Mastoiditis

Post author By bradsobo
Post date July 14, 2020

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.

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Tags external otitis, mastoiditis, otitis media

Uncategorized

Delirium

Post author By bradsobo
Post date June 9, 2020
No Comments on 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.

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Infectious Diseases

Multisystem Inflammatory Syndrome in Children

Post author By bradsobo
Post date May 21, 2020
No Comments on 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

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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.

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Tags PE, pulmonary embolism

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.

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Tags epinephrine, norepinephrine, vasopressors

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.

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Neurology

Status Epilepticus

Status epilepticus can be very stressful in the Pediatric Emergency Department. This episode of PEM Currents: The Pediatric Emergency Medicine Podcast focuses on management, and will guide you through the treatment process, starting with benzodiazepines, followed by a discussion of the recent evidence for second line therapy between fosphenytoin, levetiracetam, and valproate.

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References

Chamberlain et al. Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. LANCET, March, 2020

Dalziel et al. Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial. Lancet, 2019.

Kapur et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. NEJM, 2019.

Lyttle et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. Lancet, 2019.

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Uncategorized

Hemophilia

Factor First!

OK, did I get your attention? Hopefully I did, because giving replacement factor to children with hemophilia presenting to the Emergency Department as soon as possible is the most important thing that you can do to positively impact outcomes. This episode of PEM Currents focuses on the different bleeding complications seen in Hemophilia and Von Willebrands and reviews basic management. There is a companion post on PEMBlog.com that has more detailed information that you should check out as well.

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

References

Di Michele D, Neufeld EJ. Hemophilia: a new approach to an old disease. Hematol Oncol Clin North Am. 1998;12(6):1315- 1344.

Di Michele D. Inhibitor treatment in haemophilias A and B: inhibitor diagnosis. Haemophilia. 2006;12(Suppl 6):37-42.

Labarque V, Stain AM, Blanchette V, et al. Intracranial haem- orrhage in von Willebrand disease: a report on six cases. Heamophilia. 2013;19(4):602-606.

Melchiorre D, Linari S, Innocenti M, et al. Ultrasound detects joint damage and bleeding in haemophilic arthropathy: a proposal of a score. Haemophilia. 2011;17(1):112-117.

Nagel K, Pai MK, Paes BA, et al. Diagnosis and treatment of intracranial hemorrhage in children with hemophilia. Blood Coagul Fibrinolysis. 2013;24(1):23-27.

Oren H, Yaprak I, Irken G. Factor VIII inhibitors in patients with hemophilia A. Acta Haematologica. 1999;102(1):42-46.

Schwartz et al. Hemophilia And Von Willebrand Disease In Children: Emergency Department Evaluation And Management. EB Medicine, 2015.

Witmer C, Presley R, Kulkarni J, et al. Associations between intracranial haemorrhage and prescribed prophylaxis in a large cohort of haemophilia patients in the United States. Br J Haematol. 2010;152(2):211-216.

Witmer CM, Raffini LJ, Manno CS. Utility of computed tomography of the head following head trauma in boys wth haemophilia. Haemophilia. 2007;13(5):560-566.

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Tags factor first, hemophilia a, hemophilia b, Von Willebrands disease

Infectious Diseases

Talking with patients and families about the flu

Post author By bradsobo
Post date December 20, 2019
No Comments on Talking with patients and families about the flu

I recently had the pleasure of sitting down with the always delightful Dr. Patricia Chambers to talk about influenza. In our conversation we reviewed how to discuss testing or not for the flu, as well as why antivirals are not always indicated. I firmly believe that perhaps the most important thing that we do in the Pediatric Emergency Department is communicating with patients and their families. Ultimately, they must understand why we do what we do (or don’t do). Patricia is an expert in this realm and I hope that you will learn as much as I did by listening to this episode of PEM Currents: The Pediatric Emergency Medicine Podcast.

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References

Grohskopf et al. et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season. CDC recommendations and Reports. August 23, 2019. https://www.cdc.gov/mmwr/volumes/68/rr/rr6803a1.htm?s_cid=rr6803a1_w. Accessed December 18, 2019.

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Tags flu, flu test, Influenza, tamiflu

Prehospital

Disaster Preparedness

This episode of PEM Currents: The Pediatric Emergency Medicine Podcast is all about disaster medicine. I interviewed Brent Kaziny, Disaster Medicine and Preparedness expert who was in training during Hurricane Katrina and lead efforts in Houston during Hurricane Harvey. Brent shares practical tips on how you can get involved and how you can learn what resources your institution has.

You can contact Brent via his email at bxkaziny@texaschildrens.org

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