Tag Archive for: Pediatrics

Validation of the Step-By-Step Approach to Febrile Infants

11 May
May 11, 2017

Background: Fever without source in infants less than three months old presents a difficult diagnostic dilemma for ED physicians.  Over the past 25 years several algorithms have been developed to help guide clinicians, most notably the Rochester, Philadelphia and Boston Criteria, in determining which infants require admission vs. outpatient management.  These studies were designed published between 1992 and 1994 prior to the wide spread use of HiB and pneumococcal vaccines in children, maternal GBS screening and the development of many new biomarkers. 

The Step-by-Step approach to febrile infants was developed by a European group of pediatric emergency physicians with the objective of identifying low risk infants who could be safely managed as outpatients without lumbar puncture or empiric antibiotic treatment. The algorithm was designed using retrospective data and this study attempts to prospectively validate it. Read more →

Pediatric Septic Hip

06 Mar
March 6, 2017

Pediatric Septic Hip Definition: Bacterial infection of the hip joint space and synovial fluid

Background:

  • Causes
    • Hematogenous spread in bacteremia
    • Local spread (i.e. from osteomyelitis)
    • Direct inoculation (traumatic or surgical)
  • High-Risk Subgroups
    • Age < 2 years (peak incidence 6 – 24 months)
    • Immunocompromised state (i.e. AIDS, active cancer, etc)
    • Functional asplenia (i.e. sickle cell disease)
  • Complications
    • Sepsis
    • Osteomyelitis
    • Chronic arthritis
    • Osteonecrosis
    • Capsule damage

Read more →

Forget the PediaLyte and Just use Dilute Apple Juice in Mild Gastroenteritis

02 Jun
June 2, 2016

Dilute Apple JuiceBACKGROUND: Every year in the United States there are an estimated 178.8 million episodes of acute gastroenteritis resulting in 473,832 hospitalizations.  Most of the evidence surrounding oral rehydration centers around Oral Rehydration Therapy (ORT) studies in low-income countries where children suffer from more extensive gastrointestinal losses.  Theoretically, electrolyte maintenance solutions are recommended in order to prevent increasing diarrheal losses through the osmotic diuresis that can occur with glucose-rich drinks like juice.  However, these electrolyte maintenance solutions can cost up to $10 for a 1-liter bottle and are unpalatable to some children.  Refusal to drink often results in the need for IV hydration and can potentially result in disease progression and hospitalization.  This study attempted to look at whether a dilute apple juice solution or preferred fluids was equal to, if not superior to oral hydration with an electrolyte maintenance solution. Read more →

The Challenge of Fever in Kids

27 Jul
July 27, 2015

FeverFEVER shows up beside the name of a new 3 year old that has just been checked into your department. This can be accompanied by many feelings when you see it from “Why are they here ?” to “I hope the child is not dying.” This is a reasonable range of thoughts depending on your level of experience and resources. Many variables are important with this “chief complaint” from how the temperature was actually obtained, to immunization status of the child, to how does the child look, and many more. In my estimation, fever gets a bad rap from general society. It’s our job to set the tone and fight “fever-phobia” when needed. Let’s examine some aspects of pediatric fever to change your mindset from apprehension, to “I’ve got this”. Read more →

7 Pediatric Hacks for Your ED

21 May
May 21, 2015

7 Pediatric Hacks for Your EDHacks are all the rage! There is even a current television show dedicated to “life hacks”. While the following may not be as cool as cutting cake with dental floss or cooking a pizza on your dash board (these were actually on that show) what I have learned from my training and experience in Pediatric Emergency Medicine (and my own 5 children) is that there are some hacks that can make things much easier for you, the kid, and the parents. The hacks presented here range from treatment for common (and often benign) conditions to serious situations. Read more →

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