(Click the link to comment and to vote – voting not working through email, sorry!) You have just diagnosed an afebrile 10-year-old child who presented with sore throat, pharyngeal erythema and exudate, and tender lymphadenopathy with rapid-test-positive Group A streptococcal… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Clinic staff rush over a 6-year-old child for management in the ED. The child had received a new IV chemotherapeutic agent and 5 minutes later… Continue Reading →
The ABCDEFG of tox-caused bradycardia Alpha-2 agonists (e.g. clonidine) Beta-blocker Calcium channel blocker Digitalis ETOH Fentanyl and other opiates Gardening (pesticides with organophosphates)
What organisms do Cephalosporins not cover? Remember LAME: Listeria, Atypicals, MRSA, and Enterococci
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 16-year-old boy who was walking home from school when he experienced sudden onset of intense dread, racing heartbeat, dizziness, difficulty breathing,… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Which of the following otherwise well-appearing non-toxic patients with a low-grade fever from viral URI should NOT take ibuprofen?
Ever wonder how many doses you’re giving out when you prescribe a 10mL bottle of antibiotic eye drops? Or need to decide between prescribing a 3mL or 10mL bottle? The accepted conversion is 20 drops per mL (or 0.05mL per… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Ketamine has been in the news lately, contributing to the death of actor Matthew Perry and playing a part in the recent successful prosecution of… Continue Reading →
Tripledemic is here, and many a chief complaint will be, “he just won’t stop coughing” or “she has a fever.” PEMsource has a new Urgent Care section with tips, differential diagnoses, symptomatic treatments, dosing of common medications, and parent education aids, for… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) Parents bring in their 11 month old baby for a new-onset rash. The baby is unimmunized by parent choice. The baby had fever for the… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!)A You are seeing a 3-year-old boy with 2 days of fever to a maximum of 102.7 F, an urticarial rash (but no enanthem), and significant… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 6 year old with 1 ½ weeks of cough, nasal congestion, and malaise. Initially, he seemed to be improving a bit,… Continue Reading →
Picture this: you’re seeing a 3 year old girl with fever for 4 days, cough and runny nose (her parents estimate that since starting preschool she has had cough and runny nose 75% of the time). She has no evidence… Continue Reading →
Your next patient, actually your next 10 patients, are brought in by their parents because they have been coughing for 2 weeks. Match the characteristic of the cough with the appropriate treatment (you may use letters twice or not at… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are working locum tenens in Breckenridge, Colorado, and see a 2 year old boy with irritability, vomiting, and poor appetite. He has no fever… Continue Reading →
For children who have difficulty allowing the caretaker to administer eye drops, have them lay flat and close their eyes. Place several drops in the medial corner of the eye – when they open their eye, the drops will seep… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are caring for a 20 kg child involved in an auto vs. bicycle accident who has several superficial lacerations requiring suturing. You calculated the… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) During the recent “tri-demic” of influenza, RSV, and COVID disease, there was also a nationwide shortage of common oral liquid antibiotics used to treat otitis… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) COVID is on the rise again, with a more transmissible and immune-evading variant. Nirmatrelvir-ritonavir (brand name Paxlovid) is approved for children 12 years and older… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 5 year old child with known adrenal insufficiency with fluid and pressor-resistant hypotension. You wish to give stress-dose steroids.
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an 18 month old girl with chief complaint of itchy scalp and rash at the nape of her neck just below her… Continue Reading →
Following up on last month’s tips regarding antibiotic eye drops, it’s helpful to know that the color of the eye drop bottle cap tells you the medication class of the contents! Also, here is a great table giving a summary… Continue Reading →
If your patient with asthma can only remember the color and shape of their inhaler, but not the name, have them look at this poster to identify their medications.
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an 8 year old girl who was prescribed an oral cephalosporin antibiotic 1 week ago for rhinitis. She has 3 more days… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A seven day old neonate is brought in for a fever of 38.5 and lethargy. The baby had a home birth, and the parents have… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 10 day old ex-full term infant with bilateral watery mucoid eye discharge, mild eyelid edema, and papillary conjunctivitis. You suspect chlamydial… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are told that you will be receiving a 12 month old child in full arrest. CPR is in progress by the paramedics. Your EMS… Continue Reading →
While up to 10% of patients may think they have an allergy to beta-lactam antibiotics, fewer than 1% have a true IgE-mediated hypersensitivity, with concomitant risk of anaphylaxis. However, even if a true allergy is confirmed, this does not mean… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 3 year old ill-appearing child with high fever and rash. She initially started with tender erythema in her skin folds, progressing… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a previously healthy 9-month old boy brought in for rash. The child had 3 days of fever. He was seen yesterday evening… Continue Reading →
Everyone knows it’s nearly impossible to memorize all the formulas and doses relative to pediatric emergency medicine. That’s why 2 pediatric emergency medicine physicians created http://pocketpem.com/ when they were PEM fellows. Log on for a plethora of PEM info; maybe even bookmark… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
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A 16yo patient is brought in directly from a large “pharm” party with altered mental status, respiratory depression, and pinpoint pupils. You suspect opiate overdose and administer naloxone with improvement in spontaneous respirations. To your surprise, however, the qualitative urine… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 3 year old child with acute onset draining right ear. The child has no fever and no history of recent swimming… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
There is surprisingly sparse literature to help determine how much a child swallowed as part of a toxic ingestion. Most texts quote the work of Jones & Work in Am J Dis Child 1961, who studied 10 children aged 1.25-3.5… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) EMS is bringing you a 10yo patient that has been actively seizing for 20 minutes. They are unable to obtain IV access.
