practice updates

Pediatric airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks:
Episteme — theoretical knowledge
Techne — technical knowledge
Phronesis — practical wisdom — also called prudence.

Here we’ll invoke each type of knowledge and understanding as we go beyond the anatomical issues in pediatric airway management – to the advanced decision-making aspect of RSI and the what-to-do-when the rubber-hits-the road.

Recognizing normal neonatal conditions and behavior

Several agents, both legal and illegal, can cause significantly elevated heart rates. This article reviews the most common causes of drug-induced tachycardia. Diagnosis and management of these conditions are also discussed.

The pediatric and gravid populations have special needs regarding imaging for abdominal pain. This article reviews the more common causes of abdominal pain in children and pregnant women and how to approach imaging in these populations.

Vasopressor use in patients with sepsis has been studied extensively, with many calling for early, peripheral vasopressors. What is the literature behind this, and are patient outcomes affected? This post examines the studies for vasopressors in sepsis and more.

Emergency department (ED) overcrowding is an issue that not only impacts the ED but impacts nearly all aspects of a hospital system. The ED is the location in the hospital that feels the greatest stress from capacity issues hospital-wide. Emergency providers are uniquely positioned to have a great impact in flow improvement initiatives and this article reviews some of the problems with overcrowding and how to improve patient flow through the ED.

Acute Mastoiditis is the most common complication of AOM – how do you diagnose it and how does the ENT physician manage it?

You have all of the skills you need to care for an acutely ill infant. Learn a few pearls to make this a smoother endeavor.

Dr. Andrew Arcand & Dr. Laura Tate discuss the key clinical pearls and pitfalls in the recognition and management of many apparently benign hand emergencies that have serious morbidity, including high pressure injection injury, flexor tenosynovitis, gamekeeper’s thumb (or skier’s thumb), fight bites, hook of the hamate fractures and many more important hand emergencies. Dr. Tate & Arcand answer such questions as: which lacerations require prophylactic antibiotics? Which hand lacerations do not require sutures? How is rotational deformity best tested for metacarpal fractures? What are the pearls of tendon repair? How do you test for instability when you suspect a Gamekeeper’s thumb? How is compartment syndrome of the hand different to compartment syndrome in the leg? What are Kanavel’s signs of tenosynovitis? How should felons be managed in the ED? What are the most common errors that plastic surgeons see ED docs make?

Hand and digital wound bleeding should be managed with hemorrhage control, an adequate exam and proper treatment. There are many tools to help manage bleeding and allow for an adequate exam. Using a topical analgesic such as lidocaine, can be helpful with pain control. The addition of epinephrine to a topical analgesic in hand and digital wounds may not be as scary as once thought and may be considered to help with hemorrhage control in certain wounds.