19 (PubMed Search)
Posted: 10/24/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
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With the cooler weather on us all our favorite viral infections will start to appear. Included in this is the "slapped - cheek disease" Erythema infectiosum.
Erythema Infectiosum
Category: Pediatrics
Keywords: Pediatric Discitis, epidural absces (PubMed Search)
Posted: 10/10/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
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Pediatric Discitis is an intervertebral disc infection due to hematogenous spread to vascular channels in cartilage that disappear later in life. In 1/3 of patients it is caused by S. aureus.
Presenting Features
Management is to exclude more severe disease (osteomylelitis,abscess, tumor) and antibiotic use is debatable. Remember children this age rarely complain of back pain.
Pediatrics 2000; 105: 1299
Category: Pediatrics
Keywords: popsicle panniculitis, cold panniculitis, child abuse (PubMed Search)
Posted: 10/3/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
Click here to contact Don Van Wie, DO
Popsicle or cold panniculitis is an inflammation of the subcutaneous fat after prolonged exposure to cold. It is thought to occur more often in infants and young children because they have a higher percentage of saturated fatty acids than older children and adults. Pediatric patients may present to you to be evaluated/ruled out for abuse by social workers, schools, or police and if you have the correct history it is easy to dispo quickly.
Clinical Features of Popsicle Panniculitis
Shah B. Lucchesi M. Atlas of Pediatric Emergency Medicine. McGraw-Hill Companies. 2006.
Category: Pediatrics
Keywords: oxycodone pediatrics, codeine pediatrics, fracture pain management (PubMed Search)
Posted: 9/19/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
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Oxycodone v. Codeine for Fracture Pain Management in Children
Charney RL, Yan Y, Schootman M, Kennedy RM, Luhmann JD. Oxycodone Versus Codeine for Triage Pain in Children With Suspected Forearm Fracture: A Randomized Controlled Trial. Pediatr Emerg Care. 2008 Sep;24(9):595-600.
Category: Pediatrics
Keywords: Pediatric Anaphylaxis (PubMed Search)
Posted: 9/5/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
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When the Sting REALLY hurts!!
Remember the dose of Epinephrine is :
0.01 mg/kg or 0.01 mL/kg of 1:1,000 IM or
0.01 mg/kg IV or 0.1 mL/kg/dose 1:10,000 IV
to the adult dose or 0.3 mg
Also
Epipen Jr = 0.15 mg (use for < 30 Kg)
Epipen = 0.3 mg (use for > 30 Kg)
To show patients an instructional video click on the referenced link.
Category: Pediatrics
Posted: 8/30/2008 by Don Van Wie, DO
(Updated: 11/3/2024)
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Many things can be fatal with only one pill or sip for a young child. One teaspoonful of Oil of wintergreen (5ml) contains about 7000 mg of salicylate (the equivalent of about 21 adult aspirin). It would take only one swallow of Oil of wintergreen to be lethal for a young child.
Other Potential single dose killers for your Pediatric patients:
Alchohols
Methanol
Ethylene glycol
Isopropanol
Antidepressants
Monoamine oxidase inhibitors
Cyclic antidepressants
Antihypertensives
Clonidine
Verapamil
Diltiazem
Antimalarials
Chloroquine
Quinine
Benzocaine
Caustics
Hydrofluoric acid
Ammonia fluoride/bifluoride
Boric acid
Selenious acid
Disk batteries
Herbals
Eucalyptus oil
Pennyroyal oil
Camphor
Oil of wintergreen
Hydrocarbons
Imidazolines
Oxymetazoline
Naphazoline
Xylometazoline
Tetrahydrozoline
Insecticides/Rodenticides/Herbicides
Organophosphates
Carbamates
Lindane
Paraquat
Diquat
Nicotine
Opioids
Diphenoxylate
Methadone
Morphine
Oxycodone
Propoxyphene
Sulfonylureas
Pediatric Emergency Medicine Practice. July 2005.