(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 2-year-old girl that had a PEG gastrostomy tube placed 1.5 years ago. The parents have noticed resistance when pushing in the… Continue Reading →
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(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 →
Harbor-UCLA Emergency Medicine Residency grad and all around great educator Tom Fadial has made some highly useful apps that you absolutely need. The latest, Fractures, is a comprehensive library of fracture types along with radiograph images, pearls, a guide to… 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!) You are seeing a 15 year old who sustained significant facial trauma. He complains of decreased vision in his right eye. On exam you note… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an 8 year old male with 3 days of progressively worsening redness, tenderness, and swelling of his right index finger proximal lateral… Continue Reading →
First, highly recommend Dr. Brian Lin’s site lacerationrepair.com (free) for all your wound management education and questions. Second, in a recent blog post, there was a review of an online laceration repair course, The Laceration Course (paid). Dr. Lin posted… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 3 week old female infant presents with a palpable inguinal mass of 2 hours duration. The dad states he noticed it while changing her… Continue Reading →
The Royal Children’s Hospital of Melbourne has a great clinical guideline for pediatric lumbar puncture 22 gauge spinal needle can be used in all age groups. Use 1.5 inch length in < 2-3 year olds, 3.5 inch length in older… Continue Reading →
Our approach to nail bed lacerations has evolved quite a bit over the last decade or two. The old teaching was that a significant subungual hematoma required removal of the nail to check for a nail bed laceration, and if… Continue Reading →
Iron deficiency anemia can be seen in toddlers that have switched to cow’s milk (typically at age 1 yr) from formula. If the child’s diet is nearly exclusively cow’s milk, a severe anemia can slowly develop due to iron deficiency… 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 →
Classic teaching is to estimate the nasopharyngeal airway (NPA) size as the length from the patient’s nares to tragus of the ear, and the oropharyngeal airway (OPA) from the maxillary incisors to the angle of the mandible. However, a few… 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 an 8 year old boy brought in by ambulance for a first time unprovoked afebrile seizure. The seizure was generalized tonic-clonic and… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 14 year old boy involved in a helmet vs helmet football injury. Which of the following is true regarding his evaluation… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 16 year old female involved in a motor vehicle accident is brought into your trauma bay; she is obviously gravid and states that she… 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 →
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Parent / guardian unsure of the child’s immunization history? Almost every state has an immunization registry, and EMRs are often configured to be able to access them – ask your institution’s IT person how if that’s possible. For a quick… Continue Reading →
Dr. Rahul Patil describes using the suture packaging to create a sterile field / barrier in “Easy way of keeping hairs away while suturing ear lacerations” Indian J Plast Surg 2011;44(3):531
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing an adolescent who slammed her finger in a door and has a subungual hematoma.
Treating abscesses by making two smaller incisions and placing a loop through them is becoming popular, preferred by many over traditional I&D. For a review of the technique: https://pemcincinnati.com/blog/loop-abscess/ Don’t have a vessel loop? You can use the cuff of any glove… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A teen who plays on the high school varsity basketball team comes in after jamming her finger during a game. She has a distal phalanx… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are caring for a 19 year old woman who is breastfeeding her 2 month old infant. She has a superficial 2cm breast abscess located… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are preparing to repair an upper lip laceration that crosses the vermillion border in a cooperative 15 year old girl who was bitten by… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You are managing a 1yo patient with submersion injury who has respiratory distress and falling O2 saturation. You begin bag-valve-mask ventilation as you prepare to… 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 →
Busy ED and don’t have time for procedural sedation or prolonged anterior shoulder dislocation reduction techniques? Set ’em up in the Stimson technique position and forget ’em – check back in 20-30 minutes. AliEM posted this great tip for using… Continue Reading →
So many helpful tips and tricks can be found on twitter! Of course, for kids, adjust IV catheter size and amount of fluid infused.
From Haliloglu M, Bilgen S, Uzture N, Koner O. Simple method for determining the size of the ProSeal laryngeal mask airway in children: a prospective observational study. Braz J Anesthesiol 2017; 67(1):15-20. The child’s ear is a good estimate 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 →
(Click the link to comment and to vote – voting not working through email, sorry!) You are seeing a 16 year old boy with sore throat, worse on the left side, dysphagia, low-grade fever, difficulty fully opening jaw (trismus), and… Continue Reading →
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Photos before & after release from Wikimedia Commons Hair tourniquets (and sometimes thread tourniquets) can occur on toes (most common), fingers, and more rarely the penis, clitoris, or uvula. Peak occurrence is at age 2-6 months, corresponding with maternal… 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 →
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When resuscitating neonates vascular access is often a challenge. While IV and IO attempts are ongoing, the ability to obtain a small amount of blood for point-of-care testing of, for example, glucose, hemoglobin, electrolytes, and venous blood gas, can be… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) For which of the following patients is a laryngeal mask airway (LMA) as a temporizing measure after failure of intubation contraindicated?
