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

June 2, 2016

BACKGROUND: 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.

August 17, 2015

Welcome to the August 2015 REBEL Cast, where Swami, Matt, and I are going to tackle a couple of topics. First topic: renal colic. Renal colic is a commonly seen condition encountered in emergency departments and the use of medical expulsive therapy (MET) is commonly recommended by our urology colleagues. Proponents of MET in the treatment of ureteric colic advocate for them due to their potential ability to increase stone passage, reduce pain medication use, and reduce urologic interventions. Second topic: pediatric weights. In pediatric resuscitations many of use the Broselow tape to predict weights for dosing of medications.  With the increasing weights in pediatric patients seen in developed countries around the world, does the commonly used Broselow tape accurately predict weights?   So with that introduction today we are going to specifically tackle:

Topic #1: MET for Renal Colic Topic #2: Use of the Broselow Tape to Estimate Pediatric Weights

July 27, 2015

FEVER 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”.

May 21, 2015

Hacks 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.
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