SVT

Three of my favorite letters in the Pediatric Emergency Department are S, V and T. This episode of PEM Currents, the Pediatric Emergency Medicine Podcast focus on the diagnosis and management of paroxysmal supraventricular tachycardia in the ED. I discuss preparation, vagal maneuvers, cardioversion, disposition and more!

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References

Appelboam, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. The Lancet, 2015.

Friedman. Intraosseous adenosine for the termination of supraventricular tachycardia in an infant. Annals of EM, 1996

Garson et al. Supraventricular tachycardia in children: Clinical features, response to treatment, and long-term follow-up in 217 patients. The Journal of Pediatrics, 1981.

Getschman SJ et al. Intraosseous adenosine. As effective as peripheral or central venous administration? Arch Pediatr Adolesc Med. 1994 Jun;148(6):616-9.

Goodman et al. Intraosseous infusion is unreliable for adenosine delivery in the treatment of supraventricular tachycardia. Peds Emerg Care, 2012.

Hayes, Tricks of the Trade: Combine Adenosine with the Flush. Academic Life in Emergency Medicine, 2012. Accessed June 3, 2019.

Müller et al. “Vagal maneuvers” and adenosine for termination of atrioventricular reentrant tachycardia. The American Journal of Cardiology, 1994.

Measles

I never thought that this particular disease would make a comeback in the United States. But here we are. Measles. As of May 2019 there have been cases reported in over 20 states. Declining vaccine rates and international travel to areas with local measles epidemics have led to a sharp rise in the number of cases in the US. The goal of this epode of PEM Currents is to discuss the diagnosis, treatment and prevention of measles, as well as how you can recognize it and appropriately diagnose and report cases.

You should definitely check out the following resources – since measles is a visual illness with a memorable rash (not that most of us have actually seen it). as well as learn about local hospital and health department procedures for treating, isolating and reporting confirmed and suspected cases.

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References

CDC – Measles (Rubeola) – Main Page

CDC – Photos of People With Measles

CDC – Measles Cases and Outbreaks

AAP – RedBook Measles

Constipation

Constipation is an incredibly common problem in the Pediatric Emergency Department and amongst children who visit the Emergency Department with complaints of abdominal pain. This episode of PEM Currents, the Pediatric Emergency Medicine podcast features an interview with Danny Mallon, a Gastroenterologist from Cincinnati Children’s @dannymallon24 who is an expert in managing pediatric constipation. Our discussion focused on diagnosis in the Emergency Department, management  and why you don’t need an X-Ray to make there diagnosis.

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References

Berger et al. Value of Abdominal Radiography, Colonic Transit Time, and Rectal Ultrasound Scanning in the Diagnosis of Idiopathic Constipation in Children: A Systematic Review. Journal of Pediatrics, 2012.

Hyams et al. Childhood Functional Gastrointestinal Disorders: Child/ Adolescent. Gastroenterology, 2016.

Zeevenhooven et al. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatr Gastroenterol Hepatol Nutr, 2017.

Anaphylaxis: Admit or Discharge?

You will no doubt see a child with anaphylaxis in the Emergency Department. Recognition, management and disposition are all key questions that feel incredibly fluid at this juncture. I had the pleasure of interviewing Tim Dribin, an Emergency Medicine Attending from Cincinnati Children’s who recently published a paper in PLUS ONE focusing on admissions for children with anaphylaxis. Should we move the observation time from four to two hours? Who is most at risk for biphasic reaction? And how can we use data form kids that were admitted, and received no interventions, to inform practice in the ED?

Read the article from Dribin et al. right here! 

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References

Dribin TE, Michelson KA, Monuteaux MC, Stack AM, Farbman KS, et al. (2019) Identification of children with anaphylaxis at low risk of receiving acute inpatient therapies. PLOS ONE 14(2): e0211949. 

Sinusitis

Did you know that up to 9% of URIs are eventually complicated by acute sinusitis in children? This episode of PEM Currents, the Pediatric Emergency Medicine podcast focuses on making the diagnosis of acute bacterial rhinosinusitis clinically and when to pull the antibiotic prescription trigger.

