Categories
Choosing Wisely Radiology Respiratory

Do children with bronchiolitis, croup, asthma, or first-time wheezing need a Chest X-Ray?

For most children with children with bronchiolitis, croup, asthma, or first-time wheezing chest X-Rays are not necessary. These X-Rays are often obtained due to the possibility of missing pneumonia. But, these radiographs are hard to interpret, increase length of stay and the cost of care, and expose children to excess radiation.

This podcast episode is designed to disseminate the important work of Choosing Wisely, an initiative of the the American Board of Internal Medicine Foundation, the goal of which is the spark conversations between clinicians and patients about what tests, treatments, and procedures are needed – and which ones are not.

The Choosing Wisely recommendation: Do not obtain radiographs in children with bronchiolitis, croup, asthma, or first-time wheezing

The Choosing Wisely Pediatric Emergency Medicine Recommendations

The Choosing Wisely Campaign Toolkit


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References

Shah SN, Bachur RG, Simel DL, Neuman MI. Does this child have pneumonia? The rational clinical examination systematic review. JAMA. 2017;318(5):462-471. PMID: 28763554.

Schuh S, Lalani A, Allen U, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007;150(4):429-433. PMID: 17382126.

Ramgopal S, Ambroggio L, Lorenz D, Shah SS, Ruddy RM, Florin TA. A Prediction Model for Pediatric Radiographic Pneumonia. Pediatrics. 2022 Jan 1;149(1):e2021051405. doi: 10.1542/peds.2021-051405. PMID: 34845493

Florin TA, Carron H, Huang G, Shah SS, Ruddy R, Ambroggio L. Pneumonia in Children Presenting to the Emergency Department with an Asthma Exacerbation. JAMA Pediatr. 2016;170(8):803-805. https://doi:10.1001/jamapediatrics.2016.0310

Categories
Infectious Diseases Respiratory

Bronchiolitis

I’m sure that you’ll probably see a case of bronchiolitis this winter. Call it a hunch. In this episode of PEM Currents you’ll learn why suctioning and ensuring hydration are still the mainstays of therapy, and why albuterol, racemic epinephrine, steroids and more don’t have a place in routine cases. And if you read any publication to supplement this podcast make it the most recent American Academy of Pediatrics Guideline on Bronchiolitis.

Check out more Pediatric Emergency Medicine educational content at PEMBlog.com

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Categories
Podcast Respiratory

Vocal Cord Dysfunction

Vocal cord dysfunction, AKA paradoxical vocal fold motion is more common than you might think. Patients often present to the Emergency Department in respiratory distress and “wheezing.” Learn about the diagnosis itself, different phenotypes and what treatment options are out there.

References

Christopher KL, Wood RP 2nd, Eckert RC, Blager FB, Raney RA, Souhrada JF. Vocal-cord dysfunction presenting as asthma. N Engl J Med.1983;308 :1566– 1570

Doshi D, Weinberger M. Long-term outcome of vocal cord dysfunction. Ann Allergy Asthma Immunol.2006;96 :794– 799

Weinberger M, Abu-Hasan M. Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma. Pediatrics. 2007 Oct;120(4):855-64.

 

Categories
Podcast Respiratory Resuscitation

Interview with Ben Kerrey about Pediatric Rapid Sequence Intubation

Ben Kerrey is a rising star in Pediatric Emergency Medicine and is the point man for an ongoing initiative at Cincinnati Children’s centered around improving safety and limiting complications during rapid sequence intubation. I recently sat down with Ben to talk about the state of RSI in pediatric patients, the difference between a checklist and a a true cognitive aid, the role of residents during RSI and more.

You can check out several related articles right here – all provided by Dr. Kerrey.

Categories
gastroenterology Podcast Respiratory

Swallowed Foreign Bodies

Kids eat stuff they’re not supposed to. Most of the time foreign bodies pass harmlessly through the GI tract. Occasionally they will get stuck. It is your job to figure out who has an impacted foreign body, and how to diagnose and manage it.

Check out more Pediatric Emergency Medicine content at PEMBlog.com

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Categories
Podcast Respiratory

Grudge match! Dexamethasone versus prednisone in acute asthma

Welcome to the first podcast in the PEMCurrents series. Ted Brenkert discusses the use of dexamethasone versus prednisone in acute asthma exacerbations in the ED. You can access the podcast on iTunes, or if you’d like download the file directly. We welcome any and all feedback in the comments section.

Here are links to pdf versions of all the articles discussed on this edition.

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