Categories
Infectious Diseases

Toxic Shock Syndrome

Toxic Shock Syndrome can be hard to recognize and differentiate from clinical entities such as Kawasaki, MIS-C, and DRESS. This brief podcast episode will raise awareness of situations in which TSS can occur and drive home important management pearls – like why you need to add Clindamycin.


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References

Gaensbauer JT et al. Epidemiology and Clinical Relevance of Toxic Shock Syndrome in US Children. Pediatr Infect Dis J. 2018 Dec;37(12):1223-1226. PMID: 29601458. 

Javouhey et al. Similarities and Differences Between Staphylococcal and Streptococcal Toxic Shock Syndromes in Children: Results From a 30-Case Cohort. Front Pediatr. 2018 Nov 28;6:360. PMID: 30547021

Rodríguez-Nuñez et al. Streptococcal Toxic Shock Syndrome collaborative group of Spanish Society of Pediatric Intensive Care. Clinical characteristics of children with group A streptococcal toxic shock syndrome admitted to pediatric intensive care units. Eur J Pediatr. 2011 May;170(5):639-44. PMID: 20981441.

Categories
Toxicology

Toxicology Season 3 Episode 3: Iron

Iron ingestions always show up on standardized tests and are definitely one of those “many kids are fine but some aren’t and it’s hard to figure out who’s fine and who isn’t” ingestions. Suzan Mazor from Seattle Children’s helps iron out the details…

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CME and MOC Part II

I am delighted to offer free CME and MOC Part II through Cincinnati Children’s for the entirety of Toxicology Season 3. Just listen to all three episodes and access the CME/MOC portal via this link.

References

Gumber MR, Kute VB, Shah PR, Vanikar AV, Patel HV, Balwani MR, Ghuge PP, Trivedi HL. Successful treatment of severe iron intoxication with gastrointestinal decontamination, deferoxamine, and hemodialysis. Ren Fail. 2013;35(5):729-31. PMID: 23635030.

Chang TP, Rangan C. Iron poisoning: a literature-based review of epidemiology, diagnosis, and management. Pediatr Emerg Care. 2011 Oct;27(10):978-85. PMID: 21975503.

Categories
Toxicology

Toxicology Season 3 Episode 2: Calcium Channel Blockers

Now this is a frightening ingestion! Calcium channel blockers are hard to manage with refractory shock being one of my main “please don’t let this come to the ED” nightmares. Suzan Mazor breaks it all down and discusses management of this challenging ingestion.

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CME and MOC Part II

I am delighted to offer free CME and MOC Part II through Cincinnati Children’s for the entirety of Toxicology Season 3. Just listen to all three episodes and access the CME/MOC portal via this link.

References

Bartlett, J. W., & Walker, P. L. (2019). Management of Calcium Channel Blocker Toxicity in the Pediatric Patient. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG24(5), 378–389. https://doi.org/10.5863/1551-6776-24.5.378

Chakraborty RK, Hamilton RJ. Calcium Channel Blocker Toxicity. [Updated 2022 Feb 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537147/

Categories
Toxicology

Toxicology Season 3 Episode 1: Bupropion

There are some scary ingestions out there and I think we’d all agree that bupropion (Wellbutrin) is on the short list of drugs that should make us worry. Learn how to recognize and manage toxicity, especially the neurogenic and cardiac effects of bupropion in the first episode of the third season of Toxicology podcasts from Suzan Mazor and I.

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CME and MOC Part II

I am delighted to offer free CME and MOC Part II through Cincinnati Children’s for the entirety of Toxicology Season 3. Just listen to all three episodes and access the CME/MOC portal via this link.

References

Huecker MR, Smiley A, Saadabadi A. Bupropion. [Updated 2021 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470212/

Farkas J. Bupropion intoxication. EMCrit. October 1, 2021. Accessed April 11, 2022. https://emcrit.org/ibcc/bupropion/

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

Categories
Otolaryngology

Nosebleeds

You will see a child with a nosebleed in the ED. It is a mathematical certainty. Chances are it has already stopped. Even if it hasn’t you can stop it – and figure out why it happened – and provide reassurance and education to the patient and family. Yes, all of those things for one little bleeding nose…

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References

Béquignon E, Teissier N, Gauthier A, et al. Emergency Department care of childhood epistaxis. Emerg Med J 2017; 34:543.

Shay S, Shapiro NL, Bhattacharyya N. Epidemiological characteristics of pediatric epistaxis presenting to the emergency department. Int J Pediatr Otorhinolaryngol. 2017 Dec;103:121-124. PMID: 29224751.

Tunkel DE, Anne S, Payne SC, et al. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg 2020; 162:S1.

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.

Categories
Urology

Urinary retention

This episode of PEM Currents: The Pediatric Emergency Medicine Podcast is a brief review of the management of urinary retention in children. The most common causes are UTI and constipation – but you must be aware of neurological problems and assure that you history is thorough and your physical exam complete.

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References

Burla MJ, Benjamin J. Pediatric Urinary Retention in the Emergency Department: A Concerning Symptom with Etiology Outside the Bladder. J Emerg Med. 2016 Feb;50(2):e53-6. PMID: 26482829.

Peter JR, Steinhardt GF. Acute urinary retention in children. Pediatr Emerg Care. 1993 Aug;9(4):205-7. PMID: 8367356.

Gatti JM, Perez-Brayfield M, Kirsch AJ, Smith EA, Massad HC, Broecker BH. Acute urinary retention in children. J Urol. 2001 Mar;165(3):918-21. PMID: 11176514.

Categories
Hematology

DVT

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 deep venous thromboses (DVT). Learn how to suspect them in the first place and make the diagnosis.

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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

Jaffray J, Young G. Deep vein thrombosis in pediatric patients. Pediatr Blood Cancer. 2018 Mar;65(3). PMID: 29115714.

Rodríguez-Fanjul J, Trenchs V, Muñoz-Santanach D, de Sevilla MF, Toll T, Blanch J, Luaces C. Deep vein thrombosis: rare cases of diagnoses in a pediatric emergency department. Pediatr Emerg Care. 2011 May;27(5):417-9. PMID: 21546806.

Waheed SM, Kudaravalli P, Hotwagner DT. Deep Vein Thrombosis. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507708/

Categories
Resuscitation

Stress Dose Steroids

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 stress dose steroids. Learn about how to give them and to not worry about tons of body surface area related math when you have a sick child in front of you.

PEMBlog.com

Follow @PEMTweets on Twitter

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

Huan D and Tat S. PEM Pearls: Hydrocortisone stress-dosing in adrenal insufficiency for children. Academic Life in Emergency Medicine. https://www.aliem.com/pem-pearls-hydrocortisone-stress-dosing-adrenal-insufficiency-children/ May 2, 2016

Miller BS, Spencer SP, Geffner ME, Gourgari E, Lahoti A, Kamboj MK, Stanley TL, Uli NK, Wicklow BA, Sarafoglou K1. Emergency management of adrenal insufficiency in children: advocating for treatment options in outpatient and field settings. J Investig Med. 2019 Feb 28. PMID: 30819831