Category: Pediatrics
Keywords: bladder ultrasound, pediatrics, cathe (PubMed Search)
Posted: 8/23/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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Bladder ultrasound increases catheterization success in pediatric patients
Witt M, Baumann BM, McCans K.Acad Emerg Med. 2005 Apr;12(4):371-4.
Category: Pediatrics
Keywords: Pediatric Intubation (PubMed Search)
Posted: 8/15/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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In the rush of adrenaline that goes hand in hand with a pediatric intubation often the ETT tip can sometimes be coming out of the little guys toes after passing successfully through the vocal cords, so remember once you get it in and confirm with end-title CO2 detection (capnography or on a monitor) always remember:
Depth of insertion (cm at lip) = 3 x normal size of ETT
Start at this depth, auscultate bilaterally in the axilla to listen for equal breath sounds, and look for equal chest rise. If all are good then secure tube and get your chest xray.
Category: Pediatrics
Keywords: Sever's Disease (PubMed Search)
Posted: 8/1/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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Sever's Disease
Category: Pediatrics
Keywords: Pyloric Stenosis (PubMed Search)
Posted: 7/25/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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Pyloric Stenosis
Category: Pediatrics
Keywords: pediatric fever, pediatric seizure (PubMed Search)
Posted: 7/18/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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PEDIATRIC FEVER + SEIZURE = FEVER
When a child has a fever and a seizure, do the age appropriate workup for a fever and you won't go wrong!!!
Category: Pediatrics
Keywords: Intussusception (PubMed Search)
Posted: 7/12/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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Category: Pediatrics
Keywords: Kawasaki Disease; Cardiac; Coronary Aneurysm (PubMed Search)
Posted: 7/4/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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Cardiac Involvement in Kawasaki Disease
So the Pearl is if you have a pediatric patient with a complaint of Chest Pain, ask if there was any history of Kawasaki Disease and get an EKG ASAP if the answer is yes!
Shah B. Lucchesi M. Atlas of Pediatric Emergency Medicine. McGraw-Hill Companies. 2006.
Category: Pediatrics
Keywords: Pertussis (PubMed Search)
Posted: 6/27/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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Pertussis means "violent cough".
Think of it with prolonged coughing, inspiratory whoop, absolute lymphocytosis, or chronic cough.
Don't Use cough suppressants.
Pertussis can be a life threatening Infection!! Especially in infants and young children.
Pertussis is a reportable infectious disease in the United States.
Category: Pediatrics
Keywords: Pediatric Septic Shock (PubMed Search)
Posted: 6/14/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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Remember to save childrens lives be aggressive with septic shock treatment early!
Do NOT allow long delays at IV attempts before moving to central lines or IOs.
Goal in the first 0 to 15 minutes from presentation:
When community ED physicians successfully achieved shock reversal (defined by return of normal systolic blood pressure and capillary refill time) in the first 75 min from arrival there was an associated 96% survival and a > 9-fold increased odds of survival. Each additional hour of persistent shock was associated with >2-fold increased odds of mortality.
*To push this amount of fluid in an infant or young child it may be easier to use 60 ml syringes for boluses rather than pumps
Han Y. Carcillo J. Early reversal of Pediatric-Neonatal Septic Shock by Community Physicians Is associated with improved outcome. PEDIATRICS Vol. 112 No. 4 October 2003: 793-799.
Category: Pediatrics
Keywords: Pediatric Central Lines (PubMed Search)
Posted: 6/7/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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Pediatric vascular access can be a challenge especially in a critically ill child. When placing central lines finding information on what size catheter to use and the depth of insertion can be hard to locate so here are some starters :
Age (yrs) IJ SC Femoral
0-0.5 3F 3F 3F
0.5-2 3F 3F 3-4F
3-6 4F 4F 4-5F
7-12 4-5F 4-5F 5-8F
Use a single, double, or triple lumen. (General rule more lumens the better.)
Right IJ and Right SC Depth of insertion:
If Height < 100cm then Initial Catheter Depth (cm) = Ht (cm)/10 -1 cm
If Height > 100 cm then Initial Catheter Depth (cm) = Ht (cm)/10 -2 cm
These formulas will place 98% of catheters above R atrium.
Anesth Analg 2001;93:883.
Category: Pediatrics
Keywords: Pediatric Laryngoscope blade size, RSI, Airway Management, Intubation (PubMed Search)
Posted: 5/31/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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Remember in the heat and pressure of a pediatric intubation (if you don't have your Pediatic Qwic Card handy) you can estimate what size blade to use very quickly and successfully by using facial landmarks!!
And remember to start with a straight blade (Miller, Wisconsin, Guedel, Wis-Hipple etc.) for your patients under 2 years of age because:
Pediatric Emergency Care. 22(4):226-229, April 2006.
Mellick, Larry B. MS, MD, FAAP, FACEP ; Edholm, Thomas MD, FACEP ; Corbett, Stephen W. MD, PhD, FACEP
Category: Pediatrics
Keywords: ALTE, Menningitis, Sepsis (PubMed Search)
Posted: 5/24/2008 by Don Van Wie, DO
(Updated: 8/14/2024)
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ALTE and Infections - when to do full septic workups?
Given some recent cases of newborns with ALTEs at UMMS and Wash Co I thought I'd offer the following Pearls:
That being said THE RISK OF MISSING A SERIOUS LIFE THREATENING INFECTION is much greater than the risk of doing a complete septic workup, administering antibiotics, and admitting an infant with an ALTE.
McGovern MC, Smith MB. Causes of apparent life threatening events in infants: a systematic review. Arch Dis Child. 2004;89(11):1043-8.