April 1, 2021

Background: Respiratory tract infections (RTIs) are a common reason for medical visits in kids.  Most RTIs are self-limited and the addition of antibiotics rarely alters the course of disease. However, antibiotics are frequently prescribed for these conditions.  Antibiotic overuse is one of the main drivers of resistance to antimicrobial agents.  Additionally, antibiotic prescriptions place patients at risk for adverse events from the antibiotics themselves and makes parents believe they need to have their children seen for similar episodes in the future.

October 22, 2020

Background: Acute gastroenteritis (AGE) is a very common emergency department (ED) presentation, with “approximately 1.5 million pediatric outpatient visits and 200,000 admissions” each year (Benary).   Treatment for AGE is mainly supportive, utilizing rehydration therapy and antiemetic medications.  One common and well studied antiemetic is ondansetron, which has been shown to be effective at controlling vomiting and decreasing hospitalization rates in pediatric patients.  Despite its widespread use within the emergency department, there is significant variation in the use of ondansetron as a discharge prescription, with providers noting the fear of masking a worsening condition or missed diagnosis and thus preventing a necessary return visit.  

September 7, 2020

Definition: Medial or posterior slippage of the femoral capital epiphysis relative to the metaphysis

Epidemiology:

  • Classic patient group: overweight adolescent boys
    • Over 80% of SCFE involves children with a BMI > 95th percentile (Manoff 2005).
    • Average age of onset: 12 years old
  • Bilateral SCFE is fairly common
    • 23% will have contralateral disease at the time of initial presentation, despite only complaining of unilateral pain (Hagglund 1988, Loder 1993).
    • Up to 60% of patients will go on to develop bilateral SCFE in their lifetime
    • 88% of subsequent slips occur within 18 months of diagnosing the first slip
  • Influenced by bone maturation, strength, and weight mismatch.
  • SCFE has also been associated with endocrine disorders such as hypothyroidism, hypogonadism, pan-hypopituitarism, but this is not as common.

August 31, 2020

Case Presentation: A 4-year-old previously healthy Hispanic female presented to the ED with a diffuse rash and facial swelling, concerning for an apparent allergic reaction. She was rushed into the treatment area for evaluation of possible anaphylaxis and respiratory assessment. She was tachycardic with a heart rate in the 130s, tachypneic, and borderline hypotensive for her age. Initial exam was negative for wheezing or stridor, but she had edema to the face and neck with a red raised rash covering her face. Epinephrine, Benadryl, and Solumedrol were ordered STAT given concern for airway compromise secondary to a severe anaphylactic reaction.

March 25, 2020

Take-Home Points
  1. Before starting a neonatal resuscitation, take some deep breaths to calm yourself
  2. Call in your friends - get a second team to manage the mother, call OB, call the NICU - all hands on deck
  3. Anticipate the equipment you'll need, get it to the bedside and don't forget to turn the warmer on
  4. Assign roles so everyone knows what they're supposed to do
  5. Initiate transfer to a NICU as soon as possible
0