Category: Pediatrics
Keywords: Heat Stroke, Hyperthermia (PubMed Search)
Posted: 4/14/2009 by Don Van Wie, DO
(Updated: 12/13/2024)
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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: Hemolytic-uremic syndrome (HUS) (PubMed Search)
Posted: 4/3/2009 by Rose Chasm, MD
(Updated: 12/13/2024)
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Hemolytic-uremic syndrome (HUS)
Category: Pediatrics
Keywords: Acute Laryngotracheobronchitis, Croup (PubMed Search)
Posted: 3/25/2009 by Rose Chasm, MD
(Updated: 12/13/2024)
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Parainfluenza viruses (types 1, 2, 3) account for more than 65% of all cases. The different serotypes have seasonal patterns, with type 1 and 2 occuring in the autumn and being the most common pathogens associated with croup while type 3 is more frequent in the spring and summer and is associated with pneumonia and bronchiolitis.
Infections are rarely associated with high fever and usually last 4 to 5 days. There are no distinctive laboratory abnormalities, and diagnosis is generally made clinically. Chest and neck xray may demonstrate a “steeple sign” from narrowing of the subglottic region. Viral cultures and immunofluorescent rapid antigen identification can be obtained from respiratory secretions. Specific antiviral therapy is not available. Aerosolized epinephrine can be given to severely affected, hospitalized patients to decrease airway obstruction. Parental (>0.3mg/kg) and oral ((0.15mg/kg) dexamethasone have been demonstrated to lessen the severity and duration of symptoms and hospitalization in patients with moderate to severe croup.
American Academy of Pediatrics. Parainfluenza viral infections. In: Pickering LK, ed Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: American Academy of Peditrics; 2006
Category: Pediatrics
Keywords: Appendicitis, Pediatrics (PubMed Search)
Posted: 3/13/2009 by Don Van Wie, DO
(Updated: 12/13/2024)
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Acute Appendicitis in Childhood: Diagnosis and Treatment in the new Millennium. PEM Practice. December 2008
Category: Pediatrics
Posted: 3/6/2009 by Rose Chasm, MD
(Updated: 12/13/2024)
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Rocky Mountain spotted fever (RMSF)
Systemic small vessel vasculitis caused by R rickettsii which is transmitted by a tick bite.
Clinical features: fever, headache, myalgia, nausea, vomiting, and characteristic rash. Rash usually appears before the sixth day of the illness initially on the wrists and ankles, and spreads to the trunk within hours. Initially. It is erythematous and macular, later becoming petechial.
Laboratory findings: thrombocytopenia, anemia, and hyponatremia.
Complications: meningitis, multiorgan involvement, DIC, shock, and death.
Treatment: doxcycycline (even despite the risk of dental staining in children younger than 8 years old)
American Academy of Pediatrics. Rickettsial diseases, Rickettsialpox, Rocky Mountain spotted fever. In: Pickering LK, ed. Red Book: 2006 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 2006:529-534.
Category: Pediatrics
Keywords: pediatric seizures (PubMed Search)
Posted: 2/28/2009 by Don Van Wie, DO
(Updated: 12/13/2024)
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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
Posted: 2/19/2009 by Rose Chasm, MD
(Updated: 12/13/2024)
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Krogstad P. Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, eds. Textbook of Pediatric Infectious Diseases. Philadelphia, Pa: WB Saunders Co; 2004713-736.
Tan TQ. Osteomyelitis and septic arthritis. In: Perkin RM, Swift JD, Newton DA, eds. Pediatric Hospital Medicine: Textbook of Inpatient Management. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:497-500.
Yagupsky P, Bar-Ziv Y, Howard CB, Dagan R. Epidemiology, etiology, and clinical features of septic arthritis in children younger than 24 months. Arch Pediatr Adolesc Med. 1995; 149:537-540.
Category: Pediatrics
Keywords: Epstien Barr Virus, Mononucleosis (PubMed Search)
Posted: 2/6/2009 by Rose Chasm, MD
(Updated: 12/13/2024)
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Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM)
Most commonly presenting clinical findings: fever, fatigue, exudative pharyngitis, lymphadenopathy, and hepatosplenomegaly.
Self-limited illness that lasts an average of 2 - 3 weeks.
Treatment is primarily supportive. Use of ampicillin, amoxicillin, or penicillin during the acute phase not indicated and may result in the development of a morbilliform rash, which studies have suggested may occur in more than 50% of the cases. Antiviral therapy is not recommended. Splenic rupture occurs in about 1 - 2:1000 cases. Therefore, avoidance of activities that increase the risk for injury is recommended until splenomegaly has resolved.
Hickey SM, Strasburger VC. What every pediatrician should know about infectious mononucleosis in adloscents. Pediatr Clin North Am. 1997;44:1541-1556.
Katz BZ. Epstein-Barr virus. In: Long SS, Pickering LK, Prober CG, eds. York, NY: Churchill Livingstone; 2—3:1059-1068
Peter J, Ray CG. Infectious mononucleosis. Pediatr Rev. 1998; 19:276-279.
Category: Pediatrics
Keywords: Pediatric Bradycardia, heart blocks (PubMed Search)
Posted: 1/30/2009 by Don Van Wie, DO
(Updated: 12/13/2024)
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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: 12/13/2024)
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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
(Updated: 12/13/2024)
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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: 12/13/2024)
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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: 12/13/2024)
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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: 12/13/2024)
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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: 12/13/2024)
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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: 12/13/2024)
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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: 12/13/2024)
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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: 12/13/2024)
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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: 12/13/2024)
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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: 12/13/2024)
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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.