References

EMSC IIC Pediatric Education and Advocacy Kit (PEAK): Agitation

References

De-escalation tips for pediatric agitation: EMSC Innovation & Improvement Center

Disclaimer

The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3 million with zero percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

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Cardiology

Commotio Cordis

Commotio cordis is caused by the blunt impact of a hard object directly over the heart occurring during a specific window of ventricular repolarization leading to immediate collapse, ventricular fibrillation, and cardiac arrest. This episode focuses on risk factors and management of this rare but catastrophic injury.

American Heart Association CPR and AED Training

References

Link MS. Commotio cordis: ventricular fibrillation triggered by chest impact-induced abnormalities in repolarization. Circ Arrhythm Electrophysiol. 2012 Apr;5(2):425-32. doi: 10.1161/CIRCEP.111.962712. PMID: 22511659.

Madias C, Maron BJ, Weinstock J, et al. Commotio cordis–sudden cardiac death with chest wall impact. J Cardiovasc Electrophysiol 2007; 18:115.

Maron BJ, Gohman TE, Kyle SB, et al. Clinical profile and spectrum of commotio cordis. JAMA 2002; 287:1142.

Maron BJ, Estes NA 3rd. Commotio cordis. N Engl J Med 2010; 362:917.

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Tags AED, commotio cordis, CPR, ventricular fibrillation

Otolaryngology Procedures

Peritonsillar Abscesses

Peritonsillar Abscesses are the most common deep neck infection in adolescents and young adults. You will see them in grade schoolers as well. Learn about the diagnosis and management, including making the choice between needle aspiration versus wielding a scalpel for incision and drainage.

References

Ungkanont K, Yellon RF, Weissman JL, et al. Head and neck space infections in infants and children. Otolaryngol Head Neck Surg 1995; 112:375.

Schraff S, McGinn JD, Derkay CS. Peritonsillar abscess in children: a 10-year review of diagnosis and management. Int J Pediatr Otorhinolaryngol 2001; 57:213.

Sumpter, R, Bridwell, R. emDOCs: Emergency Medicine @3AM: Peritonsillar Abscess. http://www.emdocs.net/em3am-peritonsillar-abscess/. March 7, 2020. Accessed December 8, 2022.

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Tags peritonsillar abscess, pta

Dental Procedures

Tongue Lacerations

Tongue lacerations are surprisingly common in the Emergency Department. Fortunately most of them don’t require any specific interventions. You just let them go and they heal on their own. Really. But if you do have to repair I offer advice in this brief episode.

Resource from the British Dental Journal that has EXCELLENT pictures of healing tongue lacerations to share with patients and families.

References

Das UM, Gadicherla P1. Lacerated tongue injury in children. Int J Clin Pediatr Dent. 2008 Sep;1(1):39-41. PMID: 25206087.

Kazzi MG, Silverberg M. Pediatric tongue laceration repair using 2-octyl cyanoacrylate (dermabond(®)). J Emerg Med. 2013 Dec;45(6):846-8. PMID: 23827167.

Lamell CW, Fraone G, Casamassimo PS, Wilson S. Presenting characteristics and treatment outcomes for tongue lacerations in children. Pediatr Dent. 1999 Jan-Feb;21(1):34-8. PMID: 10029965.

Patel, A. Tongue lacerations. Br Dent J 204, 355 (2008). https://doi.org/10.1038/sj.bdj.2008.257

Ud-din Z, Aslam M, Gull S. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Should minor mucosal tongue lacerations be sutured in children? Emerg Med J. 2007 Feb;24(2):123-4. PMID: 17251622.

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Infectious Diseases

Periorbital Cellulitis

Perioribital cellulitis (AKA Preseptal cellulitis)is a soft tissue infection of the eyelids and skin anterior to the orbit. It must be differentiated from the more invasive and dangerous orbital cellulitis. Treatment varies depending on the original source (sinusitis, local trauma, stye etc,.). Learn all about periorbital cellulitis in this brief episode of PEM Currents: The Pediatric Emergency Medicine Podcast.

The companion blog post is right here!

References

Fox S. Periorbital cellultiis. Pediatric EM Morsels. March 29, 2013. https://pedemmorsels.com/periorbital-cellulitis/. Accessed October 20, 2022.

Andrea Hauser, Simone Fogarasi; Periorbital and Orbital Cellulitis. Pediatr Rev June 2010; 31 (6): 242–249. https://doi.org/10.1542/pir.31-6-242

Murphy, D.C., Meghji, S., Alfiky, M. and Bath, A.P. (2021), Paediatric periorbital cellulitis: A 10-year retrospective case series review. J Paediatr Child Health, 57: 227-233. https://doi.org/10.1111/jpc.15179

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Tags orbital cellulitis, periorbital cellulitis, preseptal cellulitis

Infectious Diseases Surgery

Neutropenic enterocolitis

Post author By bradsobo
Post date September 28, 2022
No Comments on 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.