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References

Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM Jr, Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72.

Hicks CW, Weber JG, Reid JR, Moodley M. Identifying and managing intracranial complications of sinusitis in children: a retrospective series. Pediatr Infect Dis J. 2011;30(3):222.

Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST, American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262.

Wald ER, Milmoe GJ, Bowen A, Ledesma-Medina J, Salamon N, Bluestone CD. Acute maxillary sinusitis in children. N Engl J Med. 1981;304(13):749.

Testicular Pain

Acute testicular pain is a common presenting complaint in the Pediatric Emergency Department. In this episode of PEM Currents you will learn about testicular torsion, epididymitis, torsion of the appendix testis and appendix epididymis, inguinal hernias and more. And remember, first and foremost, time is testicle!

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References

Jefferies MT, Cox AC, Gupta A, Proctor A. The management of acute testicular pain in children and adolescents. BMJ 2015; 350:h1563.

Lewis AG, Bukowski TP, Jarvis PD, et al. Evaluation of acute scrotum in the emergency department. J Pediatr Surg 1995; 30:277.

Probiotics for Gastroenteritis

This episode of PEM Currents features an in-depth interview with the lead author on the recent New England Journal paper on the use of probiotics in gastroenteritis. David Schnadower was kind enough to sit down with me and James Gray, a Pediatric Emergency Medicine Fellow from Cincinnati Children’s to talk about the study and its implications for the care of children with infectious gastroenteritis. You will find a full transcript of the podcast on PEMBlog.com.

Read the full article from the New England Journal of Medicine.

References

Freedman et al. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.

Schnadower et al. Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children. NEJM 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

Intranasal Ketamine

I am delighted to bring you this special episode of PEM Currents, the Pediatric Emergency Medicine podcast. It’s all about intranasal ketamine and its use for acute pain management in the Pediatric Emergency Department. I had the pleasure of interviewing Theresa Frey, Assistant Professor from the Division of Emergency Medicine at Cincinnati Children’s. Theresa is the 2016 winner of the Ken Graff Award from the AAP’s Section on Emergency Medicine. Funding from the award supported her study comparing intranasal fentanyl and intranasal ketamine in a randomized controlled trial for the treatment of acute, long bone fracture pain. We talk about the existing evidence, what’s to come in the future and how you can learn more about intranasal ketamine.

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References

Graudins A, Meek R, Egerton-Warburton D, Oakley E, Seith R. The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries. Annals of emergency medicine. 2015;65(3):248-254.e241.

Reynolds SL, Bryant KK, Studnek JR, et al. Randomized Controlled Feasibility Trial of Intranasal Ketamine Compared to Intranasal Fentanyl for Analgesia in Children with Suspected Extremity Fractures. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2017.

Yeaman F, Oakley E, Meek R, Graudins A. Sub-dissociative dose intranasal ketamine for limb injury pain in children in the emergency department: a pilot study. Emergency medicine Australasia : EMA. 2013;25(2):161-167.

Pelvic Avulsion Fractures

Pop goes the apophysis! In teenage athletes the apophyseal cartilage is the weak point along the pelvic rim. Learn about these common injuries in this edition of PEM Currents, the Pediatric Emergency Medicine podcast.

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References

Kocher MS, Tucker R. Pediatric athlete hip disorders. R.Clin Sports Med. 2006 Apr;25(2):241-53, viii.

Pediatric Emergency Medicine Morsels: Pelvic Avulsion Fractures

Acute Flaccid Myelitis

Acute Flaccid Myelitis is a rare but serious disease characterized by rapid onset of muscle weakness. Diagnosis also requires an MRI with lesions in multiple spinal levels or CSF pleocytosis. cases have been reported over the past several years and though a specific cause is unknown strains of enterovirus are suspected culprits.

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References

AAP – Acute Flaccid Myelitis in Children

CDC / Council of State and Territorial Epidemiologists: Revision to the Standardized Surveillance and Case Definition for Acute Flaccid Myelitis

CDC: Acute Flaccid Myelitis