Two tips for intubating the obese patient: Position the patient: build a sizeable ramp to position the patient such that his/her ears are at the level of the sternal notch, and his/her face is parallel to the ceiling Position yourself: keep… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 1 week old presents with multiple bouts of hematemesis. The baby was born full-term, no complication, has been breast-feeding normally, and is afebrile. The… 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 →
Success rates in infant lumbar punctures may be declining as we do fewer and fewer (doing fewer is a good thing, except that we get less experience). One thing that can improve success is early stylet removal. The stylet is… Continue Reading →
There are several techniques for removing a ring that is stuck on a patient’s finger, starting with the simplest – using ring cutters to cut it off. However, if the patient doesn’t want the ring destroyed, the string technique has been… 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 →
Nothing slows down the ED flow like waiting for the urine flow of an infant or toddler. Whether or not to screen for UTI with a clean catch urine vs obtain a catheterized specimen will be left for another discussion,… Continue Reading →
Your local hospital cafeteria can be a useful resource in managing your PED patients: Sugar liberally applied to the edema of a paraphimosis or rectal prolapse may help decrease swelling and improve reduction efforts A mayonnaise packet provides useful lubricant… Continue Reading →
Having trouble with bag valve mask ventilation? Don’t forget to use adjunctive airways – nasopharyngeal for conscious patients, oropharyngeal for unconscious. Reuben Strayer’s great video here advocates placing 2 nasal airways and an oral airway, then bagging over those, for the… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) You have sutured a 2cm forhead laceration on a 4yo boy using 6-0 nylon sutures.
You are caring for a 6yo oncology patient presenting in septic shock. Although he is oxygenating and ventilating well at this time, you plan to intubate him to reduce his metabolic work. The most important pre- treatment before rapid sequence… 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!)
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 →
Thanks to Tim Horeczko pemplaybook.org for tube-tape-tap mnemonic Link to the latest version
You are seeing a 4 year old with a deep cheek laceration with irregular margins, under some tension. The parents express concerns about scarring, and they are also concerned that their child will definitely not be able to stay still for… Continue Reading →
A 2 month old ex-30 week premie just discharged from the NICU comes in with respiratory distress and hypoxia. You determine that the patient needs to be intubated. The baby’s weight at discharge was 2.5 kg. What size ETT should… Continue Reading →
We all know the importance of lining up the two sides of a laceration that goes through the vermillion border of a lip laceration. Injecting lidocaine or swelling from the trauma itself can make this difficult. Use a skin marker… Continue Reading →
The Katz extractor is a great tool for removing nasal foreign bodies, as shown on the video here (I have no financial interests in this product). But, if you don’t have one available, get a Fogarty cardiac embolectomy catheter from… Continue Reading →
For minor procedures in the PED, analgesia, anxiolysis, and distraction are the most important therapies to promote cooperation and procedural success. See our algorithm for procedural pain here. But sometimes, even with all of those, physical restraint is needed. Most… 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 →
You’re seeing a 5 day old with a fever of 39. Attempts to get IV access have been unsuccessful. The child is alert and not toxic appearing, but you’d like to get empiric antibiotics started within the first hour of… Continue Reading →
3 week old infant is brought in with fever of 38.5. The baby is well appearing and does not have any high risk factors in the birth history. You plan to get urine, blood, and CSF cultures and give empiric… Continue Reading →
Check out these cuties that CHOC PED physician and former Harbor PEM fellow Seth Brindis makes! See below for step-by-step instructions and more ideas for toys to make with medical supplies. Here are instructions put together by Seth, and a video of… Continue Reading →
Use a sterile saline respiratory ampule: wet the fluorescein strip with the saline, squeeze out half of the saline, then suck the yellow fluorescein liquid back up into the ampule. Now you can use the ampule as an eyedropper. For… Continue Reading →
Cut a narrow caliber ETT short to create a semi-rigid suction catheter for foreign body removal of the nose or ears. (From EM News September 2009, Tricks of the Trade: An Improvised, Semi-Rigid, Nasal/Aural Suction Catheter, by Timothy McGuirk DO)
For a forhead laceration, place gauze over patient’s eye and hairline, cut a hole in center of a large tegaderm, peel and stick with the laceration positioned in the middle of the hole. Now you can use tissue adhesive to… Continue Reading →
Use a laryngoscope upside down as a tongue blade, or use a self-lighting pelvic exam speculum (remove top half of the speculum)
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