Category: Pediatrics
Keywords: oxycodone pediatrics, codeine pediatrics, fracture pain management (PubMed Search)
Posted: 9/19/2008 by Don Van Wie, DO
(Updated: 11/22/2024)
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Oxycodone v. Codeine for Fracture Pain Management in Children
Charney RL, Yan Y, Schootman M, Kennedy RM, Luhmann JD. Oxycodone Versus Codeine for Triage Pain in Children With Suspected Forearm Fracture: A Randomized Controlled Trial. Pediatr Emerg Care. 2008 Sep;24(9):595-600.
Category: Pediatrics
Keywords: Pediatric Anaphylaxis (PubMed Search)
Posted: 9/5/2008 by Don Van Wie, DO
(Updated: 11/22/2024)
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When the Sting REALLY hurts!!
Remember the dose of Epinephrine is :
0.01 mg/kg or 0.01 mL/kg of 1:1,000 IM or
0.01 mg/kg IV or 0.1 mL/kg/dose 1:10,000 IV
to the adult dose or 0.3 mg
Also
Epipen Jr = 0.15 mg (use for < 30 Kg)
Epipen = 0.3 mg (use for > 30 Kg)
To show patients an instructional video click on the referenced link.
Category: Pediatrics
Posted: 8/30/2008 by Don Van Wie, DO
(Updated: 11/22/2024)
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Many things can be fatal with only one pill or sip for a young child. One teaspoonful of Oil of wintergreen (5ml) contains about 7000 mg of salicylate (the equivalent of about 21 adult aspirin). It would take only one swallow of Oil of wintergreen to be lethal for a young child.
Other Potential single dose killers for your Pediatric patients:
Alchohols
Methanol
Ethylene glycol
Isopropanol
Antidepressants
Monoamine oxidase inhibitors
Cyclic antidepressants
Antihypertensives
Clonidine
Verapamil
Diltiazem
Antimalarials
Chloroquine
Quinine
Benzocaine
Caustics
Hydrofluoric acid
Ammonia fluoride/bifluoride
Boric acid
Selenious acid
Disk batteries
Herbals
Eucalyptus oil
Pennyroyal oil
Camphor
Oil of wintergreen
Hydrocarbons
Imidazolines
Oxymetazoline
Naphazoline
Xylometazoline
Tetrahydrozoline
Insecticides/Rodenticides/Herbicides
Organophosphates
Carbamates
Lindane
Paraquat
Diquat
Nicotine
Opioids
Diphenoxylate
Methadone
Morphine
Oxycodone
Propoxyphene
Sulfonylureas
Pediatric Emergency Medicine Practice. July 2005.
Category: Pediatrics
Keywords: bladder ultrasound, pediatrics, cathe (PubMed Search)
Posted: 8/23/2008 by Don Van Wie, DO
(Updated: 11/22/2024)
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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: 11/22/2024)
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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: 11/22/2024)
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Sever's Disease
Category: Pediatrics
Keywords: Pyloric Stenosis (PubMed Search)
Posted: 7/25/2008 by Don Van Wie, DO
(Updated: 11/22/2024)
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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: 11/22/2024)
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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: 11/22/2024)
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Category: Pediatrics
Keywords: Kawasaki Disease; Cardiac; Coronary Aneurysm (PubMed Search)
Posted: 7/4/2008 by Don Van Wie, DO
(Updated: 11/22/2024)
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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: 11/22/2024)
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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: 11/22/2024)
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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: 11/22/2024)
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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: 11/22/2024)
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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: 11/22/2024)
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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.
Category: Pediatrics
Keywords: Retropharyngeal Abscess, Neck Pain, Torticollis, Fever (PubMed Search)
Posted: 5/16/2008 by Sean Fox, MD
(Updated: 11/22/2024)
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Retropharyngeal Abscess
Craig, FW and Schunk, JE. Retropharyngeal Abscess in Children: Clinical Presentation, Utility of Imaging, and Current Management. Pediatrics. 2003;111;1394-1398
Category: Pediatrics
Keywords: Acute Otitis Media, Topical Lidocaine, Wait and See, Analagesia (PubMed Search)
Posted: 5/9/2008 by Sean Fox, MD
(Updated: 11/22/2024)
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Topical Lidocaine for Acute Otitis Media
Spiro, D. Tay, K. Wait-to-see prescription for the treatment of acute otitis media. JAMA 2006, 1235.
Bolt, P., Barnett, P., Babl, F., Sharwood, L. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch Dis Child. 2008; 93: 40-44.
Category: Pediatrics
Keywords: Burns, Parkland, Burn Percent, Burn Classification (PubMed Search)
Posted: 5/1/2008 by Sean Fox, MD
(Updated: 11/22/2024)
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Pediatric Burns
Duffy BJ, McLaughlin PM, Eichelberger MR. Assessment, Triage, and Early Management of Burns in Children. Clinical Pediatric Emergency Medicine. 2006; 7:82-93.
Burn Service Manual, Children’s National Medical Center. Emergency, Trauma and Burn Services, Children’s National Medical Center, Washington, DC.
Category: Pediatrics
Keywords: Inuries, Falls, Poisoning, Drowning (PubMed Search)
Posted: 4/25/2008 by Sean Fox, MD
(Updated: 11/22/2024)
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Pediatric Accidental Non-Fatal Injuries
Karin A. Mack, Julie Gilchrist, Michael F. Ballesteros. Injuries Among Infants Treated in Emergency Departments in the United States, 2001—2004. Pediatrics; May 1 2008; 121 (5), 930-937.
Category: Pediatrics
Keywords: Acute Chest Syndrome, Sickle Cell Disease, Fever, Chest Pain (PubMed Search)
Posted: 4/18/2008 by Sean Fox, MD
(Updated: 11/22/2024)
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Acute Chest Syndrome
NHLBI. Acute chest syndrome and other pulmonary complications. Management of Sickle Cell Disease. June 2003; 25 – 29. http://www.nhlbi.nih.gov/health/prof/blood/sickle/index.htm.
Kathleen Ryan, RN, MPH, Anju Chawla, MD and Matthew Heeney, MD. Management of Acute Chest Syndrome in Sickle Cell Disease. New England Pediatric Sickle Cell Consortium. 2005.