To calculate the mL of standard concentration ibuprofen (100 mg / 5 mL) or acetaminophen (160 mg / 5 mL) to give, take the child’s weight in kg and divide by 2. mL of ibuprofen or acetaminophen = child’s weight… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Match the child with acute otitis media to appropriate therapy per AAP guidelines (all children well-appearing, non-toxic, no distress or indications of severe otalgia, symptomatic… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!)
Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) EMS has brought in an 8 month old child who had a generalized tonic-clonic seizure at home. The child has a history of 2 prior… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 6 year old boy with a few days of episodes of crying and jaw clenching, decreased oral intake, and intermittent painful… Continue Reading →
Respiratory virus season is here, and we all know that the FDA recommends against the use of OTC cough medications in children < 4 years old (due to too many adverse effects and lack of efficacy). Some studies have shown… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 17yo boy with cough x 1 month. You prescribe Tessalon Perles (benzonatate). He has a 2yo sibling at home.
With the rise in legality of cannabis products, ED (and even PED) clinicians are seeing a big rise in cannabis hyperemesis syndrome. Topical capsaicin 0.025-0.075% is a known reliever of symptoms, as outlined on AliEM here. But who stocks topical… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a child with suspected methemoglobinemia from overuse of benzocaine teething gel. You plan to treat with methylene blue. Which of the following… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a pair of 14 year old girls who took “Triple C” at a party. One is altered and the other is hallucinating…. Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Which of the following topical antibiotics has the least efficacy against impetigo? (see pictures of impetigo here and a short article here)
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) A 5 year old girl presents with a 2 cm tender lump in her right armpit. It is not fluctuant and there is no overlying… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 19yo man was seen in the ED 2 weeks ago with a painless lesion to his penis. He is sexually active with men, has… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 5yo girl comes in for chest pain for 6 hours and is noted to have a heart rate of 250 that is not varying…. Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 17yo boy presents with a round lesion similar to that noted below, but on his penis, noted 1 hour after taking a dose of… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
Disclosure: I have no ties whatsoever to GoodRx When prescribing a medication to a patient who may need to pay out of pocket, use the GoodRx app or website to compare the prices at local pharmacies nearby, and sometimes, to find… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 5 month old comes in with diarrhea x 3 days, 5 times per day initially now 3 times per day, non-bloody, no fever, no… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) D5 ¼ NS is no longer recommended for maintenance fluids in hospitalized young infants. Why not?
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also… Continue Reading →
Use the PATCH mnemonic to remember transdermal medications Child with unusual symptoms, potential toxidrome? Look all over their body for a medication patch. Many are transparent or look like bandaids. P Pain (fentanyl, lidocaine) A Anti-cholinergic (scopolamine) T… Continue Reading →
You are about to incise and drain a relatively small simple abscess in a healthy child. (Click the link to comment and to vote – voting not working through email, sorry!)
A 19yo man presents with his 3rd bout of unremitting nausea and vomiting. He has been admitted twice before and treated with ondansetron and IV fluids. He was noted to take frequent long showers while admitted. (Click the link to… Continue Reading →
Placing topical anesthetic (EMLA, LMX4) on skin abscesses may result in spontaneous drainage, precluding need for incision. If topical anesthetic doesn’t result in spontaneous drainage, it at least provides some skin anesthesia prior to local anesthetic injection for incision and drainage procedure…. Continue Reading →
What do you include in your GI cocktail for adolescents?
A 7yo patient with peanut allergy at a rice krispy treat at a birthday party and discovered afterwards that it was made with peanut butter. She presents with hives, mild swelling of her lower lip and periorbital, and some faint… Continue Reading →
Mucosal atomizer devices improve administration of intranasal medications. Intranasal fentanyl 1.5 mcg/kg is a great way to give stronger pain medication (eg for fractures) without placing an IV. Intranasal midazolam 0.2 mg/kg (use concentrated 5mg/mL form to keep total volume… Continue Reading →
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