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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

Conjunctivitis In A Newborn

A mother brings her 4 day old newborn baby boy into the Peds ED for bilateral eye discharge. Mom tells you he was full-term and healthy, but she did not have prenatal care. The baby is well appearing and is eating, urinating and defecating well. A picture of his eyes are above, are you concerned? YouRead more

Broselow to the Rescue!

How do you calculate the correct ETT size for a child in a pediatric resuscitation? ETT size = (age + 16) / 4 ETT size = (age/4) + 4 ETT size = 4 + 1/4 age If you find yourself thinking about the order of operations (PEMDAS for anyone who missed elementary school math class) duringRead more

Shouldn’t I Just Give the Little Guy Some Albuterol?

You see a 20 month old with no PMH who has been wheezing and coughing for a few days.  His cousin has RAD.  Should you just give him a little albuterol and see how he does? Here’s his x-ray: What are you concerned for?Read more

Name That Rash!

A)  B)  C) D) Read more

Doing Away with Dopamine for Pediatric Septic Shock

The current Surviving Sepsis Campaign guidelines recommend starting either dopamine up to 10mcg/kg/min or epinephrine 0.05 mcg/kg/min for pediatric patients suffering from fluid-refractory septic shock. There is a significant lack of evidence as to which of the two agents is most beneficial, however, until a recent study published in Critical Care Medicine attempted to addressRead more

Fool Me Once

A 2 year old male presents with his mother with after mom saw him put something metallic in his mouth. He has no past medical problems and does not appear in any distress. His lung sounds are clear bilaterally, SpO2 99% on room air. You obtain a PA and lateral radiograph. Can this child beRead more