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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Infectious Diseases

Chicken Pox

Dewdrops on a rose petal. You’ve all heard the description, right? But how many of you have actually seen chicken pox in the wild. And what about monkey pox – does it look the same? How can I tell them apart? I wish there was a brief podcast episode focused on varicella that would help answer some of these questions…

References

CDC for Healthcare Professionals: Chicken Pox (Varicella). https://www.cdc.gov/chickenpox/hcp/index.html. Accessed 8/11/2022.

Freer G, Pistello M. Varicella-zoster virus infection: natural history, clinical manifestations, immunity and current and future vaccination strategies. New Microbiol. 2018 Apr;41(2):95-105. PMID: 29498740.

Sauerbrei A. Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections. Eur J Clin Microbiol Infect Dis. 2016 May;35(5):723-34. PMID: 26873382.

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Tags chicken pox, varicella

Infectious Diseases

Hand, Foot, & Mouth Disease

Post author By bradsobo
Post date July 19, 2022
No Comments on Hand, Foot, & Mouth Disease

Hand, Foot, and Mouth (and Butt) disease is incredibly popular in the summer/warm weather months in the Northern Hemisphere (August through October). It is so popular that I guarantee you will see it many times. This brief episode will teach you how to make the diagnosis and review strategies for management – which are largely supportive.

The Pediatric EMS Podcast: Ouch-less Pediatrics

References

Guerra AM, Orille E, Waseem M. Hand Foot And Mouth Disease. [Updated 2022 May 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431082/

Woodland DL. Hand, Foot, and Mouth Disease. Viral Immunol. 2019 May;32(4):159.

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Tags coxsackie virus, enterovirus, hand foot and mouth

Procedures

Pain management for laceration repair in children

Post author By bradsobo
Post date June 21, 2022
No Comments on Pain management for laceration repair in children

Laceration repair is one of the quintessential procedures that children undergo in Emergency Departments. Minimizing pain and anxiety for children is a much better idea than just holding them down and getting it done. This episode will teach you all about local anesthetics, when to use anxiolytics and procedural sedations s well as the considerable value of nonpharmacologic intervention – including Child Life Specialists.

This episode is a co-production of the Emergency Medical Services for Children Innovation and Improvement Center whose mission is to minimize morbidity and mortality of acutely ill and injured children across the emergency continuum. We have developed a series of pain focused episodes.

Other Episodes in the Series

EM Pulse: Please Don’t Hurt Me!

EM Guidewire: Pediatric Pain Management – EMSC Improvement Project

PediaCast CME: Pediatric Pain… from the Family Perspective

Follow my work

Instagram @BradSobolewski

The Facebook page

Disclaimer

The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov

To learn more about the Emergency Medical Services for Children Innovation and Improvement Center visit https://emscimprovement.center

Email km@emscimprovement.center

Follow on Twitter @EMSCImprovement

References

EMSC IIC Pain Toolkit

Frank et al. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? Can J Plast Surg. 2012 Summer; 20(2): 71–73. PMCID: PMC3383550

Kennedy RM, Luhmann JD The “ouchless emergency department”. Getting closer: advances in decreasing distress during painful procedures in the emergency department. Pediatr Clin North Am. 1999;46(6):1215.

Momsen OH et al. Neutralization of lidocaine-adrenaline. A simple method for less painful application of local anesthesia. Ugeskr Laeger. 2000 Aug 14;162(33):4391-4.

Resch K, Schilling C, Borchert BD, Klatzko M, Uden D. Topical anesthesia for pediatric lacerations: a randomized trial of lidocaine-epinephrine-tetracaine solution versus gel. Ann Emerg Med. 1998;32(6):693.

Sinha M, Christopher NC, Fenn R, Reeves L. Evaluation of nonpharmacologic methods of pain and anxiety management for laceration repair in the pediatric emergency department. Pediatrics. 2006;117(4):1162.

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Tags anxiolysis, laceration repair, let, lidocaine, procedural sedation

Infectious Diseases

Lyme Disease

Update 6/6/22 – there is ongoing work to determine the optimal treatment for meningitis in Lyme between doxy and ceftriaxone. The original episode recording did not make this clear – my apologies. The 2021 IDSA guideline suggests that you could use either agent. This episode was edited to reflect this change.

Lyme disease prevalence continues to rise – especially in places where we didn’t see it before (like Ohio!). this podcast episode focuses on making the diagnosis, the different stages of disease, as well as when to prophylaxis, treat, and how testing works – all in under 15 minutes.