Pediatric EM Morsels

JANUARY 19, 2024

If you have ever talked with a pediatric emergency medicine physician about some basic tenets of their practice, one of them will inevitably be, “ Never trust a neonate. ” The first few months of life outside the womb can elucidate a myriad of problems that were previously hidden during the prenatal state. We have previously touched on congenital issues like Congenital Adrenal Hyperplasia , Congenital Pulmonary Airway Malformation , Neonatal Leukemia , and of course there is always the Inconso

Plasma 230

Plasma OR EMS ED 230

Pediatric EM Morsels

NOVEMBER 17, 2023

While doing literature review for my scholarly project it dawned on me that it might be time to dust off a classic morsel from the bottom of the cookie jar. On this 10 year anniversary, we chose to throw this one back in the oven to include some even more delicious data on cuffed endotracheal tube (ETT) use. No matter whether you have the wisdom of many years of practice ( old doc like Dr.

E-9-1-1 183

E-9-1-1 Operating Room Emergency Department ALS 183

Pediatric EM Morsels

NOVEMBER 3, 2023

Imported Malaria , like all imported tropical illnesses, is a Tale of Two Cities. The infection was unknowingly obtained while enjoying a delightful holiday and then brought back in transit to a country where it is not endemic. In these non-endemic countries, we need to always be attentive to patient’s history of recent travel to correctly identify any concerns related to their recent travel.

ALS 245

ALS Critical Care EMS OR 245

Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Dr. James Broselow, a family medicine-turned-emergency medicine physician from Hickory, North Carolina , recognized that his team spent a lot of time trying to calculate doses of medications rather than spending their mental energy on the actual medical decisions for the resuscitation.

E-9-1-1 243

E-9-1-1 Emergency Medical Services Life Support ALS 243

Pediatric EM Morsels

OCTOBER 6, 2023

Post-COVID everyone seems to be posting the perfect picture of their travels to the far reaches of the world. While this is an exciting change, it allows transmission of illness to countries where they are not endemic. Recently, a pediatric patient presented to the ED who just returned from abroad with a gastroenteritis presentation. In addition to my passion for PEM, I also share a passion for global health.

OR 161

OR EMS ED 161

Pediatric EM Morsels

SEPTEMBER 22, 2023

To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Never fear. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.” Children compensate for blood and volume loss very well… until they don’t.

E-9-1-1 273

E-9-1-1 Epinephrine ALS OR 273

Pediatric EM Morsels

SEPTEMBER 8, 2023

Life is full of hazards! Chance encounters with life’s hazards seem to increase in the Summer time (ex, Trampolines , Snakes , Lawn Mowers , Water , and Heat ). It is good that continue to raise awareness of such hazards so we can prevent them ! Certainly, the care of pediatric patients is known for its “ Seasonality. ” Now that the long days of summer ( for us in the Northern Hemisphere ) might be behind us, some of those hazards may also be receding, but injuries and illnesse

EMS 208

EMS OR ED 208

Pediatric EM Morsels

SEPTEMBER 1, 2023

While the “excitement” of the Emergency Department that is seen on TV may make people think that the only skills we need are those that help us manage Critical Illnesses or Traumatic Injuries , as we have digested in prior Morsels (ex, Developmental Milestones , Formula Primer , Vegan Diets ) all aspects of patient care are important for us to be adept at.

ED 161

ED Emergency Department Overdose ALS 161

Pediatric EM Morsels

AUGUST 18, 2023

When you read the Morsel on Perichonditis of the ear last week ( or perhaps the Plantar Puncture Morsel from many many many weeks ago ) you may have objected because of the mention that, when indicated, fluroquinolones are safe in children. Some of you may have thought to yourself “first the AAP allows tetracycline ( Rocky Mountain Spotted Fever ) and now they allow fluoroquinolones use in children… what next?!

E-9-1-1 130

E-9-1-1 OR ACS ALS 130

Pediatric EM Morsels

AUGUST 11, 2023

This is the 601st Ped EM Morsel ! Having authored 575 ( well, now 576 ) of them, I am often quite convinced that there are no new topics to discuss. Then July happens and we get 14 more amazing interns who help educate me and remind me that there is always more to learn. Recently, Dr. Teresa Crow encountered an important topic in children that deserves its own Morsel.

EMS 130

EMS OR 130

Pediatric EM Morsels

AUGUST 4, 2023

In the age of Ozempic, everyone seems to be losing weight! This seems to have had an overall positive benefit on the health of many. Losing weight is a good thing, until it is a bad thing! Too much of a good thing is a bad thing. Of course, there can be many complications of rapid weight loss including gallstones , malnutrition , and electrolyte imbalances.

