Kawasaki Disease

Kawasaki Disease, AKA Mucocutaneous Lymph Node Syndrome, is one of the most common vasculitides of childhood. The hallmark is fever ≥5 days plus 4/5 of the following; mucous membrane changes, conjunctivitis, polymorphous rash, extremity changes and lymph node enlargement. It can also lead to coronary artery aneurysms, which is why its so important to make an accurate diagnosis.

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Check out PEMBlog.com for more great educational content.

References

Dominguez SR, Anderson MS, El-Adawy M, Glodé MP. Preventing coronary artery abnormalities: a need for earlier diagnosis and treatment of Kawasaki disease. Pediatr Infect Dis J. 2012 Dec;31(12):1217-20.

Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi. 1967;16(3):178.

McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E, American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.. Circulation. 2017;135(17):e927. Epub 2017 Mar 29.

Son MB, Gauvreau K, Ma L, Baker AL, Sundel RP, Fulton DR, Newburger JW. Treatment of Kawasaki disease: analysis of 27 US pediatric hospitals from 2001 to 2006. Pediatrics. 2009;124(1):1.

Acute Otitis Media

OK, so this is the least exciting topic in Pediatric Emergency Medicine… With that being said, you will all see it. And we need to be good at looking at ears, diagnosing acute otitis media, and appropriately choosing when and which antibiotic to prescribe.

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References

Karma PH, et al., Pneumatic otoscopy and otitis media: The value of different tympanic membrane findings and their combinations. In: Recent advances in otitis media: proceedings of the Fifth International Symposium, Lim DJ, Bluestone CD, Klein JO, et al (Eds), Decker, Burlington, Ontario 1993. p.41.

Lieberthal et al., The Diagnosis and Management of Acute Otitis Media. Pediatrics, March 2013, Volume 131 / Issue 3.

Rothman et al., Does this child have acute otitis media? JAMA. 2003;290(12):1633.

Shaikh et al., Development of an algorithm for the diagnosis of otitis media. Acad Pediatr. 2012;12(3):214. Epub 2012 Mar 28.

Thompson M, et al., Duration of symptoms of respiratory tract infections in children: systematic review. TARGET Programme BMJ. 2013;347:f7027. Epub 2013 Dec 11.

Venekamp RP, et al., Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 201.

Dental Infections

To tell you the tooth you’ll probably see quite a few kids with dental related complaints in the Pediatric Emergency Department. This can range from cavities to invasive infections. Brush up on all things dental infections in this episode of PEM Currents. And yes, those puns were intentional. I must’ve flossed my mind!

PEMBlog Briefs: Odontogenic Infections 

Sandor et al. Antimicrobial Treatment Options In the Management Of Odontogenic Infections. Journal of the Canadian Dental Association, 1998.

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Testing for Influenza

You don’t need a flu test to diagnose the flu! But there are situations where rapid antigen testing or PCR is valuable. Listen to this episode of PEM Currents, the Pediatric Emergency Medicine podcast, to learn more about the test characteristics of common assays and when to obtain testing when prevalence rates for the flu are high.

Check out the companion post (basically show notes) on PEMBlog.

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References

CDC: Rapid Diagnostic Testing for Influenza

CDC: Guidance for Clinicians on the Use of RT-PCR and Other Molecular Assays for Diagnosis of Influenza Virus Infection

Silvennoinen H, Peltola V, Lehtinen P, VainionpääR, Heikkinen T. Clinical presentation of influenza in unselected children treated as outpatients. Pediatr Infect Dis J. 2009;28(5):372. 

Merckx J, Wali R, Schiller I, Caya C, Gore GC, Chartrand C, Dendukuri N, Papenburg J. Diagnostic Accuracy of Novel and Traditional Rapid Tests for Influenza Infection Compared With Reverse Transcriptase Polymerase Chain Reaction: A Systematic Review and Meta-analysis. Ann Intern Med. 2017 Sep 19;167(6):394-409. doi: 10.7326/M17-0848. Epub 2017 Sep 5.

Mansour et al. Comparative Cost Analysis Between PCR Testing and DFA Testing for Diagnosing Respiratory Virus Infections. American Journal of Clinical Pathology, Volume 144, Issue suppl_2, 1 October 2015, Pages A209.

Bronchiolitis

I’m sure that you’ll probably see a case of bronchiolitis this winter. Call it a hunch. In this episode of PEM Currents you’ll learn why suctioning and ensuring hydration are still the mainstays of therapy, and why albuterol, racemic epinephrine, steroids and more don’t have a place in routine cases. And if you read any publication to supplement this podcast make it the most recent American Academy of Pediatrics Guideline on Bronchiolitis.

Check out more Pediatric Emergency Medicine educational content at PEMBlog.com

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Community Acquired Pneumonia

Fever, tachypnea and rales – it must be a community acquired pneumonia… right? Learn more about the diagnosis and management of this common problem in the Pediatric Emergency Department.

Essential Reading

Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH Jr, Moore MR, St Peter SD, Stockwell JA, Swanson JT; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011 Oct;53(7):617-30. PMID: 21890766.

CSF Shunt Complications

Ventricular CSF shunts are very common – many kids have them. The most common complications are malfunction and infection. This episode of PEM Currents reviews the basics and how you can assess for complications in CSF shunts in kids.

PEMBlog.com

Boyle, Kimia, Nigrovic. Validating a Clinical Prediction Rule for Ventricular Shunt Malfunction. Pediatric Emergency Care, 2017.

Riva-Cambrin et al. Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. Journal of Neurosurgery: Pediatrics. Apr 2016, Vol. 17, No. 4 , Pages 382-390.

Vocal Cord Dysfunction

Vocal cord dysfunction, AKA paradoxical vocal fold motion is more common than you might think. Patients often present to the Emergency Department in respiratory distress and “wheezing.” Learn about the diagnosis itself, different phenotypes and what treatment options are out there.

References

Christopher KL, Wood RP 2nd, Eckert RC, Blager FB, Raney RA, Souhrada JF. Vocal-cord dysfunction presenting as asthma. N Engl J Med.1983;308 :1566– 1570

Doshi D, Weinberger M. Long-term outcome of vocal cord dysfunction. Ann Allergy Asthma Immunol.2006;96 :794– 799

Weinberger M, Abu-Hasan M. Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma. Pediatrics. 2007 Oct;120(4):855-64.