Pediatric Emergency Playbook

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    Myth : "No olive, no problem"      Reality : Rare finding, since we diagnose earlier Pyloric stenosis occurs in young infants because the pyloric sphincter hypertrophies, causing near-complete obstruction of the gastric outlet. More common in boys, preterm babies, first-born. Less common in older mothers. Association with macrolide use.       Presentation Young infant arrives with forceful vom...

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PEMplaybook.org

Hernia Myth : " If it's not strangulated, it's elective" Reality : Unlike in adults, all hernias in children are repaired at the time of diagnosis because : The risk of incarceration and strangulation is high There is a 30% risk of testicular infarction due to pressure on the gonadal vessels It is not worth messing around and "trying to navigate the system" Most groin hernias in children are indir...

PEMplaybook.org

PEMplaybook.org

PEMplaybook.org

PEMplaybook.org

PEMplaybook.org

Constipation as a diagnosis can be dangerous, mainly because it is a powerful anchor in our medical decision-making. Chances are, you'd be right to chalk up the pain to  functional constipation  — 90% of pediatric constipation is functional, multifactorial, and mostly benign — as long as it is addressed. We're not here for " chances are "; we're here for " why isn't it? " Ask yourself, could it be...

Top 10 [ details in audio ] Set the stage – exude confidence and be prepared Choose the right cannula size – a smaller working IV is infinitely better than none Feeling is better than looking – trust yourself Mark the site – things get wonky when you take your hands off to disinfect Tourniquets can mess you up – try to use a holder's hand to occlude the vein The holder rules – get as many hands on...

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Tuft Fracture Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Seymour Fracture Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November ; 29(4): 569–578 Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Mallet Fracture Adolescent with mallet finger and Kirschner wire fixation. Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November...

A spectrum — but will you recognize the blurry signposts?   Temperature (core) Presentation Management Miliaria Crystallina Normal Salt-colored tiny papules, easily burst; not pruritic Modify environment; light clothing; hydration         Miliaria Rubra Normal Discrimiate, red papules, not assocaited with follicles; pruritic Above plus cool compresses; calamine lotion; symptomatic tx for pruritis ...

Traditional Approach:   Secretory  -- poisoned mucosal villi -- "the sieve" Cytotoxic  -- destroyed mucosal villi -- "the shred" Osmotic  -- malabsorption -- "the pull" Inflammatory  -- edema, motility -- "the push" Lots of overlap, difficult to apply to clinical signs and symptoms.   Bedside Approach: Fever/No Fever, Bloody/No Blood   Non-bloody, febrile  -- most likely viral Non-bloody, afebrile...

PEMplaybook.org

Pediatric Readiness  is not just an ideal -- it's a tangible plan, a toolkit, and even better,  an attitude     How to improve your institution, and your own personal pediatric readiness.   National Pediatric Readiness Project (NPRP)             Los Angeles County Pediatric Readiness Project    

PEMplaybook.org

PEMplaybook.org

    Lund and Browder Chart to Estimate Burn Size in Children                   Parkland Formula for Burns Amount needed  in addition to  maintenance fluids: 4 mL/kg x BSA% = X  Add 1/2 of  X  to maintenance over the 1st 8 hours Add the other 1/2 of  X  to maintenance over the next 16 hours       Escharotomy Guide and the "Roman Breastplate"             Yin et al.  Bedside Escharotomies for Burns  ...