E-9-1-1 219

E-9-1-1 ED OR EMS 219

Pediatric EM Morsels

JULY 28, 2023

Authors: Drs. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Thankfully, Dr. Fox wasn’t too “ salty” when we asked to rehydrate this topic. Rates of type 1 diabetes have increased since the COVID-19 pandemic.

E-9-1-1 212

E-9-1-1 ALS OR Critical Care 212

Pediatric EM Morsels

JULY 21, 2023

In emergency medicine, we often use illness scripts and protocols to help drive our decision-making. I recall a shift I had with Dr. Fox while I was early in fellowship ( not so many years ago ). We had just received a young child from EMS who was post-ictal with decreased mentation. Dr. Fox asked me what I wanted to do next to care for the child, and as I calculated his GCS… 7 at the time… I felt somewhat obligated to say that I should intubate the child. “ Less than 8, intubate!

Critical Care 230

Critical Care ALS OR Life Support 230

Pediatric EM Morsels

JULY 7, 2023

In the past, we have discussed several causes of Knee Pain in children. Some of those causes are benign (ex, Osgood Schlatter’s Disease ) while others are scary (ex, osteosarcoma ). Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ).

OR 141

OR EMS 141

Pediatric EM Morsels

JUNE 30, 2023

I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent. The differential could also include aspiration , asthma , and bronchiectasis depending on the patient’s history.

E-9-1-1 208

E-9-1-1 ED EMS OR 208

Pediatric EM Morsels

JUNE 16, 2023

The subcutaneous space is a vast region of potential space where things can collect. Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. Sometimes, however, these deeper layers of the subcutaneous space can collect dangerous infections , like Necrotizing Fasciitis.

Overdose 152

Overdose OR Critical Care ALS 152

Pediatric EM Morsels

JUNE 9, 2023

When we think of severe hemorrhage in children, we typically think about trauma. Maybe injuries to the spleen or kidney come to mind. Perhaps thoughts of pelvic injuries or severe head injury dominate our considerations. Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation.

OR 152

OR Critical Care EMS 152

Pediatric EM Morsels

MARCH 17, 2023

There are lots of animals that bite. Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes they bite because that’s how they feed (ie, mosquitoes Eastern Equine Encephalitis ).

Frozen Plasma 130

Frozen Plasma First Aid Plasma OR 130

Pediatric EM Morsels

MARCH 31, 2023

Children love to trick us! Sometimes it is all in good fun and other times it is quite serious! They like to pretend to be well when they are truly sick ( remember to check that Cap Refill and to never trust a Neonate! ) and they often show us “odd” findings that are really normal (ex, Growth Plates, Primitive Reflexes ). They like to keep us on our toes so much, that even their cervical bones can deceive us.

OR 130

OR EMS Critical Care 130

Pediatric EM Morsels

APRIL 7, 2023

There are many conditions that we would like to think belong only to the “ adult patient problem DDx; ” however, as we have discussed several times previously, pediatric patients can experience many “adult conditions” (see, Aortic Dissection , Kidney Stones , and Cholecystitis ). Those conditions usually have a substantial risk factor and one of the most risky of risk factors is Sickle Cell Disease !

ALS 130

ALS OR Critical Care EMS 130

Pediatric EM Morsels

APRIL 28, 2023

Pediatric x-rays are challenging. Of course, we want children to grow, but those darn growth plates really make interpretation of their films difficult !! We have previously discussed how the surrounding ligaments and tendon are often stronger than the weakest part of the child’s bone necessitating our vigilance when addressing the pediatric extremity complaint (ex, Ankle Pain , Elbow Injury , Supracondylar Fractures ).

ALS 130

ALS Ambulance OR EMS 130

Pediatric EM Morsels

MAY 5, 2023

Our world has become inundated with the newest food and diet crazes. It seems like every social media persona provides “expert” opinions on the best way to nourish our bodies. Adults are one thing, but how does that translate to our growing, developing pediatric patients? Today we are focusing on vegan diets in children , and which nutritional deficiencies we need to remain vigilant to spot!

E-9-1-1 130

E-9-1-1 OR EMS 130

Pediatric EM Morsels

MAY 12, 2023

We all know that Gravity Works ! While this fact can adversely affect anyone, it offers the greatest challenge for those who cannot protect themselves , like children less than 3 months of age ! We last pondered this in 2011 Morsel , just a couple years after PECARN head injury data was published. Since that time there have been several studies externally validating the PECARN rule in all age groups and in multiple different countries.

OR 130

OR EMS 130

Pediatric EM Morsels

JUNE 2, 2023

Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! Today we are talking about a rare disease called FPIES (food protein induced enterocolitis syndrome) and how you might encounter these patients in the Pediatric Emergency Department.

Emergency Department 189

Emergency Department ALS EMS OR 189