Respiratory virus season is here, and some kids may need oxygen supplementation. The handy figure below from this site is a good overview of oxygen delivery devices and max FiO2 achieved. For simple nasal cannula, each 1 L increase raises… Continue Reading →
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(Click the link to comment and to vote – voting not working through email, sorry!) A multi-casualty incident has occurred, and the emergency department is receiving several patients at once. You are called upon to manage a child of unknown… Continue Reading →
The lower extremity IO placement sites from medial to lateral are 1-3cm above the medial malleolus at the distal tibia, 1-3cm below the tibial tuberosity on the flat anteromedial proximal tibia, and 1-3cm above the patella in the midline of… 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 →
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(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.
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(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!) A 16 year old girl arrives to the ED by ambulance and promptly delivers a 34 weeks by dates neonate. The infant is unresponsive, apneic,… 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 →
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 →
(Click the link to comment and to vote – voting not working through email, sorry!) A full term infant born out of asepsis (BOA) at home is brought in by ambulance to your PED. No neonatologist or pediatrician is in… 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!) EMS is bringing you a 10yo patient that has been actively seizing for 20 minutes. They are unable to obtain IV access.
(Click the link to comment and to vote – voting not working through email, sorry!) A 2yo girl is brought in by ambulance after a seizure lasting 1 minute. She has had 2 days of fever, vomiting, and diarrhea. Her… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A 3 week old infant that is positive for RSV has had several prolonged episodes of apnea requiring BVM ventilation. The decision is made to… Continue Reading →
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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!) For which of the following pediatric patients is it most important to have the clinician with the most experience in advanced airway management and endotracheal… Continue Reading →
Part of the new AAP BRUE algorithm’s definition of low-risk BRUE (Brief Resolved Unexplained Event) is that the event duration was < 1 minute. I always ask the caretaker to walk me through what happened step by step, using “and then… Continue Reading →
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 →
The Coach at PEMPlaybook.org has a great podcast on using the VBG in situations where we used to try to get an ABG (which was never fun to do in small children). From the podcast: the rule of 4’s: (note… 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 →
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 →
It is commonly taught that a patient’s palmar hand represents approximately 1% of his/her body surface area (BSA), a useful tool when estimating the BSA of burns. But does one use the palm including or excluding the fingers? Adult studies… Continue Reading →
(Click the link to comment and to vote – voting not working through email, sorry!) A new edition of ATLS (10th edition) was recently released. Which of the following is not a recommendation of the 10thedition of ATLS regarding the trauma… 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 →
(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 →
It’s July, so good time to review the basics. For pediatric resuscitations of any type, the mnemonic ABCDEFG is great – Airway, Breathing, Circulation, Don’t Ever Forget Glucose. Children have lower reserves and become hypoglycemic more easily than adults when… 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!) A previously healthy 5 year old boy with PMH of ADHD presents with 9 days of lethargy, fever, vomiting, diarrhea, and weight loss. He recently… Continue Reading →
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 →
A 12yo girl presents to the ED in December with fever for 4 days, malaise, and pain in the right thigh gradually leading to her having difficulty walking. There is no history of trauma, although she did play a lot… Continue Reading →
Thanks to Tim Horeczko pemplaybook.org for tube-tape-tap mnemonic Link to the latest version
A 36-week infant is born precipitously NSVD to a 17yo G2P1 mother in the ED after the mother presented with the chief complaint of intermittent abdominal pain. Apgars are 8 and 9 at 1 and 5 minutes, with -1 for… Continue Reading →
A 20kg child sustains a 15% body surface area burn. The best answer for the rate of IV fluids that should be administered over the first 8 hours is: A. 60 cc/hr B. 75 cc/hr C. 120 cc/hr D. 135… 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 →
A 12yo boy with very high risk ALL, recent chemotherapy 4 days prior, presents to the ED with fever and lethargy. Temperature is 39C, HR 180, RR 24, BP 80/50. The patient is lethargic, has no nuchal rigidity, lungs are… Continue Reading →
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