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...

October 20th, 2011 by colinparker 

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...

October 6th, 2011 by colinparker 

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. ...

September 22nd, 2011 by colinparker 

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...

September 9th, 2011 by colinparker 

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...

August 24th, 2011 by colinparker 

Fluid Controversies

A recent paper about fluid boluses in sick African children has raised a few eyebrows around the world of pediatric emergency medicine, and the world of medicine in general… We thought we’d get in on the discussion, before everyone goes throwing the baby out with the bathwater.  In this PEMcast we try to appraise the Maitland paper in a rational, unemotional way… and almost manage! ...

August 11th, 2011 by colinparker 

Metabolic Kids in your ED

So, a well-looking child turns up to triage and gets given a high triage priority, simply because they have a Congenital Metabolic Disorder.  Do we really have to jump to it, put in an IV cannula, and call the specialist? There are individual subtleties in managing these children with Inborn Errors of Metabolism, but a few common principles apply.  This short tour of a few commoner conditions should...

July 28th, 2011 by colinparker 

Metabolic Stuff for Dummies

Inborn Errors of Metabolism… OK, calm down, check your own pulse, and resist the urge to run away. Nobody likes biochemistry (OK, maybe one or two do like it), but fortunately we don’t need to learn the actual biochemical pathways in order to diagnose or manage these Congenital Metabolic Disorders. Individually these conditions are rare, but as a group they are collectively common enough...

July 14th, 2011 by colinparker 

Treatment Options in Neonatal Jaundice

Phototherapy treatment will be sufficient for the vast majority of infants with unconjugated hyperbilirubinaemia who need treatment.  When it gets more serious, we turn to higher-risk treatments like IntraVenous Immunoglobulin or exchange transfusion. What evidence do we have to guide our decisions here? Every Special Care Nursery in the world has a bilirubin chart on the wall to guide us in terms...

June 30th, 2011 by colinparker 

Neonatal Jaundice

It takes a long time and a lot of exposure to become comfortable with jaundiced newborns. Maybe we just become less cautious or less thorough over time… Most of us feel the need to slow down and consider all the possibilities, before jumping to a benign diagnosis. Hopefully this little review will help you remember some of the basics of neonatal jaundice. [drawing by Charlotte Parker, medium:...

June 16th, 2011 by colinparker 

Clearing the Paediatric C-Spine

Excluding a broken neck or a spinal cord injury: can be tricky. We know what to do when there is an obvious bony, ligamentous or cord injury… but do you want to be the one who takes responsibility to give the ‘all clear’? Fortunately, serious injuries to the cervical spine, whether bony, ligamentous, or spinal cord injury, are uncommon in the really young… which is lucky for...

June 2nd, 2011 by colinparker 

Cervical Spine Assessment in Children

Neck Injuries in kids are fortunately quite uncommon, but the assessment of a child with a potential cervical spine injury remains stressful and challenging.  No-one wants to miss a broken neck… Because of the anatomical, physiological and behavioural differences, we can’t just do what we do for adults either. How common is SCIWORA? How aggressively do we need to apply immobilisation...

May 19th, 2011 by colinparker 

Septic Arthritis, or Transient Synovitis?

There must be a combination of clinical features and/or tests that can help us figure out whether the limping child has a benign, self-limiting “irritable hip” or the scary and serious condition of pus in the joint: septic arthritis. It turns out that Dr Kocher has been working on this for years, and a few other investigators have worked at validating the results of the original 1999 study. Our...

May 4th, 2011 by colinparker 

Limping Child

Watchful waiting or invasive investigations?  A limping child may have transient synovitis, or something more serious such as septic arthritis, osteomyelitis, or Perthes Disease. Tests can be falsely reassuring in the early stages… Join us for a tour of clinical discovery in evaluating the child with a limp. Standard Podcast [ 34:08 ]
April 21st, 2011 by colinparker 

Cranial CT for Minor Head Injury

Most children with a minor head injury (GCS 14-15) have an excellent prognosis, but a small number will deteriorate unexpectedly, and go on to require neurosurgical intervention.  The last decade has seen valiant attempts at trying to define and predict this subgroup of kids who need a cranial CT, to pre-empt this deterioration. Clinical Decision Rules seem to be the fashion when it comes to making...

April 7th, 2011 by colinparker 

Minor Head Injury

A little bump on the head… could cause a lot of trouble for you and me. Minor Head Injury used to mean GCS 13-15, nowadays it means GCS 14-15. This is the vast majority of head injury cases, and therefore we need to be really comfortable with their assessment and management. Plug in and join us as we discover the origins of the 4-hour myth, the creative definition of concussion, and the correct...

March 24th, 2011 by colinparker 

Asthma Medications: where’s the evidence?

We like to think we practice evidence-informed medicine… but what evidence do we have that these medications work in acute asthma? Inhaled treatments make sense, and we can see them working right before our eyes, but when things get serious, response to more aggressive interventions don’t seem to be quite as convincing. We have hand-picked a few papers to show the way, in terms of backing...

March 10th, 2011 by colinparker 

Asthma

Asthma in kids is common… very common.  So we should know how to manage it in our Emergency Departments.  Occasionally we see a child with severe or critical asthma; when this happens it is useful to know what your plan is – a plan you can make beforehand, rather than in the heat of the moment… Join us for this PEMcast as we navigate the current conventional wisdom on management...

February 24th, 2011 by colinparker 

Appendicitis: Improving Diagnostic Accuracy

Appendicitis is the most common surgical condition in children, and an important condition not to miss.  Can we use clinical features, scoring systems, blood tests or radiological investigations to improve our diagnostic accuracy? In this episode we put the diagnostic process under the microscope and try to figure out the most helpful symptoms, signs and tests to confirm or exclude appendicitis. ...

February 10th, 2011 by colinparker 

Appendicitis: Utility of Tests

For those of you with short attention spans… here is the synopsis of our Appendicitis PEMcast. Standard Podcast [ 0:40 ]
February 10th, 2011 by colinparker