Tag Archive for: Pediatrics

Pediatric Push Dose Epinephrine: Getting the Epi Dose Right During Pediatric Resuscitation

13 Sep
September 13, 2018

Warning: Limited Published Evidence on this Topic

You have just intubated a 4 year old with sepsis from a bad pneumonia. Post intubation BP is 70 systolic, while waiting for the epinephrine (adrenaline) infusion to come up from pharmacy you watch the BP decline into the 60 systolic range and start to use fluids to resuscitate. You are an accomplished adult resuscitationist, and are comfortable mixing, and pushing push dose epi in your adult patients.

The following questions arise as you consider mixing a batch of push dose epi:

  • How much push dose epinephrine should you give this septic 4 year old?
  • Do pediatric patients need more or less epi when given in push dose format?
  • How do some pediatric intensivists and pediatric emergency physicians manage this problem?

Read more →

IV and/or Nebulized MgSO4 in Pediatric Asthma Exacerbations?

09 Aug
August 9, 2018

Background: Acute asthma exacerbations are a common presentation to pediatric emergency departments (EDs). Standard treatment with inhaled beta agonists and corticosteroids are often sufficient in mild asthma but can fall short in the treatment of moderate to severe exacerbations. Magnesium sulfate (MgSO4) has long been touted as an adjunct treatment due to its bronchodilatory properties (both in its intravenous (IV) and nebulized form). Despite its routine use, the evidence for its benefit is inconsistent, particularly in the adult population where the most recent large RCT demonstrated modest benefits (Goodacre 2013). Read more →

Pediatric DKA: Do Fluids Really Matter?

11 Jul
July 11, 2018

Background: The most feared complication in the clinical course of children with diabetic ketoacidosis (DKA) is the development of cerebral edema. Cerebral edema is rare (<1%) but is the leading cause of death in pediatric DKA. Many of the details about the risk factors as well as the mechanisms leading to DKA related cerebral edema are not well understood. Before we review the recent, groundbreaking study by Kupperman et al (1), examining the relationship between intravenous fluid content and rate of fluid administration in the development of DKA related cerebral edema, it’s important that we review the associated risk factors as well as the proposed mechanisms. It is important to know that the available data we are about to review comes from retrospective studies as well as case reports and case series and not from randomized control trials. Read more →

Button Battery Ingestion

04 Sep
September 4, 2017

Button Batteries: Small, disc shaped battery cells which are designed for use in small electronic devices. Common sources are kids toys, watches, calculators and hearing aids. Most batteries use lithium as a power source

Button Battery Ingestion Danger:

  • Contact with mucosal surfaces (oropharynx, esophagus, nasal passage) results in transmission of current
  • Current transmission causes chemical burns and necrosis via alkaline injury (sodium hydroxide)
  • Tissue damage can progress rapidly and result in devastating injuries
  • Nasal passage and esophagus are most susceptible to injury (narrow places for battery to become lodged)
  • Injury Patterns
    • Viscous perforation
    • Fistula formation
    • Erosion into blood vessels and resultant bleeding and possible catastrophic bleeding with erosion into aorta

Read more →

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 →

Optimization WordPress Plugins & Solutions by W3 EDGE