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

March 5, 2020

Welcome back to REBEL Cast, I am your host Salim Rezaie.  In this episode we are going to review a recent focused 2019 update to the American Heart Association (AHA) pediatric advanced life support (PALS) guidelines from 2018-19. This 2019 PALS Update addresses 3 concerns:
  1. Pediatric advanced airway management in pediatric cardiac arrest
  2. Extracorporeal cardiopulmonary resus (ECPR/ECMO) in pediatric cardiac arrest
  3. Pediatric targeted temperature management (TTM) during post-arrest care

September 2, 2019

Background: Convulsive status epilepticus is the most common pediatric neurological emergency worldwide.  Currently, phenytoin (UK & Europe) or fosphenytoin (USA) is the recommended second-line IV anticonvulsant for the treatment of pediatric status epilepticus.  Some evidence and providers however suggest that levetiracetam could be an effective and safer alternative. Recently not one, but two RCTs were published trying to figure out whether levetiracetam or phenytoin should be second-line treatment of pediatric status epilepticus.
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