Categories
Toxicology

Toxicology Season 1 Episode 4: Salicylates

This is episode four of season one of the Toxicology series that Suzan Mazor, the Medical Director for Toxicology at Seattle Children’s, and I are putting together. This episode focuses on a worrisome intentional and accidental ingestion – salicylates. Learn about diagnosis, management, and more!

I am now proud to offer CME through Cincinnati Children’s. To claim CME & ABP MOC Part 2, visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

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References

Toce, Burns. The Poisoned Pediatric Patient. Pediatrics in Review May 2017, 38 (5) 207-220; DOI: 10.1542/pir.2016-0130

Calello, Henretig. Pediatric Toxicology: Specialized Approach to the Poisoned Child. Emerg Med Clin N Am 32 (2014) 29–52

Barrueto et al. Updates in the General Approach to the Pediatric Poisoned Patient. Pediatric Clinics. VOLUME 60, ISSUE 5, P1203-1220, OCTOBER 01, 2013. DOI:https://doi.org/10.1016/j.pcl.2013.06.002

Palmer, Clegg. Salicylate Toxicity. N Engl J Med 2020; 382:2544-2555. DOI: 10.1056/NEJMra2010852.

Categories
Toxicology

Toxicology Season 1 Episode 3: Acetaminophen

This is episode three of season one of the Toxicology series that Suzan Mazor, the Medical Director for Toxicology at Seattle Children’s, and I are putting together. This episode focuses on one of the most common intentional ingestions – Acetaminophen.

For those of you from across the ocean – this episode tackles paracetamol, and for you chemists out there, N-acetyl-p-aminophenol (APAP).

Suzan reviews toxicity and management and perhaps this one will help you care for an upcoming patient, and get a couple of questions right on your boards.

I am now proud to offer CME through Cincinnati Children’s. To claim CME & ABP MOC Part 2, visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

PEMBlog.com

Follow me on Twitter @PEMTweets

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References

Toce, Burns. The Poisoned Pediatric Patient. Pediatrics in Review May 2017, 38 (5) 207-220; DOI: 10.1542/pir.2016-0130

Calello, Henretig. Pediatric Toxicology: Specialized Approach to the Poisoned Child. Emerg Med Clin N Am 32 (2014) 29–52

Barrueto et al. Updates in the General Approach to the Pediatric Poisoned Patient. Pediatric Clinics. VOLUME 60, ISSUE 5, P1203-1220, OCTOBER 01, 2013. DOI:https://doi.org/10.1016/j.pcl.2013.06.002

Categories
Toxicology

Toxicology Season 1 Episode 2: Decontamination and Elimination

This is episode 2 of season one of the Toxicology series that Suzan Mazor, the Medical Director for Toxicology at Seattle Children’s, and I are putting together. This follow up episode focuses on a decontamination and elimination in the poisoned pediatric patient and offers many pearls that will serve as a foundation for upcoming episodes – including why Ipecac is no longer prescribed to every 4 month old!

I am now proud to offer CME through Cincinnati Children’s. To claim CME & ABP MOC Part 2, visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

Follow me on Twitter @PEMTweets

Check out the Facebook page

References

Toce, Burns. The Poisoned Pediatric Patient. Pediatrics in Review May 2017, 38 (5) 207-220; DOI: 10.1542/pir.2016-0130

Calello, Henretig. Pediatric Toxicology: Specialized Approach to the Poisoned Child. Emerg Med Clin N Am 32 (2014) 29–52

Barrueto et al. Updates in the General Approach to the Pediatric Poisoned Patient. Pediatric Clinics. VOLUME 60, ISSUE 5, P1203-1220, OCTOBER 01, 2013. DOI:https://doi.org/10.1016/j.pcl.2013.06.002

Categories
Toxicology

Toxicology Season 1 Episode 1: General approach to the poisoned patient

This is episode 1 of season one of the Toxicology series that Suzan Mazor, the Medical Director for Toxicology at Seattle Children’s, and I are putting together. This premiere episode focuses on a solid general approach to the poisoned pediatric patient and offers many pearls that will serve as a foundation for upcoming episodes.

I am now proud to offer CME through Cincinnati Children’s. To claim CME & ABP MOC Part 2, visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

Follow me on Twitter @PEMTweets

Check out the Facebook page

References

Osterhoudt KC, Burns Ewald M, Shannon M, Henretig FM. Toxicologic emergencies. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2000. p.951.

Toce et al. The poisoned pediatric patient. Pediatrics in Review May 2017, 38 (5) 207-220; DOI: https://doi.org/10.1542/pir.2016-0130

Categories
Infectious Diseases

Mastoiditis

Does mastoiditis always present with the classic triad of swelling behind the ear, otalgia, and protrusion of the auricle? Do you need to get a CT to make the diagnosis? What is the exact relationship with acute otitis media? Can swimmer’s ear turn into mastoiditis? These questions and more are why I recorded this episode of PEM Currents: The Pediatric Emergency Medicine Podcast.

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References

Geva et al. Conservative management of acute mastoiditis in children. Int J Pediatr Otorhinolaryngol. 2008;72(5):629.

Groth et al. Acute mastoiditis in children aged 0-16 years–a national study of 678 cases in Sweden comparing different age groups. Int J Pediatr Otorhinolaryngol. 2012;76(10):1494.

Leskinen et al. Complications of acute otitis media in children. Curr Allergy Asthma Rep. 2005;5(4):308.

