Keywords: DKA, diabetic ketoacidosis, Pediatric, Children, Mental Status Change (PubMed Search)
...more to come.
Keywords: Newborn screen, pediatrics, hypothyroidism, neonatal, congenital (PubMed Search)
Congenital hypothyroidism (CH) is almost uniformly identified before symptoms develop because of newborn screening. Though this problem will rarely present to the Emergency Department, it is not uncommon for parents with poor access to care to present to EDs after being notified of an abnormal screen. Here is what you need to know:
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.
The umbilical site normally heals by 1 month of age.
Any fluid draining after this period suggests an abnormal connection between the surface of the abdomen and the underlying structures, and requires further investigation. Clear yellow fluid could represent a persistent connection of the bladder with the umbilicus called a patent urachus. The fluid that leaks is actually urine. The treatment is surgical closure of the connection.
Pus oozing from the umbilical stump would imply infection, especially if there is concomitant redness of the skin around the umbilicus. An omphalitis can be life-threatening, and requires admission for invtravenous antibiotics.
Umbilical hernias are common in infants, and are usually noted with diastasis of the rectus muscles. Most umbilical hernias resovle by school age, and do not require surgical intervention.
An umbilical granuloma is a small piece of bright red, moist flesh that remains in the umbilicus after cord separation. It is scar tissue, usually on a stalk, that did not become normally covered with skin cells. It contains no nerves and has no feeling. Most can be simply cauterised with silver nitrate.
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: hyperleukocytosis, leukemia, blast crisis (PubMed Search)
Hyperleukocytosis is often seen in acute presentations childhood leukemias, and is defined as a WBC count of greater than 30-50K. Complications usually arise at counts greater than 300, however, keep in mind that automated cell counters may underestimate very high white counts.
Keywords: meningitis, neisseria meningitidis, streptococcus pneumoniae, haemophilus influenzae, child care, nursery (PubMed Search)
Meningitis Prophylaxis in Children
While H1N1 and garden-variety influenza have been taking the spotlight lately, we can't forget about other disease processes. Meningitis is still a severe, life-threatening/altering process which occurs in various social groups (e.g. military cadets, college students).
However, with more of our parents working out of the home, child care is more often the norm, and as such, you may find yourself dealing with cases of children who have been in proximity to another child or caregiver diagnosed with meningitis. What do you do?
The causative agent will often dictate your choice of management.
Neisseria meningitidis - nursery/child care contacts should receive chemoprophylaxis and the Menactra vaccine (if they have not already received it) within 7 days of onset; casual school or work contacts do NOT require prophylaxis
Streptococcus pneumoniae - no chemoprophylaxis or vaccination required (unless series was not continued)
Haemophilus influenzae - if only one case reported, no intervention; if 2 or more cases within a 60-day period, Hib vaccination and chemoprophylaxis with rifampin for BOTH children and caregivers (especially if the center cares for young children who have not completed their Hib series)
Pediatrics in Review, July 2009: "Infections in Child-Care Facilities and Schools"
After seeing all the electrical and extension cords supplying various seasonal holiday decorations, I thought this would be appropriate.
Keywords: Pediatric, Genital, Foreign Body (PubMed Search)
Keywords: Sexual Assault, Children, Herpes, Gonorrhea, Chlamydia (PubMed Search)
The Emergency Department is often the first line in detecting the sexual abuse of a child. Unfortunately, what you do or don't say/ask/test can significantly affect the legal protection of the abused child.
1. Know your region's dedicated sexual abuse center, if one exists. These centers have personnel trained in interviewing and forensic evidence collection. There may be different centers for children of different ages.
2. Know your state laws regarding what is and is not admissible as evidence of sexual abuse. GC/CT urine testing (NAAT), though more sensitive than swab cultures, is not currently admissible as evidence in many states.
3. Withhold prophylactic antibiotic treatment when possible - antibiotics work well, and often eliminate evidence. Withholding antibiotics is acceptable if the child is asymptomatic or only has very mild symptoms.
4. Any sexually transmitted disease in a child warrants further workup and investigation. Primary genital HSV in a young child warrants testing for Gonorrhea and Chlamydia, and appropriate referral as well as police involvement.
5. Finally, if trained personnel is available to conduct the interview of a child, limit the questions you ask the child directly. Any evidence in your note that you may have suggested something to the child in your line of questioning could negate the validity of their testimony.
Keywords: congenital heart disease, cyanosis, neonate, prostaglandin (PubMed Search)
Ductal-Dependent Cardiac Lesions in the Neonate
Keywords: Tungsten, ring, removal, hand injury, finger injury (PubMed Search)
Ring-removal is a dreaded problem in pediatric hand and finger injuries. Removal can be difficult and time consuming. The relatively recent introduction of Tungsten into the jewelry market has further complicated this problem:
However, it is:
This video explains how. Of course, this works on adults as well.
I have no relationship with the copany which made this video - it was simply chosen for its clear explanation of the solution described in this pearl.
Keywords: conjunctivitis, pinkeye, gonococcal ophthalmia neonatorum (PubMed Search)
Conjunctivitis in Children:
HOWEVER... remember to consider other common etiologies of a red eye in a child!
Emans SJ, Laufer MR, Goldstein DP. Vulvovaginal problems in teh prepubertal child. In: Pediatric and Adolescent Gynecology. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1998:75-107
Forbes D, Withers G. Prophylactic therapy in cyclic vomiting. J Pediatr Gastroenterol Nutr. 1995;21:S57-S59
Symon DN, Russell G. The relationship between cyclic vomiting syndrome and abdominal migraine. J pediatr Gastroenterol Nutr. 1995:21:S42-S43
Keywords: nasal foreign bodies, button battery, batteries, ENT (PubMed Search)
While it is often ok to defer removal of pesky nasal foreign bodies until ENT follow up, if the foreign body may be a button battery, emergent identification and removal is indicated.
Damage can occur in 3 hours, and by 24 hours, near complete necrosis of turbinates and ala has been described.
Dane S, Smally AJ, Peredy TR. A Truly Emergent Problem: Button Battery in the Nose. Academic Emergency Medicine. 2000; 7:204-206
Glynn F, Amin M, Kinsella J. Nasal Foreign Bodies in Children: Should They Have a Plain Radiograph in the Accident and Emergency? Pediatric Emergency Care. 2004;24:217-218.
Keywords: pollutant, breastfeeding, environment, contaminants (PubMed Search)
While breastfeeding is still the preferred source of infant nutrition by the AAP, a little-known fact is that breastfeeding may expose the nursing infant to environmental pollutants to which they might not normally be exposed. If you have a mother that appears ill due to exposure to any of these agents, don't forget to have the infant examined as well for signs of intoxication.
American Academy of Pediatrics Committee on Environmental Health. Chapter 3. In: Etzel RA, ed. Pediatric Environmental Health, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003.
Rimoin DL, Connor JM, Pyeritz RE, eds. Emergy adn Rimoin's Principles and Practice of Medical Genetics. 4th ed. New York, NY: Churchill Livingstone; 2002
Ryan S, Scriver CR. Phenylalanine hydroxylase deficiency. GeneReviews. Seattle, Wash: Children's Health System and University of Washington; 2003.