Pediatric Status Epilepticus Shownotes
Definition: Seizure that has been going on for >5 minutes OR recurrent seizures without return to baseline. If the patient was seizing at home and still seizing when they get to the ED, consider it to be status.
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Diagnosis and management of concussion in children is part of our everyday bread and butter in the Emergency Department. Given the estimated 1.1 million - 1.9 million pediatric concussions we see annually in the United States, it is no wonder why. [1] We are well aware that pediatric concussions (more accurately termed mild traumatic brain injury, mTBI) occur most commonly from direct blunt head trauma, but they can also occur via indirect forces. Regardless of mechanism, concussions result in temporary neurologic and/or cognitive impairment that can last hours to days, with long-term sequelae potentially lasting weeks to months....Read More
If you mainly treat adults or both adults and children like me, then you have probably heard the (very annoying) quote, “kids are not just small adults”, and so I won’t say it again. Well, I guess I just did, but at least I wont stop at this quote, but attempt to explain how kids are not small adults, and how this may impact their care in the emergency department and the intensive care unit.
Nearly all organ systems of young children are immature and developing throughout childhood and on into adulthood, including the cardiovascular system. Without a basic understanding of the key physiologic differences, the emergency and intensive care physicians will be ill equipped to care for the critical ill child.
To understand how kids with shock present differently than adults, it’s important to discuss a few basic differences regarding intravascular volume and cardiovascular system in children especially neonates and infants (1-24 months of age). Also remember shock is defined the exact same way as it would be in adults even though the presentation and underlying physiology may differ. Shock is simply a state where tissue/organ blood flow is inadequate to meet tissue/organ metabolic demands....Read More
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:
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).