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Investigation of Pediatric Headaches

In Noggin-cast part 2, we explore the relevant literature with regard to investigating headaches in children.  No magic answers yet, but we discovered a few useful tips along the way… and found a handful of references you can impress your colleagues with. When faced with a worried family, we all would like to offer the appropriate reassurance, or do the appropriate test – without being...

Headaches in kids

Pediatric Emergency Departments see a few children a day with headache. So how do we pick out the serious ones? In this “noggin-cast” we explore the causes of headache, including Primary headache like migraine and tension headache, secondary headaches from viral illness, and a few other strange ones… Headache PEMcast [ 31:39 ]

Appendicitis tests in children

It seems that this one slipped under the radar, when we originally published it… Because I followed it with a tongue-in-cheek summary post about the (lack of) utility of tests for appendicitis, and did not leave enough of a gap between the two posts, iTunes only picked up the abbreviated jokey version, leaving the original PEMcast undiscovered by many… So here it is again, for the benefit...

PEM for Dummies

Pediatric Emergency Medicine is an interesting sport. Really very broad, and really quite narrow too! There are a handful of presenting complaints that keep us busy most of the time, the same few recurring clinical scenarios – narrow. And then there is everything else, a happy hunting ground for generalists, with loads of undifferentiated problems – broad. I recently prepared a little...

Ten to the Five: 100,000 downloads

Just a quick post to say Thank You to all our followers.  Your quiet enthusiasm inspires us! We have just over 50 PEMcasts on EMPEM.org now, and our total downloads of mp3 podcasts has recently crossed the 100,000 mark. We aim to keep them coming, so send us a comment to let us know what you’d like us to cover next…  Help us reach 1 million downloads! Thanks for your support. Cheers Colin...

Pediatric UTI Controversies

So, you thought it was straightforward: suspect UTI, diagnose UTI, treat UTI… And let someone else worry about the follow-up. Unfortunately, we work in a fragmented system, where we need to kick-start the correct follow-up for our patients, who may otherwise miss out if we don’t get them on the right track before they leave the Emergency Department. We used to be paranoid about investigating...

UTI in children

Urinary Tract Infections in kids are a recurring clinical question that bugs us as clinicians… Why is Urinary Tract Infection in children different from cystitis or pyelonephritis in adults? How hard should we be looking for UTI, and what’s the best way to confirm or exclude the diagnosis? In this podcast we discuss the diagnosis, important differentials, and treatment of pediatric Urinary...

Kiddy Tox

Fortunately for us, younger kids are less dedicated in their efforts to harm themselves with a variety of poisons… On the other hand, their sneaky inventiveness knows no bounds, when it comes to getting hold of something that they shouldn’t. The principles of Clinical Toxicology are similar in kids and adults, but there are a few additional aspects to consider. Join us on a sketch of...

ISAAC blows wheezy whistle on APAP

This debate is going to be HUGE… Does paracetamol (acetaminophen) cause asthma? A series of large international studies and reviews dedicated to the question raise some interesting questions.  There appears to be an epidemiological association – not the same as a causal association – but something’s going on… For those of us who have been using APAP (=acetaminophen,...

Well Baby Oddities

Well babies can cause angst too… Except that neither parents nor doctors can be sure that they are well, until they have been properly assessed. From funny breathing to blue lips, baby boobs to milk regurgitation, a range of neonatal and infant oddities can present to our Emergency Departments. Some of these babies have real pathology and some have a minor but scary condition, with a great...

Sick Baby: undifferentiated infant under 3 months

Young infants under 3 months can be pretty scary when they get properly sick. It seems quite ‘veterinary’, and in many ways we just have to screen and treat for sepsis – and ask questions later… But there are a number of other differentials to consider. Signs of illness may be obvious, such as when we are presented with a pale, floppy baby, or they may be more subtle –...

Just Awful

Here’s a bit of fun… And some lessons for Pediatric Emergency Medicine, from 1971. It’s a kid’s book, about a boy who hurts his finger at school, and has to see the school nurse.  James feels Just Awful – until after the 3-part treatment. We learn about assessing, cleaning and dressing wounds, and gain some insights into a child’s perspective of being a patient. Enjoy. ...

MeningoCoccal Disease: Pearls and Pitfalls

A tiny, frightening little bug: Neisseria meningitidis.  The challenge for us in healthcare is to squash this little bug before it wreaks its havoc… Join us for a discussion of ways to protect yourself, and your patients, against the nasty threat of meningococcal disease. It creeps up on you… when you least expect. Standard Podcast [ 20:13 ]

Meningitis: Steroids or not?

The most important thing about treating meningitis is to give antibiotics as soon as possible.  The second most important thing is to institute appropriate supportive care.  Whether or not to give steroids as an adjunctive treatment is perhaps less clear to us… A recent Cochrane review goes a long way to pointing us in the right direction, but still leaves a few questions open.  Join us...

Meningitis Diagnosis and Management

The word strikes fear into the heart of parents. You dare not mention the ‘M’ word unless you back it up with action, or a whole heap of calming reassurance… The clinical features of meningitis are less straightforward in younger children, and CSF findings can be tricky to interpret. In this episode, our local Paediatric Infectious Diseases expert guides us through the topic with...

UltraSound uses in Pediatric Emergency Medicine

Everyone’s doing it… Is it time for your Pediatric ED to join the UltraSound craze?  For adult Emergency Medicine, there seems to be a strong following and a reasonable evidence-base.  That may be coming to the kiddy world, but maybe it’s not all that it’s cracked up to be? In this episode, we discuss the evolution of bedside clinical ultrasound use in the pediatric emergency...

Intussusception-Rotavirus Vaccine Risk

Last time we spoke about intussusception and its treatment.  This week, we try to discover whether there is a real link between rotavirus vaccines and this rare cause of abdominal pain in infants. Discussing vaccine efficacy and risks often engenders strong feelings from both sides of the river… the traditional believers AND the ‘anti-vaxxers’.  As with many controversies, it...

Intussusception

Intussusception is a ‘telescoping’ of the bowel on itself, commonest in infants between 5 and 10 months of age.  Usually, the classic triad of abdominal pain, vomiting and red-currant-jelly stools is not present, so how do we diagnose this sneaky little condition? In this episode, we explore the clinical presentation, investigation and management of this bowel-threatening condition. ...

Assessing Self-Harm Risk

Assessing the risk of self harm or suicide in adolescents is a daunting concept for the occassional player.  Many Emergency Departments have a qualified Mental Health professional embedded in their clinical workforce… which means that we can become de-skilled in the art of risk assessment. Last time, we discussed the HEADSS assessment tool for communicating with adolescent patients, and this...

Adolescent Mischief

It’s a tough transition, from childhood to adulthood… some of us are still trying to grow up. Looking after teenagers in a medical context can be tricky too – how can you be cool, without looking like a fool? In this episode we discuss the challenges of establishing trust, and making a thorough and balanced assessment in a busy, noisy Emergency Department. The HEADSS assessment...