pediatrics

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.

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.

The pediatric patient with seizure, or is it really a seizure? A host of other conditions can look just like seizure. This Peds EM Morsel provides you with some answers.

Acute mastoiditis is a common complication of acute otitis media. Diagnosis includes clinical evidence of mastoid inflammation and may necessitate further imaging to exclude other complications. IV antibiotics and a surgical consult are required.

Naturally, we have all been taught to think “outside the box” and know to consider conditions outside the abdominal cavity.. When we are thinking outside of the box, make sure we keep Ovarian Torsion on our DDx list for the young girls.

Intranasal medications, if understood and employed properly, are a great choice to avoid an IV or as a bridge until IV access is obtained.

Learn the strengths and limits of intranasal fentanyl, midazolam, ketamine, and dexmedetomidine.

Remaining vigilant for the child with a subtle presentation of a severe illness is part of our job in the Ped ED; however, sometimes, the illness is not subtle and the child requires critical actions (ex, Damage Control Resuscitation, Mechanical Ventilation, Optimize Chest Compressions) . Often, it is best to consider these critical actions prior to needing to do them so there is no delay. One such, potentially life-saving, critical action is Extracorporeal Membrane Oxygenation (ECMO). Recently there was a nice review of Pediatric ECMO [Gehrmann, 2015] that deserves further contemplation. Below are some highlights from that article:

In the young child, vomiting is the great imitator: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral. To help us organize, below is a review of can’t-miss diagnoses by age.

There is no individual sign or symptom that can reliably exclude appendicitis in any patient. Appendicitis should be considered one diagnosis among a large differential. Concerning cases with a negative CT should be considered for admission. Radiation should be limited in children. Treatment may include antibiotics along with surgery.

Children like to pretend to be grown-ups. Unfortunately, sometimes they develop grown-up problems (Cholelithiasis, Kidney Stones, and Hypertension). Additionally, often kids will complain of symptoms that warrant great concern in adults, but often engender apathy when considered in children. Chest Pain is a great example of one of these complaints.