Categories
Resuscitation

Drowning

With the warm weather upon us here in the Northern Hemisphere it will soon be time for the pools to open. This episode is therefore incredibly timely, and focuses on the spectrum of submersion injuries and their management. Learn about drowning physiology, when to admit to the hospital, and how to assess the child who went under water unexpectedly but looks fine from this episode’s special co-host and producer, Joe Finney, MD a PGY-5 Pediatric Emergency Medicine and EMS fellow from Washington University in Saint Louis, MO. You can connect will Joe via email at Josephfinney@wustl.edu.

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References

A65. NICU, PICU AND CHRONIC VENTILATION. American Thoracic Society International Conference Meetings Abstracts American Thoracic Society International Conference Meetings Abstracts, www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A2198. 

Zuckerman GB, Gregory PM, Santos-Damiani SM. Predictors of Death and Neurologic Impairment in Pediatric Submersion Injuries: The Pediatric Risk of Mortality Score. Arch Pediatr Adolesc Med. 1998;152(2):134–140. doi:10.1001/archpedi.152.2.134

Watson RS, Cummings P, Quan L, Bratton S, Weiss NS. Cervical spine injuries among submersion victims. J Trauma. 2001 Oct;51(4):658-62. doi: 10.1097/00005373-200110000-00006. PMID: 11586155.

Gonzalez-Luis G, Pons M, Cambra FJ, Martin JM, Palomeque A. Use of the Pediatric Risk of Mortality Score as predictor of death and serious neurologic damage in children after submersion. Pediatr Emerg Care. 2001 Dec;17(6):405-9. doi: 10.1097/00006565-200112000-00002. PMID: 11753182.

Noel S. Zuckerbraun, Richard A. Saladino, Pediatric Drowning: Current Management Strategies for Immediate Care, Clinical Pediatric Emergency Medicine, Volume 6, Issue 1, 2005, Pages 49-56, ISSN 1522-8401, https://doi.org/10.1016/j.cpem.2004.12.001. (https://www.sciencedirect.com/science/article/pii/S1522840104000874)

Szpilman D, Morgan PJ. Management for the Drowning Patient. Chest. 2020 Oct 14:S0012-3692(20)34896-0. doi: 10.1016/j.chest.2020.10.007. Epub ahead of print. PMID: 33065105.

Noonan L, Howrey R, Ginsburg CM. Freshwater submersion injuries in children: a retrospective review of seventy-five hospitalized patients. Pediatrics. 1996 Sep;98(3 Pt 1):368-71. PMID: 8784358.

Quan L, Kinder D. Pediatric submersions: prehospital predictors of outcome. Pediatrics. 1992 Dec;90(6):909-13. PMID: 1437433.

Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases. Chest. 1997 Sep;112(3):660-5. doi: 10.1378/chest.112.3.660. PMID: 9315798.

Best RR, Harris BHL, Walsh JL, Manfield T. Pediatric Drowning: A Standard Operating Procedure to Aid the Prehospital Management of Pediatric Cardiac Arrest Resulting From Submersion. Pediatr Emerg Care. 2020 Mar;36(3):143-146. doi: 10.1097/PEC.0000000000001169. PMID: 28486266.

Davey M, Callinan S, Nertney L. Identifying Risk Factors Associated with Fatal Drowning Accidents in the Paediatric Population: A Review of International Evidence. Cureus. 2019 Nov 19;11(11):e6201. doi: 10.7759/cureus.6201. PMID: 31890403; PMCID: PMC6919957.

Habib DM, Tecklenburg FW, Webb SA, Anas NG, Perkin RM. Prediction of childhood drowning and near-drowning morbidity and mortality. Pediatr Emerg Care. 1996 Aug;12(4):255-8. doi: 10.1097/00006565-199608000-00005. PMID: 8858647.

Son KL, Hwang SK, Choi HJ. Clinical features and prognostic factors in drowning children: a regional experience. Korean J Pediatr. 2016 May;59(5):212-7. doi: 10.3345/kjp.2016.59.5.212. Epub 2016 May 31. PMID: 27279885; PMCID: PMC4897156.

“Almost 800 Kids Drown Each Year; More than Half Are Under Age 5.” Safe Kids Worldwide, 29 June 2016, safekids.org/press-release/almost-800-kids-drown-each-year-more-half-are-under-age-5.

“Drowning Prevention.” Services.aap.org, services.aap.org/en/news-room/campaigns-and-toolkits/drowning-prevention/.

