Category: Surgery

Categories
Infectious Diseases Surgery

Neutropenic enterocolitis

Bad things happen when you don’t have enough neutrophils. After getting cytotoxic chemotherapy you tend to have even fewer neutrophils. This can put you at risk for neutropenic enterocolitis which should be suspected in an immunocompromised child with fever and abdominal symptoms. Treatment is broad spectrum antibiotics and the imaging test of choice is CT with contrast. Learn all about this potentially catastrophic condition in this brief podcast episode. 

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References

Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011 Feb 15;52(4):e56-93. doi: 10.1093/cid/cir073. PubMed PMID: 21258094.

McQueen A, et al. Oncologic Emergencies. In: Shaw KN, et al. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 8th ed. 2021:901-935.

Moran H, Yaniv I, Ashkenazi S, Schwartz M, Fisher S, Levy I. Risk factors for typhlitis in pediatric patients with cancer. J Pediatr Hematol Oncol. 2009 Sep;31(9):630-4. doi: 10.1097/MPH.0b013e3181b1ee28. PMID: 19644402.

Kirkpatrick ID, Greenberg HM. Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT. Radiology. 2003 Mar;226(3):668-74. doi: 10.1148/radiol.2263011932. Epub 2003 Jan 24. PMID: 12601214.

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Categories
Radiology Surgery

Ultrasound for Appendicitis

This episode of PEM Currents: The Pediatric Emergency Medicine podcast is focused on the use of ultrasound to make the diagnosis of acute appendicitis. You’ll learn about how a right lower quadrant ultrasound is performed, what we look for on the images, how to interpret positive, negative, and intermediate/equivocal results and much more! This episode was co-produced by Liz Lendrum, a senior pediatric resident at Cincinnati Children’s. She developed the learning objectives, compiled the references, and did a stellar job preparing the script and show notes that we used to record this episode. You can follow her on Twitter @liz_lendrum.

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CME & MOC Part 2

We are proud to offer CME and MOC Part 2 from Cincinnati Children’s. Click this link to go to the page for credit. Credit is free and registration is required.

Click here to claim CME and MOC part 2 Credit

Appendicits Clinical Scores

Pediatric Appendicitis Score – MD Calc

Alvarado Score for Acute Appendicitis – MD Calc

Pediatric Appendicitis Risk Calculator – MD Calc

References

Kharbanda AB, Vazquez-benitez G, Ballard DW, et al. Development and Validation of a Novel Pediatric Appendicitis Risk Calculator (pARC). Pediatrics. 2018;141(4).

Cotton DM, Vinson DR, Vazquez-benitez G, et al. Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting. Ann Emerg Med. 2019.

Samuel M. Pediatric Appendicitis Score. Journal of Pediatric Surgery, Vol 37,No 6 (June),2002: pp 877-881.

Goldman RD. The Paediatric Appendicitis Score (PAS) was useful in children with acute abdominal pain. Evid Based Med 2009;14:26 doi:10.1136/ebm.14.1.26

Kharbanda, AB. Validation and Refinement of a Prediction Rule to Identify Children at Low Risk for Acute Appendicitis. Arch Pediatr Adolesc Med 2012;166(8):738-744. doi:10.1001/archpediatrics.2012.490

Shah SR, Sinclair KA, Theut SB, Johnson KM, Holcomb GW 3rd, St Peter SD. Computed Tomography Utilization for the Diagnosis of Acute Appendicitis in Children Decreases With a Diagnostic Algorithm. Ann Surg. 2016 Sep;264(3):474-81.

Becker C, Kharbanda A. Acute appendicitis in pediatric patients: an evidence-based review. Pediatr Emerg Med Pract. Sep 2019;16(9):1-20.

Trout AT, Towbin AJ, Fierke SR, Zhang B, Larson DB. Appendiceal diameter as a predictor of appendicitis in children: improved diagnosis with three diagnostic categories derived from a logistic predictive model. Eur Radiol. Aug 2015;25(8):2231-8. doi:10.1007/s00330-015-3639-x

Anandalwar SP, Callahan MJ, Bachur RG, et al. Use of White Blood Cell Count and Polymorphonuclear Leukocyte Differential to Improve the Predictive Value of Ultrasound for Suspected Appendicitis in Children. J Am Coll Surg. Jun 2015;220(6):1010-7. doi:10.1016/j.jamcollsurg.2015.01.039

Gendel I, Gutermacher M, Buklan G, et al. Relative value of clinical, laboratory and imaging tools in diagnosing pediatric acute appendicitis. Eur J Pediatr Surg. Aug 2011;21(4):229-33. doi:10.1055/s-0031-1273702

Podcast: Play in new window | Download (Duration: 23:10 — 31.8MB)

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Categories
Surgery

Intussusception

Any list of “Top 10 Emergency Department diagnoses in children you can’t miss” should include intussusception. This episode reviews the diagnosis and management in practical manner that should help you on your next shift. It also features the talents of Kriti Gupta, MD, a Pediatric Emergency Medicine fellow from NewYork Presbyterian Brooklyn Methodist Hospital who is both the producer and host of this episode.

