Keywords: Pediatrics, Hyperpronation, Radial Head Subluxation, Nursemaid (PubMed Search)
Hyperpronation: This reduction technique for a nursemaid's elbow (radial head subluxation) has been found to have better first attempt success than classic supination/flexion technique. (Pediatrics July '98). Support the elbow with a finger on the radial head, and forcefully hyperpronate.
Keywords: Adolescent Consent, EMTALA (PubMed Search)
EMTALA stipulates that any patient presenting to the Emergency Department is required to receive a medical screening exam regardless of age, ability to pay, or whether or not a parent accompanies the child.
EMTALA supersedes any state/local provisions or laws.
In performing a medical screening exam if an emergency medical condition exists then diagnostic testing, surgery or even transfer of hospitals may be appropriate without ever obtaining parental consent
MInors have the right to give or refuse informed assent of a procedure
If their is conflict between physician, parent or patient in the rendering of emergent care the physician must weigh the severity of the condition, risks and benefits of the treatment, as well as the patients maturity and cognition. The physician may have to seek ethical committee review, or assistance from either social services or the court system.
If an emergent condition does not exist, EMTALA does not apply after the MSE.
Consent for Emergency Medical Services for Children and Adolescnets: Committee on Pediatric Emergency Medicine, Pediatrics VOL 111 No.3 March 20003, pp703-706 reaffirmed 2007.
Levine, S. Adolescent Consent and Confidentiality. Pediatrics in Review. Vol 30 No. 11 pp 457-8. Nov 2009.
Keywords: Pediatrics, Sedation (PubMed Search)
Precedex (Dexmedetomidine) - Great for pediatric imaging procedures
Alpha-2 agonist with sedative properties
No analgesic effect alone, but shown to decrease the amount of opioids required for a painful procedure
Benefits pts go to sleep and awake in a more natural state. Caregivers tend to prefer this as opposed to other sedatives. Short recovery time- about 30 minutes
Adverse effects include bradycardia and hypotension. Not recommended in any child with cardiac abnormalities. Paradoxical hypertension with loading dose has also been observed
Effective for MRI or CT scans at loading doses of 2mcg/kg over ten minutes, then maintenance of 1mcg/kg/hr
Residents can gain experience with Precedex with Peds sedation on M,W,F mornings with sedation team, contact me to arrange a time for you to participate.
Keywords: Pediatric Constipation (PubMed Search)
Pediatric Constipation is a common presentation to PED and large percentage of GI clinic patient volume
Defined as less than 2 stools per week for two weeks with hard, large pellet like stools
Broad Differential includes functional constipation (most common), stricture, obstruction, celiac disease, Hirschsprung, hypothyroid, Cow's milk protein allergy, CF and spina bifida. Always inspect the spine and perform rectal
Success of treatment is based on the aggressive nature of treatment and timing of treatment. Ttreatment is longer and more difficult if patient has to wait on referral to GI specialist.
Keywords: Pediatric, Genital, Foreign Body (PubMed Search)
Keywords: Brain Abscess, Pediatrics (PubMed Search)
Keywords: Pediatrics, hypertension, encephalopathy (PubMed Search)
Hypertensive encephalopathy is generally seen in children with renal disease, e.g. acute glomerulonephritis or ESRD.
Signs and symptoms include bp >99th percentile for age and height and neurologic impairment. May present acutely with seizure or coma, or subacute with HA, vomiting, lethargy, blurry vision or change in mental status. Exam findings may also include papilledema.
MRI may show increased signal in occipital lobes of T2 weighted images, known as reversible posterior leukoencephalopathy.
Treatment is to lower BP by 20-25% for the first 8 hours and to normative levels over 24-48 hrs. IV therapy with esmolol drip, labetalol or nicardapine are the treatments of choice. Nitroprusside prudent in most hypertensive adult emergencies must be used cautiously if history of renal disease secondary to cyanide toxicity. Seizure should also be treated as you would with status epilepticus.
Belsha CW - Ann Emerg Med - 01-MAR-2008; 51(3 Suppl): S21-3
Herman, Andrea "Visaul Diagnosis: A Child Who Has a Nosebleed and High Blood Pressure." Pediatrics in Review 2001 22:104-107
Kleigman et al. Nelson Textbook of Pediatrics. 18th edition 598.3.