Blog

A ‘normal’ chest Xray

What do you see when you take a look at this Chest radiograph? It isn’t immediately noticeable (and was read as normal), and is a good reminder of why you should always check your own films, and why a systematic read is important.  If all you were looking for was “r/o PNA/PTX” you could easilyRead more

Ketamine PSA with Desaturation

During a busy day in the ED, it becomes apparent that the pulling and yanking on your patient’s shoulder has done absolutely nothing to reduce their shoulder. You perform your pre-procedure PSA Checklist, know that this young and active 18 year old poses little difficulty, and push your desired dose of ketamine. Suddenly, you notice theRead more

Sinusitis In Pediatrics?

You’re working in pediatrics, when a mother comes in stating her 5 year old has sinusitis. He presents with fever, cough, runny nose, and some discomfort over where his frontal sinuses are. Does he have sinusitis? Not so fast! The ethmoid and maxillary sinuses develop during gestation, and are therefore present at birth. The sphenoidRead more

Reduction technique for Nursemaid’s elbow

It’s another busy afternoon in the peds ED when grandma comes in stating that her grandson broke his arm. He was jumping on the bed, and reached out to grab hold of a side rail before falling to the ground. It looks normal, but now the little guy refuses to use the arm and isRead more

52 in 52: A Clinical Predictive Tool for Intra-Abdominal Trauma in Pediatric Patients

Title: Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma Article Citation: Holmes JF, Mao A, Awasthi S, McGahan JP, et al. Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma. Ann Emerg Med. 2009 Oct;54(4):528-33. PMID: 19250706 WhatRead more

52 in 52: Dexamethasone in Mild Croup

Bjornson CL, Klassen TP, Williamson J, Brant R, et al; Pediatric Emergency Research Canada Network. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. 2004 Sep 23;351(13):1306-13. PMID: 15385657   What we already know: Croup, also known as acute laryngotracheobronchitis, is a disease that commonly affects the pediatricRead more

Hyperpronation for Nursemaid’s elbow reduction

“Childhood means simplicity. Look at the world with the child’s eye – it is very beautiful.” -Kailash Satyarthi   Nursemaid’s elbow is a radial head subluxation, typically caused by a “pulling” mechanism. It occurs most often in children six months to five years of age. The child will present with pain and will not useRead more

NEC, volvulus, pyloric stenosis, oh my!

This is a review of specific pediatric entities that may cause abdominal pain, bloody diarrhea, or vomiting. The following lists are not comprehensive and emergency physicians should consider a broad differential based on symptoms and presentation. The aim of this pearl is to familiarize us with these select pediatric conditions. Case courtesy of A.Prof FrankRead more

Tricky Orthopedics

That being said, let’s go through some commonly tested and easily confused orthopedic entities… Salter-Harris Classification http://orthoinfo.aaos.org/topic.cfm?topic=A00040 Type 1 – Slipped (Physis) Type 2 – Above (metaphysis) Type 3 – Lower (Epiphysis) Type 4 – Transverse all 3 Type 5 – Rammed (crush) Hand/Wrist injuries Scapholunate vs. Perilunate vs. Lunate Dislocation Mechanism for all 3:Read more

Imaging in Intussusception

Clinical Scenario: A 2-year-old female with no significant past medical history presents with vomiting and abdominal pain for 1 day. Among other entities in your differential diagnosis you are considering intussusception, however it is lower on your differential. How would you work-up this child?   Presenting Symptoms for Intussusception1 Sudden onset of intermittent, severe, crampy,Read more