Transcript

The transcript for this episode can be found on PEMBlog

CME & MOC Part 2

We are proud to offer CME and MOC Part 2 from Cincinnati Children’s. Click this link to go to the page for credit. Credit is free and registration is required.

Click here to claim CME and MOC part 2 Credit


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References

Shaw, K. N., Bachur, R. G., Chamberlain, J. M., Lavelle, J., Nagler, J., & Shook, J. E. (2021). Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. Wolters Kluwer. 

Dahan, N., & Francisco, B. (2021, November 3). Pediatric small talk – the rule of 6: Pediatric abdominal surgical emergencies. emDOCs.net – Emergency Medicine Education. Retrieved November 8, 2021, from http://www.emdocs.net/pediatric-small-talk-the-rule-of-6-pediatric-abdominal-surgical-emergencies/. 

Sobolewski, B., PEM Blog Intussusception Part 2: Ultrasound-ing good. (2013, September 11). PEMBlog. Retrieved November 9, 2021, from https://pemcincinnati.com/blog/intussusception-2/ 

Sobolewski, B., Intussusception part 1: The basics. (2013, September 10). PEMBlog. Retrieved November 8, 2021, from https://pemcincinnati.com/blog/intussusception-1/.  

Fox, S. M. (2013, February 28). Intussusception. Pediatric EM Morsels. Retrieved November 10, 2021, from https://pedemmorsels.com/intussusception/.  

Giovanni JE, Hrapcak S, Melgar M, Godfred-Cato S. Global Reports of Intussusception in Infants With SARS-CoV-2 Infection. Pediatr Infect Dis J. 2021 Jan;40(1):e35-e36. doi: 10.1097/INF.0000000000002946. PMID: 33105341; PMCID: PMC7720868.

Ultrasonographic Diagnosis of Intussusception in Children: A Systematic Review and Meta-Analysis. J Ultrasound Med. 2021 Jun;40(6):1077-1084. doi: 10.1002/jum.15504. Epub 2020 Sep 16.

Doo JW, Kim SC. Sedative reduction method for children with intussusception. Medicine (Baltimore). 2020 Jan;99(5):e18956. doi: 10.1097/MD.0000000000018956. PMID: 32000420; PMCID: PMC7004751.

Centers for Disease Control and Prevention. (2018, July 25). Rotavirus vaccination. Centers for Disease Control and Prevention. Retrieved November 14, 2021, from https://www.cdc.gov/vaccines/vpd/rotavirus/index.html. 

Centers for Disease Control and Prevention. (2011, April 22). Vaccines: VPD-VAC/rotavirus/Rotashield and intussusception historical info. Centers for Disease Control and Prevention. Retrieved November 14, 2021, from https://www.cdc.gov/vaccines/vpd-vac/rotavirus/vac-rotashield-historical.htm.

Podcast: Play in new window | Download (Duration: 16:46 — 23.0MB)

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Categories
Gynecology Surgery

Ovarian Torsion

Your time is valuable and so is mine. That’s why I’m sharing brief, focused podcast episodes that will hone in on a single problem. This time, it’s ovarian torsion. Learn about the presentation, diagnosis, and treatment of this can’t miss surgical condition.

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I am proud to offer CME and MOC Part II through Cincinnati Children’s for listening to my podcast. All you have to do is listen to these four brief episodes that were released in the last couple of months, and then complete the multiple choice questions at the following link. Note that registration is open to any provider seeking physician CME even if you are not a Cincinnati Children’s employee.

The link to the CME for these episodes are: https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

The episodes included in this CME / MOC Part II program are:

Cannabis Hyperemesis Syndrome – 10/29/2021

Ovarian Torsion – 11/3/2021

Stress Dose Steroids – 11/9/2021

DVT 11/29/2021

That CME link again is – https://cchmc.cloud-cme.com/course/courseoverview?P=0&EID=40150

References

Schmitt ER, Ngai SS, Gausche-Hill M, Renslo R. Twist and shout! Pediatric ovarian torsion clinical update and case discussion. Pediatr Emerg Care. 2013 Apr;29(4):518-23; quiz 524-6. PMID: 23558274.

Guile SL, Mathai JK. Ovarian Torsion. [Updated 2021 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560675/

Podcast: Play in new window | Download (Duration: 4:45 — 6.5MB)

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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.

Podcast: Play in new window | Download (Duration: 11:58 — 16.4MB)

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