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.

PEMBlog

@PEMTweets on Twitter

The Facebook page

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.

Follow me on Twitter @PEMTweets

Check out the facebook page

PEMBlog.com

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.

Categories
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.

Follow me on Twitter @PEMTweets

Check out the facebook page

Visit PEMBlog.com

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.

Categories
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.

Follow me on Twitter @PEMTweets

Check out the facebook page

Visit PEMBlog.com

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. 

Categories
Infectious Diseases

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.

PEMBlog.com

@PEMTweets on Twitter

Facebook

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.

Categories
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

PEMBlog.com

@PEMTweets on Twitter

Facebook

References

AAP Children and Disasters Webpage

EMSC EIIC Webpage

Link to AAP Family Readiness Kit

Pediatric Disaster Preparedness MOC Part IV Initiative

Categories
Orthopedics

Foot Fractures

Don’t toe the line when it comes to your education. Step up, don’t be a heel, and listen to this episode of PEM Currents: The Pediatric Emergency Medicine Podcast focusing on fractures of the feet and toes. Learn all about metatarsal fractures, including the Jones fracture, Lisfranc injuries, why you should worry about a fracture of the talar neck, and more in this seventh and final epode of the Fracture Season.

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 my facebook page

Check out PEMBlog for more great educational content, including seven years worth of Fracture Fridays posts

References

Inokuchi et al. Calcaneal fractures in children. J Pediatr Orthop. 1998;18(4):469. 

Lim et al. Pediatric Forefoot Fractures: Assessment of Fracture Patterns and Predictors of Complicated Outcome. Pediatr Emerg Care. 2018;34(4):233.

Mahan et al. Likelihood of surgery in isolated pediatric fifth metatarsal fractures. J Pediatr Orthop. 2015 Apr;35(3):296-302. 

Categories
Orthopedics

Femur Fractures

The fifth episode of the Fracture Season of PEM Currents, the Pediatric Emergency Medicine podcast focuses on fractures of the tibia and fibula, including the ankle. This episode also features a review of the neurovascular assessment of the lower extremity.

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 my facebook page

Check out PEMBlog for more great educational content, including seven years worth of Fracture Fridays posts

References

Bauer JM et al. Toddler’s Fractures: Time to Weight-bear With Regard to Immobilization Type and Radiographic Monitoring. J Pediatr Orthop. 2017. 

Boutis K et al. Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study. Lancet. 2001;358(9299):2118.

Sapru K et al. Management of the Toddler’s fracture with and without initial radiological evidence. Eur J Emerg Med. 2014;21(6):451.

Schuh AM wt al. Management of Toddler’s Fractures in the Pediatric Emergency Department. Pediatr Emerg Care. 2016;32(7):452.