Thompson et al. Effect of antibiotics for otitis media on mastoiditis in children: a retrospective cohort study using the United kingdom general practice research database. Pediatrics. 2009;123(2):424.

van den Aardweg  et al. A systematic review of diagnostic criteria for acute mastoiditis in children. Otol Neurotol. 2008;29(6):751. 

Categories
Uncategorized

Delirium

Yes, PEM Currents is a Pediatric Emergency Medicine podcast, but during the COVID-19 pandemic we may be tasked with seeing patients outside of our area of expertise. Plus, there’s a lot we can learn from big people that we can extrapolate to children. I have partnered with POPCoRN, the Pediatric Overflow Planning Contingency Response Network to deliver content that will benefit those of us who may have been asked to care for adults both in their native habitat, and in our pediatric facilities. This episode, brought to you by yours truly and Barrett Burger, a Medicine-Pediatrics Resident from the University of Arkansas focuses on delirium and confusional states and delivers some sound advice on how to address the confused patient. Though this is geared towards the care of adults there are some great pearls to help with patients of any age.

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References

Things We Do for No Reason: Neuroimaging for Hospitalized Patients with Delirium. J. Hosp. Med. 2019 July;14(7):441-444. March 20, 2019. | DOI 10.12788/jhm.3167

Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994; 97:278.

Inouye S, Westendorp R, Saczynski J. Delirium in elderly people. Lancet. 2014;383(9920):911-922.

Marcantonio. Delirium in Hospitalized Older Adults, NEJM, 2017.

Setters B, Solberg LM. Delirium. Prim Care 2017; 44:541.

Shenvi. Assessing and Managing Delirium and Older Adults. Academic Life in Emergency Medicine. July 25, 2015. http://www.aliem.com/delirium-in-older-adults/. Accessed June 7, 2020.

Categories
Infectious Diseases

Multisystem Inflammatory Syndrome in Children

Multisystem Inflammatory Syndrome in Children (MIS-C) is an evolving clinical entity that is occurring, possibly in association with or following a COVID-19 infection. This episode of PEM Currents expands upon a recent PEMBlog post, as well as includes information from two studies published in The Lancet as well as included in a recent CDC webinar. This episode also provides recommendations on lab workup and the evolving criteria for diagnosis and the current case definition from the CDC.

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References

CDC Webinar: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). May 19, 2020.

CDC Health Alert Network: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). Accessed May 15, 2020.

Riphagen et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020. Advance online publication, doi: 10.1016/S0140-6736(20)31094

Verdoni et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020. Advance online publication, doi: 10.1016/ S0140-6736(20)31129-6 

Categories
Resuscitation

Pulmonary Embolism

Yes, PEM Currents is a Pediatric Emergency Medicine podcast, but during the COVID-19 pandemic we may be tasked with seeing patients outside of our area of expertise. Plus, there’s a lot we can learn from big people that we can extrapolate to children. I have partnered with POPCoRN, the Pediatric Overflow Planning Contingency Response Network to deliver content that will benefit those of us who may have been asked to care for adults both in their native habitat, and in our pediatric facilities. David Shore, a 4th year Internal Medicine/Pediatrics Resident from Penn State delivers some timely content on PE diagnosis and management, including an instructive case of a young adult that is very applicable to the Pediatric Emergency Department in this brief, focused episode.

References

Aujesky et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 2011 Jul 2;378(9785):41-8. doi: 10.1016/S0140-6736(11)60824-6. Epub 2011 Jun 22.

Aujesky et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005 Oct 15;172(8):1041-6. Epub 2005 Jul 14.

Kline et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 1247–55.

Stein et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100(3):598.

Wells et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001 Jul 17;135(2):98-107. PubMed PMID: 11453709.

Categories
Resuscitation

Vasopressors

Vasopressor use in the Pediatric Emergency Department has been a moving target for my entire career. Back when I was a resident and fellow we used Dopamine. Then we went to epinephrine because it can be given through a peripheral IV because norepinephrine was too dangerous to run peripherally. But maybe that’s not entirely true. I talked about initial pressor choice and more in a recent recorded Zoom conference call with Critical Care Attending Matt Zackoff from Cincinnati Children’s. I hope you find his thoughts on vasopressor selection, pitfalls, and the emerging therapies as illuminating as I did.

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References

Sadoway et al. A systematic review of local complications from central and peripheral administration of vasopressors in the pediatric population. Canadian Journal of Emergency Medicine, 2019.

Surviving Sepsis Campaign: Initial Algorithm for Children

Weiss et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children.Pediatr Crit Care Med. 2020;21(2):e52. 

Categories
Neurology

Stroke in Adults

Yes, PEM Currents is a Pediatric Emergency Medicine podcast, but during the COVID-19 pandemic we may be tasked with seeing patients outside of our area of expertise. Plus, there’s a lot we can learn from big people that we can extrapolate to children. I have partnered with POPCoRN, the Pediatric Overflow Planning Contingency Response Network to deliver content that will benefit those of us who may have been asked to care for adults both in their native habitat, and in our pediatric facilities. Marie Pfarr, a Hospital Medicine physician from Cincinnati Children’s delivers some timely content on stroke in adults in this brief, focused episode.

References

Candelise L, Gattinoni M, Bersano A, et al. Stroke-unit care for acute stroke patients: an observational follow-up study. Lancet 2007; 369:299.

Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2032.

Lansberg MG, O’Donnell MJ, Khatri P, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e601S.

Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019; 50:e344.