We are all aware of the potential severe impact that infections can have in pediatric patients. Infections are one of the most common topics in the PedEM Morsels (clearly a significant measure of their importance! ? ) and we all know that the critically ill child must have potential infection and sepsis high on the list of possible etiologies. Sepsis is a term that gets iterated often in our Emergency Departments, whether we are caring for adults or children. While it may be a quick way to communicate the severity of illness, the word actually has meaning and, recently, the definition of “ped ..read more

Traveling Ticks are more than just ticking off a checklist before you get ready to travel! Climate change and changes in land usage have contributed to an expanded range of ticks (Beard 2016). There are species of ticks found on every continent and carrying a variety of vectors capable of infecting humans. Globally, ticks are the second most common vector to transmit illnesses after mosquitos (Parola 2018). We frequently ask children and their parents if they have had recent tick bites when they present for fever after a recent camping activity. However, it is often overlooked that ..read more

Often our job requires us to consider the presence of needles of significant illness in the haystack of nonspecific symptoms. With the help of our favorite geneticist, Dr. Liz Baker, we will dive into the haystack headfirst and find those needles. Hopefully, without getting poked. Let’s consider Inborn Errors of Metabolism Presenting in the ED: Inborn Errors of Metabolism: Basics Common Presentations, Uncommon Kiddos For the child with lethargy, vomiting, acidosis, hypoglycemia, organomegaly, or cardiopulmonary arrest remember to consider Inborn Errors of Metabolism (IEM) on your ..read more

Although it is less common for children to present with cardiac problems than respiratory problems in the ED, every so often there is a little heart that has a big problem.  We have previously discussed some cardiac causes of chest pain.  Sometimes children can develop cardiac arrhythmias, including catecholaminergic polymorphic ventricular tachycardia, commotio cordis, atrial fibrillation, and short QT syndrome.  We have also discussed when children have allergic reactions, they can have a reaction that is relatively minor, like diaper dermatitis, maybe a bit more impressive ..read more

We encounter seizures commonly in the Emergency Department.  While they can be dramatic and devastating, we have learned to become comfortable with the wide variety that may present in children.  From the simple febrile seizure to the complex seizure, we know how to stabilize and how to evaluate.  While fortunately most seizure activity is short lived, we also know that status epilepticus can be difficult to manage, and persistent seizures should make us consider specific etiologies (ex. Vitamin B6 Deficiency).  Being comfortable evaluating and managing ..read more

We have digested many Morsels regarding various pulmonary complaints. While some are very rare (ex, Pulmonary Embolism, Pulmonary Hypertensive Crisis, Negative Pressure Pulmonary Edema, CPAM) others are commonly encountered (ex, Croup, Bronchiolitis, Sinusitis). It is pneumonia, however, that often generates the most conversations. When should I consider a CXR? What antibiotics are appropriate? Why does this infiltrate appear round? Why does this pneumonia keep recurring? Sure, most pneumonia’s are pretty strait forward, but ever so often they can also become complicated. We’d discussed parap ..read more

There have been many times I have encountered a triage note which states “patient recently returned from … (insert awesome foreign country)…” Not only does this leave me daydreaming about my future travel adventures, but has often caused me to take pause. Thoughts of what endemic illnesses could this child potentially have been exposed to in their travels? Should I get labs on all these patients? It’s probably just a typical virus, right? If you have also had a similar thought process, you are in good company. While there is no “right” work up for these patients, hopefully this morsel wi ..read more

If you have ever talked with a pediatric emergency medicine physician about some basic tenets of their practice, one of them will inevitably be, “Never trust a neonate.”  The first few months of life outside the womb can elucidate a myriad of problems that were previously hidden during the prenatal state.  We have previously touched on congenital issues like Congenital Adrenal Hyperplasia, Congenital Pulmonary Airway Malformation, Neonatal Leukemia, and of course there is always the Inconsolable Infant. Unfortunately, the possibility of congenital infections always looms large as we ..read more

While doing literature review for my scholarly project it dawned on me that it might be time to dust off a classic morsel from the bottom of the cookie jar. On this 10 year anniversary, we chose to throw this one back in the oven to include some even more delicious data on cuffed endotracheal tube (ETT) use. No matter whether you have the wisdom of many years of practice (old doc like Dr. Fox) or are just a young buck (like myself), straight out of training, you should be appetized by this rebaked morsel on using Cuffed Entotracheal Tubes in children.  Cuffed Endotracheal Tubes: Evoluti ..read more

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians.  Dr. James Broselow, a family medicine-turned-emergency medicine physician from Hickory, North Carolina, recognized that his team spent a lot of time trying to calculate doses of medications rather than spending their mental energy on the actual medical decisions for the resuscitation.  He, along with Dr. Bob Luten, a PEM physician in Jacksonville, FL, designed the Broselow-Luten color-code ..read more