UMEM Educational Pearls - By Jenny Guyther

Title: Conjunctivitis

Category: Pediatrics

Keywords: Conjunctivitis (PubMed Search)

Posted: 4/5/2013 by Jenny Guyther, MD
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Children frequently present with "pink eye" to the ED.  When they do, parents often expect antibiotics.  How many of these kids actually need them?  Previous studies have shown approximately 54% of acute conjunctivitis was bacterial, but antibiotics were prescribed in 80-95% of cases.

A prospective study in a suburban children's hospital published in 2007, showed that 87% of the cases during the study period were bacterial.  The most common type of bacteria was nontypeable H. influenza followed by S. pneumoniae.

Topical antibiotic treatment has been shown to improve remission rates by 6-10 days.

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Epidemiology:

Trampoline injuries doubled between 1991 and 1996, increasing from 39,000 injuries per year to more then 83,000 injuries per year.  Injury rates and trampoline sales peaked in 2004 and have been decreasing since; however, hospitalization rates are still between 3% and 14%.

Risk Factors:

¾ of injuries occur when multiple people are on the trampoline at once

Smaller participants were 14x more likely to be injured then their heavier playmates

Falls account for 27-39% of all injuries

Springs and frames account for 20% of injuries

Up to ½ of injuries occur despite adult supervision

Injury types:

Lower extremity injuries are more common than upper extremity

Head and neck injuries accounted for 10-17% of trampoline injuries

Unique Injuries:

Proximal tibial fractures

Manubriosternal dislocations and sternal injuries

Vertebral artery dissection

Atlanto-axial subluxation

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Conventional pediatric nasal cannula can safely deliver up to 4 lpm but are limited by cooling and drying of the airway. This leads to decreased airway patency, nasal mucosal injury, bleeding and possibly increase in coagulase negative staph infections.

HFNC delivers flow up to 40 lpm with 95-100% relative humidity at a controlled temperature. In infants, the initial flow rate is set between 2-4 lpm and can be increased to 8 lpm. Older children and can be started at 10 lpm and increased as high as 40 lpm. Oxygen is also adjustable.

Studies have shown improved comfort, respiratory rate and oxygenation compared to nasal CPAP.

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Title: Vaccines in children less then 1 year

Category: Pediatrics

Keywords: Vaccines (PubMed Search)

Posted: 10/5/2012 by Jenny Guyther, MD (Updated: 2/18/2025)
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We often ask our pediatric patients if there vaccines are up to date, but what does this mean?

Hepatitis B: birth, 2 and 6 months

Diphtheria/Tetanus and Acellular Pertussis: 2, 4 and 6 months

Pneumococcal vaccine: 2, 4 and 6 months

Haemophilus influenzae B : 2, 4 and 6 months

Polio: 2, 4 and 6 months

Rotavirus: 2 and 4 months or 2, 4 and 6 months depending on the brand. 

Influenza: 6 months and older

Children less than 8 years old should receive 2 doses of flu vaccine at least 4 weeks apart during the first flu season that they are immunized.  Children older than 2 years are eligible for the nasal vaccine if they do not have asthma, wheezing in the past 12 months or other medical conditions that predispose them to flu complications.

To see the full vaccine schedule including exact time frames between doses and catch up schedules, see: http://www.cdc.gov/vaccines/schedules/downloads/child/0-6yrs-schedule-pr.pdf

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Title: Apnea and bronchiolitis

Category: Pediatrics

Keywords: hospitalization, RSV, bronchiolitis (PubMed Search)

Posted: 12/17/2021 by Jenny Guyther, MD (Updated: 2/18/2025)
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Typical admission considerations for patients with bronchiolitis are work of breathing, hypoxia, and dehydration.  The patients risk of apnea should also be considered.  Younger infants with bronchiolitis are at a risk for apnea.  Studies have cited anywhere from a 16-25% risk in younger infants.  The problem lies in identifying those patients who are at risk and those who are not.  This older study looked at 691 infants and developed criteria which identified all of the 2.7% of patients who developed apnea.
The high risk criteria used in this study were: 1) Full term and younger than 1 month; 2) Born < 37 weeks gestation and younger than 48 weeks post conception or 3) Parents already noted an episode of apnea with this illness.
Bottom line: Incorporate the infants risk of apnea into your disposition decision for patients with bronchiolitis.

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