“WISQARS (Web-Based Injury Statistics Query and Reporting System)|Injury Center|CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 July 2020, www.cdc.gov/injury/wisqars/. 

Idris AH, Berg RA, Bierens J, Bossaert L, Branche CM, Gabrielli A, Graves SA, Handley AJ, Hoelle R, Morley PT, Papa L, Pepe PE, Quan L, Szpilman D, Wigginton JG, Modell JH. Recommended guidelines for uniform reporting of data from drowning: the “Utstein style.”Circulation. 2003; 108:2565–2574. doi: 10.1161/01.CIR.0000099581.70012.68

Categories
Toxicology

Toxicology Season 2 Episode 3: Nicotine

This is Season 2 of the Toxicology podcast series that Seattle Childrens’ Toxicologist Suzan Mazor, MD and I put together. This three episode season turns its focus to drugs of abuse – continuing with this episode on nicotine toxicity – the final episode of this #ToxTuesdays season.

I am now proud to offer CME through Cincinnati Children’s. To claim visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

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References

American College of Medical Toxicology: Nicotine

CDC: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

Yale medicine – E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI). YaleMedicine.org

Categories
Toxicology

Toxicology Season 2 Episode 2: Marijuana

This is Season 2 of the Toxicology podcast series that Seattle Childrens’ Toxicologist Suzan Mazor, MD and I put together. It is a joint effort so to speak. This three episode season turns its focus to drugs of abuse – continuing with this episode on marijuana toxicity. So, let’s weed out the bad information, hash out the details, and learn about cannabinoid toxicity in this #ToxTuesdays episode.

I am now proud to offer CME through Cincinnati Children’s. To claim visit Cincinnati Children’s Online Courses and search ‘PEM Currents’.

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References

Graham et al. Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series, PEDIATRICS, 2017.

Wang, Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization, J Med Toxicol. 2017 Mar; 13(1): 99–105.

Categories
Toxicology

Toxicology Season 2 Episode 1: Opioids

This is Season 2 of the Toxicology podcast series that Seattle Childrens’ Toxicologist Suzan Mazor, MD and I put together. This three episode season turns its focus to drugs of abuse – beginning with this episode on opioid toxicity. So, slow your breathing, constrict your pupils, and focus in for the return of #ToxTuesdays.

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

Allen, et al. Prescription Opioid Exposures Among Children and Adolescents in the United States, PEDIATRICS, 2017.

Boyer, Management of Opioid Analgesic Overdose, NEJM, 2012.

Forti, Opiate Overdose, Pediatrics in Review January 2007, 28 (1) 35-36; DOI: https://doi.org/10.1542/pir.28-1-35.

Matson et al. Opioid Use in Children, J Pediatr Pharmacol Ther. 2019 Jan-Feb; 24(1): 72–75.

www.takebackyourmeds.org

Categories
Cardiology

Return to sports following COVID-19

Even though we won’t be “clearing” patients in the ED we still need to be familiar with return to sports recommendations for children and adolescents who have had COVID-19. Remember, these are just recommendations and are based off of practice patterns at many centers and on the AAP guideline. Consult with your local hospital and Cardiology groups for up to date information. The information in this episode is intended for any young person (21 and under) who tests positive for COVID-19 and wants to return to sports. It is structured based on the severity of initial presenting symptoms.

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References

COVID-19 Interim Guidance: Return to Sports. American Academy of Pediatrics. December 17, 2020. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/. Accessed 12/23/2020.

Categories
Surgery

Hypertrophic pyloric stenosis

Hypertrophic pyloric stenosis results from progressive thickening of the pyloric muscle, which leads to gastric outlet obstruction and vomiting in newborns. It is a can’t miss diagnosis and one of the most common surgical problems in newborns. Learn more about the diagnosis and management in this episode of PEM Currents: The Pediatric Emergency Medicine Podcast.

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References

Kapoor R et al. Prevalence and descriptive epidemiology of infantile hypertrophic pyloric stenosis in the United States: A multistate, population-based retrospective study, 1999-2010. Birth Defects Res 2019; 111:159.

Tutay et al. Electrolyte profile of pediatric patients with hypertrophic pyloric stenosis. Pediatr Emerg Care. 2013 Apr;29(4):465-8. doi: 10.1097/PEC.0b013e31828a3006.

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’.

PEMBlog.com

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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

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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