Nasal foreign bodies present with a wide variety of complaints ranging from history of insertion without symptoms (71-88% of patients), mucopurulent nasal discharge (17-24%), foul odor (9%), epistaxis (3-6%) to mouth breathing (2%). Most commonly, foreign bodies are located under the inferior turbinate on the nasal floor or in front of the middle turbinate. Foreign […]

Summertime brings us all sorts of playground, sports and even graduation party injuries. Injuries to the teeth, though not usually life threatening, can often make us uncomfortable. Next time you approach a patient with a dental injury, remember the Ellis system of classification system for a tooth fracture. Ellis 1: injury of the crown into […]

Today we have a guest Pearl writer, our very own rising PGY2 Arjun Prabhu. He learned about an interesting complication while at a committee meeting and wanted to share: You are getting set up for a femoral central line in resus and are thinking of the possible complications while you’re getting things together. You don’t […]

Have you spent the past week wondering how you could express empathy more successfully? Don’t re-invent the wheel, use a tool from palliative care — NURSE statements! Name the emotion: “Many people would feel angry if that happened to them, I wonder if you have felt that way?” Understand the emotion: “Although I personally have […]

Ornithine transcarbamylase deficiency, citrullinemia, methylmalonic acidemia, tyrosinemia, phenylketonuria, Galactosemia… did I lose you yet? These words bring me back to the dark place of step one studying. So take a deep breath, don’t worry about the big words and here are a couple of tips next time you have a “metabolic kid” in the peds […]

Have you ever tried to figure out what the appropriate starting dose of naloxone is? When you dig in the literature it’s pretty clear that its a lot of hand waving and muddy water — but let me give you an approach and some of the literate that is out there Apneic patient: 1-2mg naloxone […]

I have a new niece, Kaitlyn Marie, who is just crushing life so far, but my brother called me and asked all about neonatal jaundice, so here is some info to help you the next time you see this in the peds ED or someone you know calls you to ask. Why are babies at […]